How to Choose the Right Birth Control for your Life
by MICHELLE KONSTANTINOVSKY
Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You shouldn’t rely on this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
For the painfully indecisive among us, even simple choices can fuel fear and insecurity. And if picking the right lunch special or selecting the perfect Netflix offering makes you sweat, then it’s safe to assume life’s bigger decisions can be debilitating. Take birth control for example — the deceptively simple concept of contraception is actually incredibly complex when you take into account all the factors at play, including your current lifestyle, medical history, future fertility plans, and more. All those variables make it extra worthwhile to work with a medical provider who gets you and can offer expert guidance along the decision-making journey.
“I typically ask a few broad questions which may help the decision-making process,” says New York-based OB/GYN, Alyssa Dweck, MS, MD, FACOG. “For example: are you looking for something permanent like tubal ligation or vasectomy or a temporary and reversible option? Do you prefer hormonal or non-hormonal options? Do you have multiple partners or are you in a monogamous relationship? Are there medical issues like hormonal cancers or a risk for blood clots that we need to consider? Do you smoke? And finally, do you have trouble remembering to take a daily pill? If so, long-term reversible methods like an IUD, shot, or implant may be best.”
“When a woman doesn’t have a birth control method in mind when she comes in for consultation, I start with a single question: What matters to you about your birth control?” says Kate White, MD MPH, director of the Family Planning Fellowship and associate professor of OB/GYN at Boston University. “Most women look at me strangely, as they’ve never been asked that question before. So I’ll prompt them — is it important that you see a period every month? That you avoid irregular or unpredictable bleeding? That you control when you start and stop the method? That you keep your birth control private from your partner or your parents? These questions tend to get to the heart of what’s really important to them about their birth control method, and it guides me on how to discuss all of their options.”
Breaking Down The Big Questions
Clearly there’s a lot to think about when picking the contraceptive that fits into your life. And while all of the above factors matter, Dr. White says to start with at least two big questions to narrow down the choices, and then move on from there:
How important is avoiding pregnancy to you? “If getting pregnant would be a surprise but not awful, then choosing a method that is less effective but perhaps works for your life better — like the pill or condoms — may be just right,” she says. “But if a pregnancy would be catastrophic for your life right now, then maybe choosing one of the most effective methods is most important.”
How important is a particular bleeding pattern to you? “Take skipping periods,” she says. “Some women think it would be awesome to not get a period every month, while others like the monthly reassurance that they’re not pregnant! Or spotting — some women are not bothered at all by irregular bleeding, and can put up with it for months when trying a new birth control method. For women who won’t ever be intimate with a partner while they’re bleeding, though, or who hate the idea of either wearing daily liners or having surprise bleeds (especially at work when it can be hard to change underwear), spotting can be a deal-breaker.”
If you’re ready to do a little research so you can have an informed, educated convo with your doctor, read on for info on some of the more popular birth control options out there:
The Birth Control Pill
The most familiar form of hormonal contraceptive is probably the classic birth control pill which combines two hormones — estrogen and progestin — to prevent ovulation and change the lining of the uterus to prevent pregnancy. The pill also changes the mucus at the opening of the uterus (aka the cervix) to keep sperm from getting in. There are a ton of different types of birth control pills, so you and your doctor will have to decide which combination of hormones is right for you, and you may need to go through some trial and error before finding the right one.
“The pill is the most popular option, it’s well-studied, and very effective for contraception — it approaches 98% effectiveness if taken properly,” Dr. Dweck says. “It also offers cycle control, meaning more regularity, lighter, shorter flows, and less cramps. It can help with PMS in most cases, it’s easily reversible, and has non-contraceptive benefits such as control of acne, polycystic ovary syndrome (PCOS)-related hormone imbalance, and can help prevent ovarian and uterine cancers. The pill comes with a small risk of blood clot — keep in mind, the risk of this is actually higher with pregnancy. Controversy about whether it can increase the risk of breast cancer or not is ongoing, but for the most part, that risk appears negligible or very low. Studies show that weight gain on the pill is negligible and can usually be attributed to other factors.”
Otherwise known as the progestin-only pill, the minipill is an oral contraceptive that works by thickening the mucus in the cervix, stopping ovulation, and thinning the uterine lining so that if an egg does become fertilized, it can’t attach to it. When minipills are taken on time, they’re considered 99% effective (91% if some pills are skipped).
“The progesterone-only mini-pill is good for smokers over 35, lactating women, and those with high blood pressure, but it can result in irregular bleeding or no bleeding at all,” Dweck says.
Hormonal intrauterine devices (IUDs) — known by the brand names Mirena, Skyla, Liletta, and Kyleena — are small, T-shaped devices that are inserted by a doctor into the uterus and then release progestin to thicken the mucus in the cervix to prevent sperm from fertilizing the egg, thin the uterine lining, and partially suppress ovulation. Mirena is considered 99% effective and perhaps one of the biggest perks is that once the hormonal IUD is in place, it can stay there for up to five years.
