Birth Control

What you need to know and choosing an option that’s right for you

Birth
Control

What you need to know
and choosing an option
that’s right for you

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Birth Control

Hormonal birth control is the most effective form of contraception. These types of medication are not only useful in helping you plan your fertility, they can also be used to help relieve symptoms connected to your period and hormonal changes throughout the month. Learning more about how birth control works can help you decide what option may be best for you. Being aware of the potential side effects also helps you to better understand your body if you do decide to start taking this medication.

If you’re having (or likely to have) sex where you could get pregnant and you don’t want this to happen, you need to think about using some form of birth control. When people think about birth control options, the contraceptive pill is usually what comes to mind. However, there are actually a lot of other options available, that you might want to think about exploring.

To help you make that decision, it’s good to be aware of what the different types of birth control are, how you would use them, and what the possible side effects might be. Along with this you will want to think about what option may suit you and your lifestyle best. Are you the type of person that can never remember to take that daily vitamin you bought 3 months ago? If so, the daily contraceptive pill may not be the best choice for you. Don’t worry though, with more than a dozen categories of contraceptives on the market, there are plenty of options to choose from.

Did you know: 45% of all pregnancies in the United States are unplanned.

In general, contraception can be divided into 2 main categories. There are barrier methods, such as condoms and diaphragms; and hormonal methods, such as the pill, the patch, the shot or an implant.

Hormonal methods of birth control work by either stopping ovulation from happening, and/or stopping sperm from being able to enter the uterus.
There’s several types of hormonal birth control available. Nearly all of them contain the hormone progestin and some also contain the hormone estrogen. Birth control options that contain both of these hormones are referred to as the combined pill.

When it comes to birth control, what works for one person may not for another. You might love a particular pill, whereas your bestie can’t stand it. This is because we all have different hormonal sensitivities, and our bodies will often react differently to particular hormones.

Unfortunately, most birth control will cause some side effects. The most common are breast tenderness, headaches, mood swings, or light spotting. Side effects are usually at their worst when you first start a new method of birth control. Most clinicians say it takes about 3 months for your body to adjust and for side effects to subside completely. You shouldn’t feel unwell or unable to function when taking birth control though, so if something isn’t working for you, be sure to talk to your healthcare provider about this.

To find out more about the different types of birth control available, the pros and cons of each of these methods and how to choose an option that’s right for you, keep scrolling!

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Further reading

Your Cycle Explained

PMS

PMDD

Hormones and Your Sex Life

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Birth Control
& Risk

Hormonal methods including the patch, the ring and the contraceptive pill are on average 91% effective. This statistic increases to 99% if they are always used as directed.

Barrier methods vs hormonal contraceptives

There are a lot of different birth control methods available which can make choosing an option confusing. Take a look at our table below to find out what the major differences are, between barrier methods, and hormonal methods of contraception. Like any decision, there are pros and cons for both.

Barrier Method (condoms, caps, diaphragm, copper coil)

How does it work?

Stops the sperm from reaching the egg.

Barrier Method (condoms, caps, diaphragm, copper coil)

Pros +

  • Good protection against sexually transmitted infections.
  • Hormone free so has no risk of side effects or health risks.
  • Effective at preventing pregnancy when used correctly.

Cons – 

  • Most require you to make a contraceptive decision ‘in the moment’.
  • Condoms require cooperation from a partner.
  • Barrier methods can be misplaced or break, increasing your level of risk.

Hormonal methods (pill, shot, implant, patch, ring, hormone coil)

Hormonal methods (pill, shot, implant, patch, ring, hormone coil)

How does it work?

Generally suppresses ovulation. Some stop sperm from entering the uterus meaning conception cannot occur.

How does it work?

Generally suppresses ovulation. Some stop sperm from entering the uterus meaning conception cannot occur.

Pro’s +

  • Are often easy to use.
  • Effective at preventing pregnancy when used correctly.
  • Long-acting methods can last for 3-5 years before they need replacing.
  • They can stop your period or make them lighter and less painful.

Cons – 

  • Will not protect you against STIs.
  • May cause some side effects.
  • Some methods have a very small risk to your health such as increasing your risk of getting a blood clot.

Which method will suit me best?

Firstly, you can use both a barrier method and a hormonal method of birth control. Many people do this to reduce the risk of contracting a sexually transmitted infection (STI) as well as minimizing the risk of pregnancy. Some use both types because they like the idea of being as protected as possible against a pregnancy.

Barrier may be best...

  • If you’re happy with your periods as they are
  • If you only have sex rarely
  • If you have more than one sexual partner or you change partners regularly
  • If you do not want to take medication
  • If you have had adverse reactions to hormone-based treatments in the past

 

Hormonal may be best...

