Healthiest Birth Control

Healthiest Birth Control
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Hatcher RA, et al., eds. Contraceptive Technology. 21st ed. Ayer Company Publishers; 2018.
Hatcher RA, et al. Managing Contraception 2019-2020: For your pocket. 15th ed. Bridging the Gap Foundation; 2020.
Oral contraceptives and cancer risk. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet. Accessed Oct. 14, 2019.
AskMayoExpert. Contraception. Mayo Clinic; 2019.
Bartz DA, et al. Combined estrogen-progestin contraception: Side effects and health concerns. https://www.uptodate.com/contents/search. Accessed Oct. 28, 2019.
American College of Obstetricians and Gynecologists. Practice Bulletin No. 206: Use of hormonal contraception in women with coexisting medical conditions. Obstetrics & Gynecology. 2019; doi:10.1097/AOG.0000000000003072.
Burnett TL (expert opinion). Mayo Clinic. Jan. 2, 2020.

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Choosing a birth control pill

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Choosing the right birth control pill can be a challenge. Learn the pros and cons of different types of birth control pills.
If you're considering taking birth control pills, you're not alone. Birth control pills are some of the most popular contraceptives. And for good reasons — they're effective and easy to use. The variety of birth control pills available, though, can seem daunting. Fortunately, they can be sorted into just a few categories to make it easier to understand your options.
There are two main kinds of birth control pills:
Combination birth control pills come in different mixtures of active and inactive pills, depending on how often you want to have periods:
Combination birth control pills are also categorized according to whether the dose of hormones in the active pills stays the same or varies:
Most combination birth control pills contain 10 to 35 micrograms of ethinyl estradiol, a kind of estrogen. Women who are sensitive to hormones may benefit from taking a pill that contains a dose of estrogen at the lower end of this range. However, low-dose pills may result in more breakthrough bleeding — bleeding or spotting between periods — than higher dose pills.
Combination birth control pills prevent your ovaries from releasing an egg. They also slow an egg's progress through the fallopian tubes, thicken cervical mucus and thin the lining of the uterus (endometrium). All of these actions help keep sperm from joining the egg.
The minipill slows an egg's progress through the fallopian tubes, thickens cervical mucus and thins the endometrium — all of which help prevent sperm from reaching the egg. The minipill sometimes also suppresses ovulation.
No. Your doctor will ask about your medical history and any medications you take to determine which birth control pill is right for you.
Your doctor may discourage use of combination birth control pills if you:
Your doctor may discourage use of the minipill if you:
You have many options for birth control. If you choose to take birth control pills, work with your doctor or other care provider to decide which type of birth control pill is right for you.
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Medically Reviewed by Brunilda Nazario, MD on October 19, 2020
The best birth control is the one that most effectively prevents pregnancy and fits with your lifestyle. Generally, a male condom plus another form of birth control is the most effective way to prevent pregnancy.
What's "best" among birth control methods differs from person to person. What's right for you may not be right for everyone. And your needs may change over time.
Here’s what to think about when choosing a kind of birth control:
You can compare facts about birth control methods in the sections below, including the basic ways they work. The types of methods are:
When doctors talk about how effective a birth control method is, there are different rates when it's used "ideally" (exactly the way it was designed) or “typically” (by the average person in real life). “Typical" use takes into account that people can't or don't always use birth control correctly or consistently.
Keep in mind that out of every 100 women who don't use any birth control, about 85 will get pregnant within a year.
The various kinds of birth control, from most effective to least effective, are:
How it works: Some people consider abstinence to mean zero sexual contact (complete abstinence). Others say it's when the penis does not have contact with the vagina (contraceptive abstinence).
Number of pregnancies per 100 women:
How long it lasts: As long as you abstain
STD protection? Yes, when you practice complete abstinence; no, if you practice only contraceptive abstinence.
Pros: Highly effective when used correctly. No side effects. No cost.
