Medically reviewed by Dr. Betty Acker, MD on September 21, 2020
Nearly all genetically female people use contraception at some point in their lives. And yet for many, pregnancy prevention doesn’t start with the question, “Which birth control is best for me?”
If you’re like most, you went to the doctor’s office to ask for the pill and took whatever was prescribed. But choosing the best birth control is a highly personal decision that can involve trial and error. What works well for your sister or your best friend might not be the best option for you — either because you have different needs or a different biological makeup.
The medical term “allergy” refers to a specific reaction in your body to a specific trigger. It is identified with precise medical testing by an allergist. All women have estrogen in their bodies so the term you are thinking of is probably “intolerance”. Something in the pills you take may be causing a reaction in your body that makes it difficult to tolerate them due to undesired side effects. Fortunately, it is rarely the actual hormones in the pills that cause the reaction. It is far more likely that some inert component of that specific pill is causing you trouble.
For instance, estrogen and progestin are commonly used in birth control pills, and any pill containing them can cause a reaction or uncomfortable side effects. You might have trouble tolerating that specific pill if you experience worsening of the following symptoms:
- premenstrual syndrome
- premenstrual asthma
- menstrual migraine
- weight problems
- skin problems
- mood swings
- diminished sex drive
However, a worsening before an improvement is a very common occurrence whenever you begin medication with hormones in it. Typically the worsening will improve with a short adjustment period of 1-3 months.
If you find that you are experiencing side effects and you are thinking about whether you need to change your pill, let us know. We will help you work through the situation.
Birth Control Methods Without Estrogen
Some women conclude that their side effects are worsened on pills containing both estrogen and progestin. They decide to remove the estrogen effects on their bodies by using progestin-only birth control methods.
There are multiple types of progestin-only birth-control you can use if you want to avoid estrogen:
- Mini-pills: Mini-pills are progestin-only birth-control pills that are very effective when taken at the same time every day. They work by increasing cervical mucus to prevent sperm from meeting up with an egg, in addition to preventing ovulation and thinning the lining of the uterus.
- Depo-Provera: The depo shot is an injection that slowly releases progestin into the body to prevent pregnancy for up to 14 weeks. The mechanism of action is the same.
- Hormonal IUD: Mirena, Kyleena, Skyla are popular brands of a T-shaped device that is inserted into the uterus. They all work in similar ways to the pill and shot but they also have a local and more direct effect on the uterus and ovaries. Again, the release of a steady level of progestin reduces your chances of ovulation and conception.
- NEXPLANON Implant: This is a subdermal implant about the size of a matchstick that releases progestin over time. It’s inserted into your arm in a very short and painless procedure in an office.
Non Hormonal Birth Control Methods
Another option is to avoid hormones altogether. Here are some of those options:
- Copper IUDs: Sold under the brand name Paragard, the copper IUD works without any hormone at all. It prevents pregnancy for up to 12 years. It is thought to work by creating an environment in the uterus that prevents fertilization.
- Condoms: Worn externally (male condom) or internally (female condom) to prevent the exchange of fluids between partners. When used perfectly, male condoms are particularly effective at preventing pregnancy.
- Other barrier methods: Diaphragms, cervical caps, and the sponge are worn internally and used in combination with spermicide to prevent sperm from entering the uterus and causing fertilization of an egg.
How do I know which birth control is best for me?
When choosing contraception, you should start by weighing which factors are most important to you. While pregnancy prevention is usually the goal, it’s not the only consideration.
Here are a few things to think about:
When it comes to preventing an unwanted pregnancy, not all birth-control methods are created equal. Apart from permanent sterilization, the most effective birth-control methods are IUDs and arm implants, which are 99 percent effective.
The birth-control shot is 94 percent effective, and the pill and the patch are 99 percent effective with perfect use (91 percent effective with typical use). Male condoms are 98 percent effective with perfect use (85 percent effective with typical use).
Other non-hormonal methods like the cervical cap, and the diaphragm range from 76 to 88 percent effective.
The biggest factor that determines effectiveness is how good the user is at actually using it. We know that IUDs are most effective because the user only has to remember to do anything once every 3, 5, 7, or 12 years. The implant is every 4 years, the ring is every month, the patch every week and the pill every day. Condoms and barriers must be used every time you have intercourse.
Protection Against STIs
If you’re in a long-term monogamous relationship, preventing sexually transmitted infections might not be a concern. But if you are not sure of your partner or partners’ statuses, you may want birth control that can also protect you against STIs. When used correctly, male condoms and female condoms both do a great job of preventing the transmission of STIs, though female condoms aren’t as effective at preventing pregnancy.
Some of the most common questions about birth control are related to potential side effects: What birth control has the least side effects? Which birth control does not cause weight gain? Will the pill make me break out?
It’s important to know that most birth control side effects go away after the first 3-4 months, once your body adjusts to the new rhythm of hormones. During the first few months (and sometimes after that) the estrogen and progestin in hormonal birth control are associated with achy breasts, nausea, headaches, decreased libido, and irregular bleeding.
The most common side effect of progestin-only birth control methods is irregular bleeding, which gets better over time. But contrary to popular belief that all hormonal contraceptives can cause you to gain weight, Depo-Provera is the only birth-control method actually linked to weight gain in controlled studies.
Hormonal and non-hormonal IUDs have their own side effects and risks, as well. Unfortunately, the best way to find the birth control method with the fewest side effects is simple trial and error.
You might not be thinking about how your birth control affects your sex life, but this can be a big factor that determines whether or not you use it consistently. For instance, many people feel that condoms reduce their sensitivity, which can lead to putting one on later (increasing the risk of pregnancy) or having unprotected sex.
Convenience and Ease of Use
Convenience and ease are two factors that will determine how consistent you are with your birth-control method — and, therefore, how effective it is.
Some women don’t mind having to go to the doctor to get a birth-control shot every few months. Others would prefer to order their method online and get it delivered without ever having to set foot in a doctor’s office.
The biggest question for those considering the pill is, “Can you remember to take a pill at the same time every day?” If you’re switching from the combination pill to the mini-pill, you should know that every pill in your pack is active and that you have to take the mini-pill within the same 3-hour window every day. If you travel frequently or have an irregular schedule, the mini-pill might not be the best choice since its effectiveness depends on a high degree of consistency.
Hormonal birth control does come with certain risk factors, but progestin-only birth control is considered safer than combination pills for a variety of conditions. You might benefit from progestin-only birth control if:
- You’re over 35 and smoke
- You’re breastfeeding
- You have high blood pressure or hypertension
- You have a history of blood clots or stroke
- You get migraines with an aura
- You have unexplained uterine bleeding
- You have advanced diabetes
Your doctor may advise against the mini-pill if you have liver disease, unexplained uterine bleeding, or if you’re taking certain medications. If you have a history of breast cancer, your doctor will likely advise you to steer clear of some hormonal contraceptives altogether.
Finding the right birth control method can be tricky. If you’re struggling to know what’s right for you, answer a few quick questions and our medical professionals can help find the best birth control for you.