  • If you want your periods to be lighter, less painful, or reduce your PMS symptoms
  • If you have sex regularly with the same partner
  • If you don’t want to think about contraception when you’re having sex
  • If you want to keep your birth control method private
  • If you’re likely to get carried away in the moment and worry about forgetting to use a barrier method, such as a condom

Remember

If you’re in a new relationship or you and your current sexual partner are not exclusive, you’ll need to use a barrier method as well.

Hormonal Contraception Options

If hormonal birth control seems like it’s going to meet your needs, it’s time to think about which type of treatment to go for.

One of the main things to think about when making this decision is:

  • whether you are going to be able to remember to take a pill daily or change a patch every week,
  • or, whether you want to use something you can forget about for a while.

Let’s run through your main hormonal options and their possible side effects:

Combined pill: this is often called 'the pill' or 'birth control'

  • As the name suggests, the pill is a tablet you swallow. It contains two artificial hormones, estrogen and progestin.
  • You need to take the pill at the same time every day for it to be most effective.
  • With some types of combination pills, each of your pill packs will contain ‘placebo pills’. These are at the end of each monthly strip of pills and contain no active hormones. Taking the placebo pills will cause you to have something called a ‘withdrawal bleed’. This is like a pseudo period and lasts for a few days.  With other types of these medications, there will simply be no pills for week 4, and you don’t take anything at all, producing the same effect of a ‘withdrawal bleed’.
  • Some people choose to take their pill ‘back to back’ skipping the placebo pills. This is so no bleeding happens and other PMS symptoms remain well managed.
  • The pill can help you to manage heavy or painful periods.
  • The pill may not be suitable for you if you are over 35 and smoke, or if you have certain other medical conditions.

Side effects could include:

  • changes to your mood or ‘mood swings’
  • feeling nauseous
  • breast tenderness
  • headaches (these usually settle down after a few months)
  • a small increased risk of a blood clot or cervical cancer. These risks vary from pill to pill but are very small. For example, when it comes to a blood clot, your risk could increase by 0.1% by taking the pill. To put this in more straight forward terms, out of every 10,000 women that take the pill 10 of these women will develop a blood clot.  The concern with a blood clot is that it could result in a deep vein thrombosis (DVT) which can lead to a pulmonary embolism, if it ends up in the lungs, a heart attack or a stroke.  All of these conditions can be life threatening or cause long term health complications.

Progestin-only pill: sometimes called the ‘mini-pill’

Hormonal methods (pill, shot, implant, patch, ring, hormone coil)
  • Is also a tablet you take every day, but only contains the hormone progestin.
  • You need to take this pill at the same time every day for it to be most effective.
  • You usually take this pill continuously over the month with no breaks.
  • Your periods may stop, become lighter, or become more infrequent.
  • Some women can’t or don’t want to take estrogen, so this type of pill can be a good option for them. For example, if you suffer from migraine headaches with aura, healthcare providers will generally advise you don’t use birth control with estrogen in it.
  • You can also take the progestin-only pill if you’re over 35 and you smoke.

Side effects may include:

  • pimples or breakouts
  • breast tenderness
  • feeling nauseous
  • spotting
  • headaches (these usually settle down after a few months).

Some women find they have a sensitivity or intolerance to progesterone meaning this may not be the best type of contraception for them.

Implant

  • This is a small, flexible, plastic rod (around the size of a short matchstick) that is inserted under the skin in the upper part of your arm.
  • The implant releases progestin steadily.
  • It lasts for up to 5 years and after that will need to be changed to ensure you remain protected.
  • Is a great option if you struggle to remember to take a pill every day.
  • It can be removed at any time and your normal cycle and fertility will return quickly.

Side effects:

  • When the implant is first inserted, you may feel some bruising, or swelling around the implant.
  • Your periods may change. For most, they will stop altogether, but for others, some light spotting can happen throughout the month.
  • Some people dislike being able to ‘see’ the implant when pulling the skin on their arm.
  • Less common side effects include: headaches, breast pain, nausea, weight gain, ovarian cysts, or an infection at the implant insertion site. Also acne is a very common side effect.

Injection: you may hear people call this ‘the shot’ or ‘the depo’. Depo refers to the brand name of a common injection - Depo-Provera.

  • The injection releases progestin directly into your bloodstream.
    Depending on the product, it will last for between 12 to 13 weeks.
  • It’s a useful option if you’re likely to forget to take a pill at the same time every day.
  • The effectiveness of the injection is not affected by other medicines you might take.
  • You need to remember to get your next shot before the previous one expires.

Side effects could include:

  • weight changes
  • headaches
  • stomach pain
  • changes to your mood or mood swings
  • breast tenderness
  • changes to your periods, including them stopping altogether

Some things to think about when it comes to the injection, is that you will need to have your shot administered by a healthcare provider. This means a regular visit to the doctor will be needed. It can also take up to 1 year for your fertility to return to normal after your injection wears off.