Cons: Giving up sex for a long time may be very hard. You might also have trouble saying "no" or "stop" while you're enjoying other sex play.
How it works: A doctor blocks, ties, clamps, seals, or cuts the two fallopian tubes that connect a woman’s ovaries and uterus. It’s also known as a tubal ligation or "getting your tubes tied ."
Cons: You'll have to go to the hospital, and you'll need general anesthesia for the surgery. Risks of pain, bleeding, infection, and ectopic pregnancy afterward. Not meant to be reversed.
How it works: The tubes from the testes to other glands are blocked so the semen no longer has sperm.
Pros: One-time procedure. Needs only local anesthesia.
Cons: Risks of pain, bleeding, and infection. Waiting period before it's effective. Not meant to be reversed.
How it works: Using a needle, a doctor puts a matchstick-sized rod with progestin under the skin on your arm.
Pros: Long-term protection against pregnancy. Can be reversed easily if you want to get pregnant.
Cons: May cause weight gain and changes in your bleeding pattern. Possible breast and stomach pain .
Progestin IUD (Kyleena, Liletta, Mirena, Skyla)
How it works: A small T-shaped device that has progestin goes into your uterus.
How long it lasts: Up to 3-5 years
Pros: There’s nothing to do right before having sex. Once it’s removed, you can get pregnant. Can be used while breastfeeding . May cause lighter periods or no periods.
Cons: May cause irregular periods , pain, or ovarian cysts . In some unusual cases, can make pelvic infections worse. Rarely, the IUD may get stuck in or on your uterus or cause a serious infection.
How it works: A small T-shaped device with copper goes into your uterus. It keeps sperm from reaching or fertilizing the egg. It may keep the egg from attaching to the lining of your uterus.
Pros: There’s nothing to do right before having sex. Once removed, it's possible to conceive. Can be used while breastfeeding .
Cons: May cause cramps or bleeding. In some unusual cases, can make pelvic infections worse. Rarely, the IUD could get stuck in or on your uterus or cause a serious infection.
How it works: Your doctor gives you a shot of progestin.
Pros: There’s nothing to do right before having sex. Birth control protection starts with the first shot. Reversible. Can use while breastfeeding .
Cons: Must get repeat injections on time. You may lose bone density when you get shots for more than 2 years in a row. May cause bleeding between periods, headaches , weight gain, nervousness, or belly discomfort. You may not ovulate for up to a year after a shot.
How it works: You put a flexible plastic ring into your vagina. It releases progestin and estrogen .
How long it lasts: 1 month for each ring
Pros: Easy to use. Nothing to do right before having sex.
Cons: Must keep the ring in place, and change it on schedule. May cause vaginal discharge and mild discomfort. Higher risks of heart attack and stroke . Can come out of place.
How it works: You insert the gel into your vagina via applicator immediately before or up to one hour before sex.
How long it lasts: One act of intercourse
Pros: Easy to insert. Lubricates vagina.
Cons: Must be put inside the vagina immediately before or up to one hour sex. If you have sex more than once within the hour, you must use another applicator. May cause irritation, allergic reactions, and infections.
How it works: You stick a square patch that's about 2 inches across on your abdomen , buttocks, arm, or back. Your skin absorbs estrogen and progestin from it. Use it for 3 weeks, and then skip a week so you have a period.
How long it lasts: 1 week per patch
Pros: Easy to use. Nothing to do right before sex.
Cons: Must be changed on time. May cause a skin reaction. Raises risks of blood clots and strokes.
Extended- or continuous-use birth control pill
How it works: You take a pill with progestin and estrogen every day.
How long it lasts: 3 months or 1 year, depending on your prescription
Pros: Nothing to do right before sex. Fewer or no periods. Makes menstrual cramps and acne less severe.
Cons: Must take a pill at the same time every day. May cause more spotting between periods than with regular birth control pills . Fewer or no periods makes it harder to know if you're pregnant. May cause changes in your period, nausea , breast tenderness, headache , high blood pressure risks , and higher chances of blood clots, heart attacks , and stroke .
