When it comes to birth control, there’s a wide range of options
Today, women have an embarrassment of riches when it comes to options for preventing pregnancy. There are different options to suit different lifestyles and medical needs, so finding one that’s right for you is a matter of sitting down with your doctor to discuss your particular situation.
There are so many choices, each with their advantages and disadvantages, that choosing the right method of birth control can be a bit overwhelming. To help you get started in learning about some of the choices available, here is a quick overview of some popular birth control methods, along with the pros and cons of each one.
It is important to note that while all of these forms of contraception are designed to prevent pregnancy, none of them offer protection against sexually transmitted diseases (STDs). Only condom use can help prevent STDs.
These are the birth control options most commonly prescribed at our office:
- Birth control pills
- Vaginal ring (NuvaRing)
- Birth control patch (Xulane)
- Birth control injections (Depo Provera)
- Intrauterine device (IUD)
Birth Control Pills
Since their introduction in 1960, birth control pills have been used by millions of women worldwide because they are affordable, are well-tolerated by most women, and have a relatively high degree of effectiveness. Birth control pills contain hormones that, when taken daily, keep the sperm from reaching the egg. There are two kinds of birth control pills:
Combination birth control pills
Combination birth control pills contain a mix of estrogen and progestin that work by suppressing ovulation and also by thickening the cervical mucus and thinning the uterine lining. This prevents the sperm from reaching the egg to fertilize it. Of 100 women taking combination birth control pills in a year, nine may become pregnant.
Mini-pills contain just one hormone – progestin. This hormone prevents pregnancy by thickening the cervical mucus and thinning the uterine lining, all of which result in keeping the sperm from reaching the egg. Of 100 women taking mini-pills in a year, five will become pregnant.
Advantages of the birth control pill
- Very easy to use: just one pill at the same time every day
- Safe and effective in preventing pregnancy, if taken correctly
- Helps control or prevent cramping and decreases menstrual blood loss
- It helps reduce PMS and PMDD symptoms
- Improves acne
- May reduce the risk of endometrial and ovarian cancer (decreasing the risk of ovarian cancer by up to 50%)
- You have the option to decrease the number and length of your periods (some pills come in a 28 day “on”/ 4 day “off” format, so you get your period just four days per month
Potential downsides of the birth control pill
- To prevent pregnancy, you must take your pill every day and some pills at the same time every day.
- Combination pills can cause nausea, breast tenderness, headaches.
- Certain medications and supplements can make the pill less effective (i.e., St. John’s Wort, Rifampin to treat tuberculosis, and certain anticonvulsants)
- Very rarely, some women can develop high blood pressure while on the pill.
- There’s a slightly increased risk of breast and cervical cancer for women taking the pill five years or more.
The pill isn’t for everyone. It’s not recommended if you:
- Are breastfeeding
- Are a smoker over 35 (due to increased risk of blood clots, heart attack, and stroke)
- Have poorly controlled hypertension
- Have a history of breast cancer, stroke, heart disease, liver disease, deep venous thrombosis, or a pulmonary embolism
- Have advanced diabetes
- Need to be immobilized for a long-time following surgery
The vaginal ring is a flexible ring made of plastic that is inserted in your vagina and continually releases hormones that are absorbed through the vaginal wall to prevent pregnancy. You insert the ring yourself and leave it inside your vagina for three weeks and then remove it and leave it out for one week, during which you get your period.
A popular brand of vaginal ring prescribed in our office is NuvaRing, which has a 91 to 99.7% effectiveness rate in preventing pregnancy.
Advantages of the vaginal ring
- It doesn’t require daily dosing: once you insert the ring, it stays in for three weeks
- It’s easy to insert. Once it’s inserted, you’re good to go!
- It allows for more spontaneous intimacy because you don’t need to apply anything before engaging in sex.
- It can lead to more regular, lighter, and shorter periods
- It’s discreet: it’s usually not felt by most partners
- It’s protective against ovarian cysts and cancer, ectopic pregnancy, PMS related depression, cramps, pelvic inflammatory disease (PID), acne, hirsutism (unusual hairiness), vaginal dryness, osteoporosis, and benign breast tumors
Potential downsides of the vaginal ring
- You must adhere strictly to the insertion schedule to prevent pregnancy: you leave it in for three weeks, then leave it out for one week
- You can increase your pregnancy risk if the ring is not inside your vagina for three weeks in a row, or if it is left inside for over three weeks at a time, or if it falls out and you don’t re-insert it within 3 hours
- During initial use, the ring can cause headaches, nausea, increased vaginal discharge, weight gain or loss, breast tenderness, mood swings, or worsening of existing depression
- It cannot be used simultaneously with some other means of birth control, such as a sponge, a cervical cap, or a diaphragm.
Birth Control Patch
The birth control patch is a thin plastic adhesive bandage, about 2 inches wide, containing hormones that are absorbed gradually through your skin while you’re wearing the patch. You can put it on your stomach, buttock, back, or upper outer arm. It is worn for three weeks, and then you remove it and leave it off for one week, during which time you get your period. After the fourth week, you put a new patch on, and a new cycle begins.
The birth control patch that we prescribe the most is called Xulane. It contains estrogen and progestin, which act to prevent your ovaries from releasing an egg and also thicken your cervical mucus to keep sperm from reaching an egg. The patch is quite effective in preventing pregnancy: of 100 women who wear the patch in one year, about nine may become pregnant.
