Birth control isn’t one-size-fits-all. Having been on both hormonal and non-hormonal birth control, I’ve found that I can’t deal with hormones flowing throughout my whole body (so goodbye, shot and pills). I’ve also learned that the copper IUD, Paragard, makes me feel like my uterus is attacking itself. Now, I have the Mirena IUD, which doses me with localized hormones rather than a full-body experience.
But that’s just my experience. No woman is the same – two women on the same pill could have drastically different experiences. With so many types of birth control on the market, it can be overwhelming to consider all of your options. If you’re looking for the basics, here are summaries of each type.
I must emphasize: it’s CRUCIAL to talk with your OB/GYN and discuss the right birth control for you. I’m not sure what I would have done without my doctor’s guidance, so use this article as a briefing before your appointment.
Hormonal vs. Non-Hormonal Birth Control
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Many of the usual birth control methods you hear about – the pill, the ring, the shot – rely on hormones. That’s because the hormones (usually estrogen and progestin, though there are options that only have progestin) stop ovulation. This means there are no eggs that sperm can fertilize. Progestin can also thicken your cervix’s mucus, so sperm can’t reach your eggs. Non-hormonal birth control does not protect you from STIs, though — just pregnancy.
Non-hormonal birth control, on the other hand, is just that: non-hormonal. The most common form is condoms, which also help stop the spread of STIs. Other options include spermicide or diaphragms and cervical caps (we’ll get into those later), but like hormonal birth control, they do not stop the spread of STIs.
Hormonal Options
If you’re wanting a hormonal option, there are many different types. There’s a variety of pills, rings, the Depo Provera shot, the Nexplanon implant, certain IUDs, and two brands of patches.
While most are to be used for three weeks and removed for one week (during which you’ll have your period), you can skip your period by continuously using your hormonal birth control. Make sure you continue taking your birth control on schedule (so, if you inserted the ring at 12 pm on Monday for the past three weeks, insert the new ring at 12 pm on Monday) for proper protection.
Birth Control Pill
There are a bunch of different pills. Conventional pills with estrogen and progestin, aka combination pills, usually contain 21 active pills (pills filled with hormones) and seven inactive pills (pills without hormones), or 24 active pills and four inactive pills. You’ll have your monthly period when taking the placebo pills. Combination pills can be monophasic – meaning they only contain one level of active hormones at a time – or multiphasic, which have active ingredients that vary based on the phases of your cycle.
There are other options; for example, extended-cycle pills contain 84 active pills and seven inactive pills, giving you about four periods a year. Low-dose pills contain less estrogen for those who are sensitive to hormones, and monophasic minipills contain only low levels of progestin.
Your standard combination pills work two ways: one, they prevent your ovaries from releasing an egg, and two, they build up excess mucus at the opening of your cervix, creating a barrier from sperm. Some combination pills also thin out the lining of your uterus, so fertilized eggs have difficulty attaching and developing. Minipills generally only prevent pregnancy through the thickening cervical mucus, though some may prevent ovulation – do your research!
There are, of course, side effects: combination pills can cause weight gain, bleeding between periods, headaches, and nausea. Minipills can cause acne, ovarian cysts, and bleeding between periods as well.
Overall, with so many options, pills tend to be the most popular and common birth control methods. When used perfectly (meaning you don’t skip a dose), it’s 99% effective; with typical use, it’s about 91% effective.
Vaginal Rings
There are two types of vaginal rings: Annovera and the NuvaRing. The NuvaRing contains estrogen and progestin – the same hormones found in your combination pills. One single NuvaRing is inserted into your vagina, where it stays for three weeks and continuously administers low doses of hormones. After three weeks, you take one week off, when you’ll have your period. You then insert a new NuvaRing and restart the process. One Annovera ring, on the other hand, provides protection for a year.
The side effects with the ring include headaches, more vaginal discharge, nausea, and breakthrough bleeding in between periods. In terms of efficacy, Annovera is 97.3% effective, while the NuvaRing is 91% effective with typical use. Rings are great if you want to insert and forget for a month.
Patches
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The three patches are Xulane, Evra, and Twirla. Simply apply the patch to your stomach, back, or butt (or, if you choose Xulane or Evra, your upper arm), and the hormones will seep into your system, stopping ovulation and thickening your cervical mucus.
When used properly, patches are 99% effective. But if you accidentally make a mistake – say, by not replacing a patch that is falling off or not having one on for an extended period of time, the hormones will no longer be administered. Because of this, patches are typically 91% effective. Side effects are the standards: spotting, nausea, and headaches. It’s also common to have a reaction to the patch’s application site, such as dry and itchy skin, so switch where you place the patch each cycle.
Depo Provera Shot
The Depo Provera shot is super subtle, much like vaginal rings, and it’s long-lasting – you only need one shot every 12-13 weeks. While there’s the slight inconvenience of having to see your doctor every three months to administer the shot, many prefer it over remembering to take a pill or switch out a ring, or needing to go to the pharmacy to pick up a monthly prescription.
I had plenty of side effects on Depo Provera – some I liked, some I hated. For example, I stopped getting my period, which was a miracle (this is common for about half of those who get the shot). However, I also experienced deep depression. That’s just me, though – talk with your doctor to see if it’s right for you!