“Hormonal IUDs are excellent forms of contraception,” Dr. Dweck says. “They’re reversible and the user doesn’t have to remember to take a daily pill. They are effective for up to five years. They can also help control cramps and a heavy flow. Irregular bleeding is common for the first three to six months, and women with hormonal IUDs should still use condoms if they have multiple partners. Another thing to consider is that the hormonal IUD requires insertion by a doctor.”
The Copper IUD
Another type of IUD is the copper IUD, aka ParaGard. Unlike Mirena, ParaGard doesn’t release hormones directly into the uterus — instead, the copper wire that’s coiled around it prevents pregnancy by creating an inflammatory reaction that’s toxic to sperm and eggs. The device can stay in place for up to a decade and it’s also considered to be about 99 percent effective (with pretty much no wiggle room for user error).
“The copper IUD — ParaGuard — is effective for up to 10 years, is an excellent form of reversible contraception and it can be used for post-coital contraception,” Dweck says. “Cycles remain regular while using it, and it’s a great option for those who can’t or won’t take hormones. It can, however, cause heavier, crampier flows and it requires insertion by a healthcare provider.”
Formally known as medroxyprogesterone acetate, the contraceptive injection is marketed under the brand name Depo-Provera. The medication is administered by a doctor through a shot every three months and it works by suppressing ovulation and thickening the cervical mucus to keep sperm out. It can be a good option for some women because it doesn’t require daily action and it can sometimes tame heavy bleeding, but it may also increase the risk of certain side effects for some.
“The shot — Depo Provera — is highly effective, but requires administration every three months and may cause a temporary loss of menses,” Dweck says. “Many women who use it complain of weight gain.”
Until recently, NuvaRing was the only hormonal birth control device that came packaged as a transparent, flexible plastic ring that could be inserted into the vagina, then removed during menstruation. “The ring is inserted vaginally by the patient,” Dweck says. “It’s effective, can regulate menstrual flow, and it won’t interfere with intercourse. It can cause a light vaginal discharge and while there’s a ‘yuck factor’ for some women, many others love it.”
NuvaRing is no longer the only ring option available — last August, the U.S. Food and Drug Administration (FDA) approved a new product called Annovera, the first vaginal ring contraceptive that can be used for an entire year. Unlike NuvaRing, which has to be discarded after three weeks and replaced with a new one after menstruation, Annovera is designed to be washed and stored in a compact case for the seven days out of each month that it’s not in use, and then reused each month for a year.
“Annovera is a great option for women who love their bleeding patterns on their birth control pill — lighter, shorter, predictable periods — but who don’t like (or don’t remember) to take a pill every day,” White says.
Condoms and Other Barrier Methods
When used correctly every time, male condoms, female condoms, and other barrier methods can do more than prevent pregnancy — they can also reduce the risk of sexually transmitted infections (STIs), including HIV. If used perfectly, male condoms can be 98 percent effective at reducing pregnancy and female condoms are 95 percent effective (both figures drop significantly if the methods aren’t used perfectly).
“Condoms and other barrier methods are the old standby,” Dweck says. “They protect against STIs and are 85% effective with perfect use. Just avoid products with the spermicide, Nonoxynol-9, this can be caustic for some and actually increase the risk of STIs.”
The Rhythm Method
Some women opt out of all the options above and prefer to track their menstrual cycles in order to predict when they’ll ovulate — and then act accordingly, depending on whether they’re trying to have a baby or not. There’s no real direct risk of following the rhythm method…other than the fact that it isn’t a sure thing for all people. According to the Mayo Clinic, “as many as 24 out of 100 women who use natural family planning for birth control become pregnant the first year.” Add to that the fact that this method doesn’t protect against STIs.
“The rhythm method, otherwise known as ‘natural family planning’ involves watching the cycle for the fertile times of the month to avoid pregnancy or to get pregnant,” Dweck says. “It’s very effective for those with reliable and regular cycles, and there’s an app for that.”
If you’ve ever heard someone talk about having their “tubes tied,” this is what they were talking about. Tubal ligation involves cutting, tying, or blocking the fallopian tubes to permanently prevent pregnancy. The procedure doesn’t affect menstruation, but it can come with some serious risks since it is an abdominal surgery.
“Tubal ligation is considered permanent, though it’s technically reversible,” Dweck says. “It requires anesthesia and there’s a risk of infection or bleeding, but that’s rare.” The potential risks also include damage to the bowel, bladder, or major blood vessels, infection, and more. Since tubal ligation is considered permanent (not all attempts at reversal are successful), you’ll want to dedicate a lot of thought to this one and talk it over at length with your doctor.
Whichever method you and your doctor decide is right for you, remember that birth control isn’t just about preventing pregnancy — it’s about finding a sustainable practice that supports your lifestyle and keeps your health a top priority.