Advantages of the birth control patch
- No daily dosing is required: you wear the patch for three weeks, take it off for one week, and reapply it for your next 3-week cycle
- The patch allows for spontaneous intimacy because you do not have to apply anything before relations
- Like all hormone-containing birth control options, the patch helps reduce cramping, lightens menstrual bleeding, promotes regular periods, and protects you against PID
- Health benefits associated with patch use include improving acne, preventing ovarian and breast cysts, reducing the risk of ectopic pregnancies as well as endometrial and ovarian cancer, and reducing PMS symptoms
- The patch is an entirely reversible form of birth control: you can get pregnant as soon as you remove the patch.
Potential downsides of the birth control patch
- Some women can experience side effects such as breakthrough bleeding between periods, headaches, breast tenderness, and nausea
- Some women may have a skin reaction to the adhesive on the patch
- It can be challenging to keep up with the three weeks on, one week off usage schedule
- The patch is not as effective on very overweight women
- Sometimes the patch can fall off without you realizing it
- Certain medications can interfere with the patch’s effectiveness
- If you suffer from depression, patch use can worsen your symptoms
- The patch exposes women to higher levels of estrogen than either combined birth control pills or the vaginal ring. The consequence of this is not well studied.
Not everyone is a good candidate for patch use. It is contraindicated if you:
- Are a smoker over age 35
- Experience migraines with auras
- Have a history of breast cancer
- Have advanced diabetes or liver disease
- Have uncontrolled high blood pressure
- Have a clotting or venous disorder.
Birth control shots
Birth control shots are injections of the hormone progestin that prevents pregnancy in two ways: by keeping ovaries from releasing eggs and also by causing the cervical mucus to thicken and the lining of the uterus to thin. This prevents sperm from reaching and fertilizing an egg.
These injections are typically placed in your buttocks or your upper arm and are given at your doctor’s office every three months. The most commonly used birth control shot brand is Depo Provera. Shots are slightly more effective than birth control pills and patches in preventing pregnancy: of 100 women who get shots in one year, about six may become pregnant.
Advantages of birth control shots
- Because it requires just four shots per year, dosing is more convenient than other forms of birth control
- Shots allow you to have spontaneous sex because you don’t need to apply anything before intimacy
- Many women who get shots have lighter periods, or no periods at all, and experience fewer menstrual cramps
- It is private. It’s up to you whether your partner knows that you are on birth control.
Potential downsides of the birth control shot
- It requires a visit to your doctor every 12 weeks to get a shot
- Some women may have a reaction at their injection site, though this is usually temporary
- You cannot get shots if you’re breastfeeding
- It may take longer to get pregnant after stopping birth control shots than if you were on other birth control methods
- Taking birth control shots for more than 2 years can cause bone thinning, although normal bone growth returns once you are off the shots
- Some women can have side effects such as headaches, spotting, abdominal discomfort, breast tenderness, weight gain, joint pain, bloating, fatigue, hot flashes, and nervousness.
Intrauterine Device (IUD)
An IUD is a small T-shaped device that is placed inside your uterus by your doctor. Once it is inserted, you cannot feel it. IUDs can stay inside you and be effective for up to 10 years. IUDs are more effective at preventing pregnancy than birth control pills, condoms, patches, vaginal rings, or shots: of 100 women using IUDs for a year, less than one may become pregnant.
There are two kinds of IUDs: hormonal and non-hormonal. The hormonal ones continually release progestin, which causes your cervical mucus to thicken and your uterine lining to thin. This keeps sperm from reaching and fertilizing an egg. The non-hormonal IUD is made of plastic and copper. Any sperm that reach the uterus are neutralized in the presence of copper and, thus, can’t fertilize an egg.
Advantages of IUDs
- The IUD is very safe and well-tolerated by most women
- It’s more effective at preventing pregnancy than other reversible forms of birth control (like the pill, patch, shot, ring, or condom)
- Recent research has shown that IUD use dramatically decreases a woman’s risk of ovarian cancer, out-performing even birth control pills in decreasing ovarian cancer risk2
- It is convenient: once an IUD is inserted, you don’t need to think about birth control
- It is one of the most cost-effective long-acting forms of reversible contraception
- It does not interfere with sexual spontaneity and cannot be felt by your partner
- Depending on the type of IUD you choose, it can be effective from 3 to 10 years
- It is private; you can choose whether to tell your partner about your birth control
- The copper IUD can be used for emergency contraception to prevent pregnancy if it is inserted within 5 days of unprotected sex
Potential downsides of IUDs
- The IUD must be placed inside you by a doctor, so it requires an office visit
- Very rarely, an IUD can fall out of the uterus
- Shortly after insertion of the IUD, some women may experience cramping and irregular bleeding
- Extremely rarely, some women can get pelvic infections within 3 weeks of IUD placement
- US Medical Eligibility Criteria (US MEC) for Contraceptive Use, 2016
- Wheeler, L.J., Desanto, K., Teal, S.B., Sheeder, J., Guntupalli, S.R., Intrauterine Device Use and Ovarian Cancer Risk: A Systematic Review and Meta-Analysis. Obstetrics and Gynecology: 134 (4): 791-800, October 2019.