Birth Control Options: What’s Right for You? (video)

Several factors may influence your contraceptive choice. Here are a few things to consider:

Effectiveness

How effective is each method at preventing pregnancy? Some have very high success rates when used correctly, while others have a greater risk of failure.

Convenience

How likely are you to use the method correctly and consistently? For example, birth control pills can be extremely effective, but you must remember to take them daily.

Side effects and risks

What are the potential side effects? Contraceptive methods that contain hormones may cause side effects. such as menstrual changes, weight gain or headaches in some women. There is also concern about hormones such as estrogen increasing the risk of cancer, but it may lower the cancer risk for some women.

“It's difficult to know for sure about risks, but some things have definitely been demonstrated over time,” says Dr. Dunn. “Interestingly, women actually have a decreased risk of having uterine and ovarian cancer if they’ve been on hormonal contraception for at least a decade.”

Reversibility

How long does the contraceptive protection last after you stop using it? Some women who discontinue hormonal contraception may find it takes several months for their menstrual periods to return to normal. Non-hormonal methods, such as condoms and some intrauterine devices (IUD), are more easily reversible.

Hormonal contraceptives use hormones to help prevent ovulation and are highly effective when used correctly. They include the following methods:

Formally known as oral contraceptives, birth control pills use estrogen, progesterone or both to help prevent pregnancy. The amounts of hormones have decreased considerably since they were first introduced, and there is now a range of dosages available. There is also a progesterone-only “mini-pill” for women who cannot take estrogen for various reasons. Both are highly effective.

“The failure rate for the combined estrogen and progesterone birth control pills is about 4 percent,” says Dr. Dunn. “Factors, such as forgetting to take the pill, vomiting within a few hours of taking it, and taking certain medications, can raise the risk of pregnancy.” 

First introduced in 1990, this injectable form of progesterone is given by a physician. A single injection is effective for three months and is likely more effective than oral contraceptives since the woman doesn’t have to take a pill or do anything else other than stay current on injections.

“Injectable birth control may raise the risk of irregular menstrual bleeding,” says Dr. Dunn. “Also, it can take a while to clear from the body, so it may not be the best choice for people who hope to become pregnant soon after discontinuing birth control.”

Implantable progesterone is effective for three years. The implant is slightly larger than a quarter and is implanted by a physician, usually on the underside of the upper arm. It has about the same effectiveness and side effects as an injectable contraception.

Skin patches release hormones through the skin. Women can place the small patches themselves almost anywhere on their body; the patch and location are changed weekly. After three weeks, women skip a week to have their menstrual period. The patch can be worn during exercise and swimming. 

This small, flexible ring contains estrogen and is inserted by the patient into the vagina, where the hormones are slowly absorbed through the vaginal walls. After 21 days, the ring is removed for a week to allow menstruation. A new ring is then inserted.

Available with and without hormones, the IUD is inserted into the vagina and is highly effective. Progesterone-containing IUDs constantly release a low level of hormone and tend to result in lighter menstrual periods. Hormone-free IUDs are made of copper and create a sterile inflammation of the uterine lining, which may cause heavier periods.

In addition to the non-hormonal IUD described above, there are other methods of hormone-free contraception.

Condoms not only help prevent pregnancy, they can also help prevent sexually transmitted diseases. However, their effectiveness depends greatly on the user; they must be used correctly and consistently, and they can break or fall off. Unlike the other methods, condoms do not affect a woman’s fertility.

Women whose menstrual periods are very regular may know when they are most likely to get pregnant and avoid sex during that time. “Now there’s an app for that,” says Dr. Dunn. “I encourage my patients to track their periods using any one of a number of smartphone apps. Some actually notify patients when they’re at the peak of their fertility.”

Talk to your doctor about which birth control methods would be best for your personal health and lifestyle. Together, you can discuss the benefits and risks, and make an informed choice.