Nexplanon Implant
The Nexplanon implant is my next choice for birth control. A flexible implant the size of a matchstick is inserted into your arm by a medical professional, and it lasts for three years. It releases progestin only, preventing pregnancy by stopping ovulation and thinning the lining of your uterus. It’s described as a “minor surgical procedure,” because an applicator places the implant underneath the skin. However, only 5.2% of those in clinical trials experienced pain, thanks to the numbing cream applied beforehand.
Nexplanon is 99% effective, and you don’t have to think about changing it out regularly. This is ideal for those who may not be diligent about taking pills or switching out rings every month. It’s also reversible, so you’re not stuck with Nexplanon in your arm for those three years. Common side effects are acne, weight gain, and depressed moods. When it comes to your period, it can cause spotting between your cycle or stop your period entirely.
Hormonal IUDs
I have the Mirena IUD, and I. am. in love. with it. I’ve completely stopped getting my period or any symptoms when I should be having it, I don’t have to think about it until three years are up, I don’t feel it, and its 99% efficacy rate is so relieving. However, “the insertion and removal can be pretty shocking,” as my OB/GYN put it. (I was under some sedation, so I have no recollection of it.)
There are other hormonal IUDs: Kyleena, Liletta, and Skyla. Each one has a different lifespan – for example, the Mirena and Liletta work for up to seven years, Kyleena works up to five, and Skyla works up to three. All of these can make your period lighter or stop it completely. Most people have few side effects, such as spotting between periods, cramping, and irregular periods, but they usually work themselves out within three to six months.
Non-Hormonal Options
When you think non-hormonal, you probably think of condoms — no surprise there. But there are so many other options that can work for you and are worth trying, should you want to go hormone-free.
Condoms
Planned Parenthood estimates that 450 million condoms are sold each year. They’re affordable, protect against pregnancy AND STIs (unless you use lambskin condoms, which do not protect against STIs) and easy to access. Walk around your local pharmacy, and you’ll have an array of choices.
Used typically, men’s condoms have an efficacy rate of 85% — one of the most effective forms of non-hormonal birth control – and women’s internal condoms have a 79% efficacy rate. Before you rely on this method, make sure that you know how to use them properly. The last thing you want is for a mishap, like the condom slipping off.
Diaphragms, Cervical Caps, Spermicide, & Sponges
A diaphragm is a shallow cup made from soft silicone. It’s folded in half, then inserted into your vagina, covering your cervix. This way, sperm doesn’t join the egg. When used properly, they’re 88% effective. Cervical caps do the same thing, but they’re slightly smaller and are shaped differently. For women who have given birth, the cervical cap is 71% effective; for women who have not given birth, it’s 86% effective.
When using diaphragms and cervical caps, you must use spermicide. Spermicide contains nonoxyonol-9, a chemical which cuts off sperm from reaching eggs by blocking the cervix and stopping sperm from moving properly to the egg. Spermicide is bought OTC and comes in many forms – suppositories, gels, and foams are just a few options. Used typically, it’s 72% effective.
Sponges combine the best of both worlds. The sponge blocks sperm from entering the cervix, and it also contains spermicide to stop sperm from meeting the egg (it doesn’t kill the sperm). Thanks to its dual-action work, its efficacy is 91%.
Phexxi
We just wrote about Phexxi, the latest non-hormonal birth control. It’s a dose of gel that’s inserted an hour before sex with an applicator, then prevents pregnancy for one romp session. Sperm increases the pH of the vagina; Phexxi works by using lactic acid, citric acid, and potassium bitartrate to keep the vagina’s pH normal, preventing the possibility of pregnancy.
Don’t get Phexxi mixed up with spermicide – spermicide kills and paralyzes sperm, while Phexxi works with your vagina’s pH. With typical use, it’s 86% effective, making it one of the safer non-hormonal birth control methods.
Paragard IUD
Unlike hormonal IUDs, the Paragard IUD is made up of coiled copper. Both hormonal and non-hormonal IUDs change the way the sperm cells move, diverting them from reaching the egg. On top of this, the Paragard’s copper is similar to an inflammatory response in the uterus, so sperm avoid it. It lasts for up to 12 years, meaning you can have it inserted and forget about it for more than a decade, and it’s 99% effective. Another cool fact: if you insert a copper IUD within five days of unprotected sex, it’s 99.9% effective and can work better than your usual Plan B.
Because it doesn’t use hormones, you’ll still have your period on a regular basis. However, side effects can cause heavier, longer, and more painful periods, as well as intense cramping. (I had the Paragard, and, oh man, did I have side effects…which started after three years of having it inserted.)
Sterilization
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Finally, if you really don’t want to get pregnant – and you should think long and hard about this – you can go with sterilization. Sterilization, aka tubal ligation, involves the blockage or full removal of your fallopian tubes, and it’s 99% effective…which might sound confusing. How can you get pregnant when you’ve messed with your fallopian tubes? Well, ectopic pregnancies – meaning, when a fertilized egg implants on the fallopian tube – are still possible, especially if your doctor performed the tubal ligation incorrectly. So, make sure you trust the doctor performing the surgery.
We hope this article answered some of your questions, and good luck at your next appointment! Which birth control has worked for you? Are you planning on changing? Let us know in the comments.
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