This is the fifth installment in a series of articles about the science of various aspects of college life. Any Brown student can schedule an appointment with Student Health Services to review various contraceptive options. But finding the so-called “best” birth control option often requires more than a prescription. According to Tanya Sullivan, a nurse practitioner and the associate clinical director of Student Health Services, the process of helping students decide often involves getting to know the student and understanding why they are looking to use birth control.”We call it shared decision-making, where you are hearing from the student and what they’re seeking and then providing them with all of their different options,” Sullivan said. This includes discussing side effects that “they’ve heard about, read about, a friend has experienced or they’ve experienced previously on a method.”She noted that birth control does not always have to be for contraceptive purposes and can be used to control acne symptoms and unpleasant menstrual periods.”In terms of individualizing, it is helping people think about what is most important to them,” said Naomi Ninneman, the associate director for empowerment and prevention services at BWell Health Promotion. “It really helps to have different options. In Health Services, we provide the full spectrum of contraceptive management and really value accessible reproductive healthcare,” Sullivan said. This spectrum includes short-acting, long-acting and emergency contraceptive methods, she said, adding that “students can get appointments relatively quickly” for these options, especially if there is a limited window for pregnancy prevention. Students can choose between an oral contraceptive, injections, vaginal rings, implants and hormonal IUDs, among other options. Health Services also provides options for non-prescription contraception, including external and internal condoms, dental dams and spermicide. There are currently no widely available hormonal birth control options for men. How current options workAccording to Gary Wessel, a professor of biology at Brown, the “two targets” of hormonal birth control in women are the ovaries and the uterine lining for implantation. A hormone called follicle-stimulating hormone, or FSH, facilitates the development of immature female egg cells, called oocytes, in the ovary. This is important for ovulation when a mature egg is released from the ovary into the fallopian tube which is triggered by a surge in a second hormone called luteinizing hormone, or LH. While traveling through the fallopian tube, the egg can be fertilized by sperm. Oral contraceptives often contain progestin or a combination of progestin and estrogen, intended to stop this process. Progesterone the naturally occurring hormone mimicked by progestin suppresses the release of the gonadotropin-releasing hormone, which is responsible for the secretion of FSH and LH. Estrogen similarly suppresses FSH release, but to a lesser extent.”Progestin also works to thin the endometrial lining and thicken cervical mucus, which makes it harder for an egg and a sperm to meet and impairs the normal tubal motility,” Sullivan said. Contraceptives containing both estrogen and progestin can thus prevent fertilization by curtailing ovulation, as well as preventing fertilization. Birth control pills containing only progestin can also be effective, but users must follow stricter ingestion schedules than those ingesting estrogen-progestin combination pills, Sullivan said. Still, some individuals choose not to take pills containing estrogen for a variety of reasons, such as the hormone’s potential reduction of breast milk production, she added. Wessel also explained that combination pills containing estrogen can put users at risk for blood clots. Sullivan added that other, more long-acting and reversible methods like IUDs and Nexplanon implants “are becoming much more popular and certainly recommended as a first line method for someone,” especially compared to when she first started practicing. An alternative like the copper IUD a non-hormonal option also creates an environment that is not conducive to fertilization, but “does not prevent ovulation,” Sullivan said. Experiences with various optionsFor Gabriela Picazo ’28, the main reason she started birth control was to avoid pregnancy.”I know condoms have a super high effectiveness rate, but I just wanted something that I could fall back on, just in case,” she said. When choosing a contraceptive method Picazo went to BWell to discuss her options. She ultimately went with the Depo-Provera injection “because it was something that I would just need to do every three months, then get to forget about until my next appointment came up, rather than something that was routine like taking the pill,” Picazo said. Picazo said her first couple of injections brought irregular periods and cramping. But now after almost a year on Depo-Provera, she explained that her side effects have been reduced to soreness from the injection. Common side effects of the injection include belly pain, bloating and depression, among others. She noted that despite few immediate effects, “there are long term consequences to taking this kind of birth control, and you can only take it for up to four or five years because your bone density starts to decrease.”The U. S. Food and Drug Administration warns the medicine should not be used for longer than two years as the product may raise the risk of osteoporosis. Picazo said that she will likely opt for a longer-term contraceptive option like an IUD when she can no longer use Depo-Provera. But preventing pregnancy is only one of the potential uses for hormonal birth control. Talia Reiss ’27, a co-president of Planned Parenthood Advocates, said she was prescribed birth control for menstrual health reasons when she was 11 years old.”I had really irregular periods and really heavy ones, so I was on a period for about 60 days straight in the sixth grade,” Reiss said. “I fainted in class, I went to the hospital, I had a gynecologist and the only solution they were able to offer was hormonal birth control, which is tough for an 11-year-old.”When Reiss started the pill, she remembers “feeling pretty depressed,” and stopped using it less than a year after starting.”It was supposed to be temporary to kind of get things in check,” but when she started college, Reiss’s periods became more irregular and painful, she said.”I had multiple experiences freshman and sophomore year where I was immobilized by cramps,” she said. “The only solution they were able to offer for immediate relief was literally taking 12 Advil a day and sitting with a heating pad.”After this, she tried the pill again the summer after her first year but experienced symptoms of depression and stopped after two weeks. When her periods remained irregular and painful, Reiss tried the NuvaRing during the spring of her sophomore year but experienced similar mental health symptoms and stopped again.”Despite my awful experiences, I know many people who have had really positive ones,” Reiss said. “I don’t think it has made me less inclined to encourage birth control use or try to expand access to it.”.