From pills to patches to implants to injections, there’s no shortage of choices.
When it comes to contraception, there are so many available options that choosing the “right” birth control method can sometimes feel overwhelming. As an OB-GYN, it’s common to be asked by patients for advice about choosing the contraceptive that’s right for them.
Here’s what I tell them: The right form of contraception is ultimately the one that you’re happy with and – most importantly – you will use consistently.
That being said, there are definite pros and cons to different birth control methods. Certain types of contraception are more appropriate for certain women, depending on their lifestyle, health history and personal preferences.
Below I’ve outlined the most common types of reversible birth control and included important pros, cons and considerations for each. These methods are appropriate for most women wanting to prevent pregnancy. Even if you have existing medical diagnoses that prevent you from taking certain types of birth control, not to worry, we can almost always find a method that will work for you! None of these methods cause long-term effects on fertility or ability to ultimately achieve pregnancy once discontinued.
The methods described below do not protect against sexually-transmitted infections (STIs). Use of condoms is still recommended for STI prevention.
Lastly, while no form of birth control is 100 percent effective, the contraceptive methods discussed below are all highly effective when used consistently and as directed, and some forms are more effective than others.
Combined hormonal birth control methods (the pill, the patch and the ring)
These all work to prevent pregnancy by the same mechanisms, but vary in how they are administered. These methods rely on a combination of estrogen and progestin to prevent pregnancy. These hormones prevent ovulation (the release of an egg), thin the uterine lining, and thicken the mucus within cervix, all of which work together to prevent pregnancy.
These methods all have typical effectiveness rates of around 91 percent for most users (this number accounts for occasionally missing a dose, forgetting to apply a patch or changing a ring late). However, if used exactly as directed, they are effective 99 percent of the time.
There are multiple forms of “the pill” available in various doses and regimens. There is also a progestin-only pill (this type of birth control is sometimes referred to as the “minipill”). Progestin-only birth control pills have lower effectiveness than combined hormonal contraceptives, but are useful for women whose medical histories indicate they should avoid estrogen. They’re also frequently prescribed in the immediate postpartum period.
The transdermal patch can be worn on the upper arm, stomach, back or buttocks, and hormones are absorbed through the skin. The patch must be replaced weekly.
The vaginal ring (NuvaRing), is inserted into the vagina, and hormones are absorbed through the vaginal lining. It must be replaced every four weeks to work properly. This can be done at home by the patient.
Pros of combined hormonal methods
- User-controlled (patient can easily start and discontinue use)
- Improvement in acne and decreased menstrual bleeding and pain for most patients
- Predictable timing of menstrual bleeding
- Decreased symptoms of premenstrual syndrome (PMS)
- Can address pain from other conditions such as endometriosis
- Can be an affordable option for patients without insurance coverage
Cons of combined hormonal methods
- Must be taken as prescribed to be effective (daily, weekly or monthly depending on method)
- Some patients experience undesired side effects including headaches, nausea, breast tenderness, mood changes and decreased libido
- May increase risk of blood clots, particularly in patients with certain other medical conditions like hypertension, clotting disorders or smoking
Depo-Provera (sometimes called the “depo shot”) is administered by a healthcare provider every 12 weeks. The injection contains the hormone medroxyprogesterone, which prevents ovulation. When administered on schedule, the Depo-Provera injection is highly effective (over 99 percent). Its typical effectiveness rate is closer to 94 percent, accounting for the fact that most users occasional receive an injection a bit late.
Depo-Provera is best suited for women who don’t anticipate having children in the near future because it can cause a delayed return to fertility in some patients. A woman who wishes to come off of birth control and get pregnant within the next year or so may prefer methods that are easier to start and stop, such as the pill or the patch.
Pros of the Depo-Provera injection
- Only has to be administered once every 12 weeks
- Progestin only, making it a good option for women who don’t tolerate estrogen well or have a medical reason that prevents them from taking estrogen
- Most women will stop having periods after 2-3 injections
Cons of the Depo-Provera injection
- Must visit the office every 12 weeks for an injection
- Delayed return to fertility (usually only a few months, but up to a year for some patients)
- Weight gain (the only birth control statistically proven to cause weight gain). Women taking Depo-Provera typically only gain a small amount of weight.
Contraceptive implant (Nexplanon)
The birth control implant (Nexplanon) is a small, flexible rod-shaped implant that is inserted by a healthcare provider under the skin of the upper arm to deliver a slow release of a progestin hormone (etonorgestrel). This prevents ovulation, thickens the cervical mucus and thins the uterine lining.
Once in place, it prevents pregnancy for up to three years. Since it requires no action by the patient in order to remain effective, it prevents pregnancy over 99 percent of the time. The implant is the most effective form of hormonal birth control. It is an ideal method for women who don’t want to deal with the daily, weekly or monthly commitments required for many other contraceptive methods to work effectively.
Pros of the contraceptive implant
- Works continuously and very effectively for up to three years
- Once implanted, requires no action on the part of the patient
- Decreases menstrual bleeding
Cons of the contraceptive implant
- Irregular and unpredictable bleeding (but overall less than regular menses for most patients)
- Some women experience side effects including mood changes and headaches
Intrauterine devices (IUD)
The intrauterine device (IUD) is a small, T-shaped device that is inserted through the vagina and into the uterus by a healthcare provider. It is an extremely effective form of birth control, preventing pregnancy over 99 percent of the time. There are a few different types and brands of IUDs, but they are broadly divided into two categories: hormonal IUDs and the copper IUD.
Hormonal IUDs work by releasing a progestin hormone (levonorgesterol) that thickens the cervical mucus (preventing sperm from entering the uterus) and thining the uterine lining. The copper IUD prevents pregnancy because copper is a spermicide that prevents the sperm from fertilizing the egg. Hormonal IUDs last for 3-5 years, and the copper IUD can work effectively for up to 10 years.
Copper IUDS may also be used as an emergency contraceptive if it is implanted within five days after unprotected intercourse.
Pros of the IUD
- Works continuously for to 3-10 years, without an action needed by the patient after insertion
- Hormonal IUDs contain a relatively small amount of hormones compared with other methods
- Copper IUD may be used as an emergency contraceptive
Cons of the IUD
- Discomfort with insertion (this is usually brief and manageable)
- Irregular bleeding in the first few months is possible
Parting thoughts on birth control methods
Given the many methods available, most women are able to find one that suits them well. This may initially require a process of trial-and-error in partnership with her OB-GYN. Once a method is found that suits a woman well, birth control can improve a her life in many ways. Periods can be more predictable, lighter or absent altogether. Appropriate birth control can give women relief from discomfort associated with periods or certain gynecologic disorders like endometriosis.
Lastly, birth control allows women to feel confident in planning their reproductive futures, preventing pregnancy when they desire. This allows them to focus on other personal goals, with easy reversal of the birth control if and when they desire to become pregnant.
Ultimately, I am confident that by providing my patients with good information, they can find a contraceptive method that works for them.