Choosing a birth control method is an important personal decision. With so many options, it can be confusing to know which is best for your health and lifestyle. What you choose at this point in your life may be different from what you need later.
Since different types work in different ways, an open conversation with your doctor will help you make an informed decision with your health in mind. To help provide some clarity, here is an overview of hormonal and non-hormonal birth control methods, their risks and benefits.
Hormonal methods of birth control
Birth control pills are not all the same. Their formulas and composition vary. The combined pill contains an estrogen and progestin combo. When used as directed, the pills are about 99% effective.
The minipill contains only progesterone and may be a good option for women who cannot take estrogen, such as women with a history of deep vein thrombosis (DVT) or those who are breastfeeding. Used as directed, the mini-pill is 99% effective.
The transdermal contraceptive patch releases combined hormones, is over 99% effective and works the same as birth control pills. The patch is replaced once a week and worn for three weeks, with no patch on the fourth week.
Intrauterine device (IUD) with progesterone
Once placed in the uterus by a doctor, an IUD provides long-lasting contraception. Mirena® is an approved IUD option to prevent pregnancy for up to seven years. It also treats heavy periods for up to five years. Over 99% effective, it can be removed by your doctor at any time. Some women who do not qualify for the use of birth control pills or injections may qualify for an IUD.
Also known as NuvaRing®, the vaginal ring is a combination of hormones like the combined pill. It is worn for three weeks and replaced every four weeks. Monthly and annual options are available. The ring is 96% to 99% effective when used correctly.
Also known as Depo-Provera®, the injection delivers progestin into the buttocks or arm and is 96% effective. Injections should be taken every 12 weeks to stay fully protected.
Also known as Nexplanon®, the implant releases a progestogen. It is a single thin rod inserted under the skin of the upper arm. The implants are 99.95% effective and should be replaced every three years.
Risks and Benefits of Hormonal Methods of Contraception
- Prevention of pregnancy if taken as directed, without interrupting sexual intercourse
- Some relief from menstrual pain, heavy periods, and menstrual headaches
- Fewer rashes and mood swings
- A decrease in circulating testosterone in women with polycystic ovary syndrome (PCOS) when taking a combined hormonal pill
- More flexibility with combined hormonal methods to manipulate the timing of your period and possibly skip a period
- No protection against sexually transmitted infections (STDs) or HIV
- May be affected by certain medications
- May delay the return of normal menstrual cycles
- May cause irregular periods or spotting
- May cause weight gain, breast tenderness, headaches or irritability
Increased risks with combined hormonal methods
Birth control methods that contain estrogen can increase the risk of blood clots, deep vein thrombosis (DVT), heart attack, high blood pressure, and stroke. Women who smoke or have a serious liver disorder, especially those over the age of 35, are advised not to use birth control methods that contain estrogen.
Some medications may interact with hormonal methods or reduce their effectiveness
“The most common question I get in this area is about antibiotics,” says Kelsie Cabrera, DO, an obstetrician and gynecologist at Nebraska Medicine. “Rifampicin is the only antibiotic that has been shown to decrease the effectiveness of hormonal contraceptives. According to the hormonal method, the most common drug interactions occur with birth control pills. These include anticonvulsants and some anti-HIV drugs, St. John’s wort, and some antifungal drugs.”
Paragard® is a hormone-free copper IUD that is over 99% effective. Once inserted by a doctor, it provides pregnancy prevention for 10 years. The copper IUD can also be placed right after childbirth, can be removed at any time, and can be used in women with certain medical conditions.
Phexxi® is a relatively new on-demand method of contraception. It prevents pregnancy by taking advantage of the natural acidity of the vagina and the vulnerability of sperm to acidic environments. A pre-filled applicator is inserted immediately before or up to one hour before vaginal intercourse. When used perfectly, Phexxi® is 93% effective.
- The gel can be combined with other methods of contraception, but it is not recommended to use it with vaginal rings
- Side effects may include burning, itching, discomfort or pain
- There is a slight risk of bladder inflammation, kidney infection or urinary tract infection
- The gel is not recommended for people with a history of recurrent UTIs or urinary tract abnormalities
Barrier methods are generally the least effective (18 to 28 pregnancies per 100 women per year). Pregnancy prevention is highly dependent on correct use if spermicide is used and if more than one method is used together. These include male or female condoms (90% effective), diaphragms (80-95% effective), cervical caps (86% effective), and sponges (76% effective). To be most effective, barrier methods must be used correctly, fitted properly, and used with spermicide. Male condoms are the only method that helps prevent STDs.
Regular checkups and screenings are necessary at every stage of life. When considering which birth control method might be right for you, your doctor:
- Perform an examination and review your medical history
- Discuss health risks that may rule out certain options
- Discuss all your options, along with the risks and benefits
- Discuss how long you want contraception, family planning goals, and what might fit your lifestyle
Ready to discuss birth control options that might be right for you? To call 800.922.0000 make an appointment.