IUD (intrauterine device): sometimes you will just hear people call this an ‘IUS’ or intrauterine system

  • IUS stands for intrauterine system.
  • It is a small, T-shaped plastic device that’s inserted into your uterus by a healthcare professional.
  • An IUD releases progestin directly into your uterus.
  • If you’re progestin sensitive, this option could still work for you, as the progestin doesn’t have to be metabolized via the digestive system, as with the progestin only pill.
  • It will last for 3 to 5 years, depending on the brand. (If you opt for the non-hormonal type of IUD (made with copper), it can last up to 12 years.)
  • If you are using estrogen to help with perimenopausal or menopausal symptoms, you can use an IUS for the progestin component of your hormone therapy (HT).

Side effects:

  • Side effects are less common than with other types of contraception
  • Some people can experience changes to their
    • mood
    • headaches
    • nausea
    • breast tenderness
    • spotting and/or irregular periods for first 3-6 months after insertion
  • There’s a very small risk of getting an infection after it’s been fitted
  • It can be uncomfortable when the IUD is inserted; similar to having a PAP smear.

Patch

The Patch
  • Is a small sticky patch that can be stuck to most parts of your body. The most common places people tend to stick their patch is on their upper arm or thigh.
  • The patch contains both progestin and estrogen.
  • For three weeks out of the month, you will wear a patch for 7 days then change to a new one. Once you’ve done that 3 times, you have a week where you’re patch-free
  • You may have a period-like bleed in your patch-free week, but this doesn’t happen for everyone.
  • After a week without wearing a patch, you will start the cycle again.
  • Unlike oral pills, the patch still works if you’re unwell and vomit or have diarrhea.
  • Patches are not suitable for everyone depending on your health history, so make sure to talk to a healthcare provider if you’re interested in this method.

Side effects:

  • When you first start using the patch, it may cause:
    • headaches
    • nausea
    • breast tenderness
    • spotting
    • changes to your period
  • Depending on where you place the patch, it could be visible to others.
  • The patch can cause skin irritation, itching and soreness.
  • As with other types of combination hormone contraceptives, there is a small risk of developing a blood clot when using this method of birth control.

Vaginal ring: sometimes people just call this ‘the ring’

  • The vaginal ring is a small soft, plastic ring you can insert inside your vagina yourself.
  • It releases a continuous dose of estrogen and progestin into your bloodstream.
  • One ring provides a month’s worth of protection.
  • You can still have sex with the ring in place.
  • The ring can sometimes come out on its own, but you can rinse it and reinsert it.
  • It can help with PMS and your periods may become lighter and less painful.

Side effects:

  • Side effects of the ring are usually temporary but can include
    • having more vaginal discharge
    • breast tenderness
    • headaches
    • nausea
    • period changes
    • spotting
    • vaginal irritation.
  • On very rare occasions, there’s a chance of developing a blood clot.

Remember none of these hormonal methods of contraception protect against sexually transmitted infections so if you think you may be at risk of this, use a barrier method as well.

Some hormonal contraception treatments are less effective if you take other medications.

Some types of contraception are not advised if you have a history of certain health conditions.

Before changing or starting a new method of contraception, always discuss it with your healthcare provider.

Aside from the methods listed above there is also the option of ‘permanent birth control’ or sterilization. This is where you undergo a surgical procedure called bilateral tubal ligation in the hospital (aka “having your tubes tied”). A tubal ligation can be performed by a specialist in a health center and is 99% effective at preventing pregnancy.

Birth Control Risk

Avoiding sex at certain times of the month or using the ‘pull out’ is considered the least effective method of contraception when it comes to preventing pregnancy.

Diaphragms or cervical caps are 71-88% effective when they are used effectively.

Condoms are 79-87% effective at preventing pregnancy when used correctly.

Hormonal methods including the patch, the ring and the contraceptive pill are on average 91% effective. This statistic increases to 99% if they are always used as directed.

Long-acting contraceptive methods such as injections, IUDs and implants are 99% effective at preventing pregnancy. This makes them the most reliable option on our list!

Reminder: you still need to use birth control during perimenopause and when you are going through menopause. Even if it’s less likely, a pregnancy is still possible!

Making the ‘right’ choice

As we have explained, when it comes to birth control, there are a lot of different options available to you.

It’s important to remember that it’s not about making the right choice, just a choice that’s right for you!

Choosing a contraception can also involve a process of trying different things until you find an option that works well for you. If you find yourself feeling frustrated and like no option is going to work, try to remember finding the right birth control is a process that we sometimes need to persevere with.

It’s OK to keep talking to your doctor about the different options if a particular birth control isn’t working for you. Some women feel like they don’t want to ‘bother’ their healthcare provider with lots of questions, or keep asking to try new things, but it’s important you feel able to talk to your doctor about how you feel. They are there to support you and find the thing that will work best for you and your lifestyle.

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