How it works: You take a pill with progestin and estrogen every day.
How long it lasts: 1 month per package
Pros: Nothing to do right before sex. Makes periods more regular and lighter. Makes menstrual cramps and acne less severe.
Cons: Must take a pill at the same time every day. May cause changes in your period, nausea , breast tenderness, or headache . You may have high blood pressure . Brings higher risks of blood clots, heart attacks , and stroke .
How it works: You take a pill with progestin every day.
How long it lasts: 1 month per package
Pros: Nothing to do right before sex. Can be used while breastfeeding. Makes periods lighter. Makes menstrual cramps less severe. May be used if you can’t take the regular birth control pill because of high blood pressure , blood clots, migraines , and smoking over age 35.
Cons: Must take a pill at the same time every day. Can cause irregular bleeding, headache, breast tenderness, nausea, and dizziness .
How it works: You load a dome-shaped disk with sperm-killing jelly (nonoxynol-9) and put it into your vagina to cover your cervix.
Pros: Works immediately. Neither you nor your partner can feel it. Can be used while breastfeeding. No hormonal changes. Can be inserted hours before having sex. Can be left inside the vagina for up to 24 hours, as long as you add spermicide each time you have sex and then every 2 hours afterward.
Cons: Must be fitted to your size and refitted often. Can cause irritation, allergic reactions, or infections. Spermicides with nonoxynol-9 can increase risks of HIV . Must leave diaphragm in for at least 6 hours after sex. More than 24 hours of use raises risks of toxic shock syndrome .
How it works: You put a thin sheath over your erect penis right before sex and take it off before the penis gets soft.
How long it lasts: One act of intercourse
Pros: Widely available, easy to carry, and disposable. Latex condoms are the best protection against STDs other than abstinence.
Cons: Must be used every time you have sex. Makes sex less spontaneous, since you need to put the condom on the right way. May cause irritation or allergic reactions.
How it works: You put a thin pouch into your vagina before sex.
How long it lasts: One act of intercourse
Pros: Can be inserted before sex. Less decrease in sensation for men than with a male condom. Stronger than latex.
Cons: Can slip while using. May be hard to insert or remove. Not easy to find. Costs more than male condoms.
How it works: Men take their penis out of the vagina before they ejaculate.
How long it lasts: One act of intercourse
Pros: Free. Can be used with other forms of birth control.
Cons: The man may not pull out in time. Pre-ejaculate can still contain sperm.
How it works: Women track their fertility to figure out which days to abstain from sex or use a barrier method.
How long it lasts: As long as it's practiced
Pros: May be OK for some religious practices. Inexpensive. Helps you understand your body better.
Cons: Requires careful record-keeping. You can't be sexually spontaneous during fertile periods. Not useful if your menstrual cycle lasts fewer than 26 or more than 32 days.
How it works: You put a disk with sperm-killing jelly (nonoxynol-9) into the vagina before having sex.
Pros: Works right away. Can have sex more than once while inserted, with no need to add more spermicide.
Cons: May not fit well for women who've had a baby. Can cause irritation or allergic reactions or be difficult to remove from vagina. Spermicides with nonoxynol-9 can increase risks of HIV. Must leave sponge in for at least 6 hours after sex. More than 24 to 30 hours of use raises risk of toxic shock syndrome.
How it works: You put a soft cup loaded with sperm-killing jelly (nonoxynol-9) inside your vagina to fit snugly over your cervix.
Pros: Smaller and uses less spermicide than a diaphragm. Reusable. Can be put in up to 6 hours before sex. Can have sex more than once while it’s in, with no need to add more spermicide.
Cons: May not fit well for women who've had a baby. May need to be resized. May cause irritation, allergic reactions, or unusual Pap smears. Spermicides with nonoxynol-9 can increase risks of HIV. Must be left in for at least 6 hours after sex. More than 48 hours of use raises risks of toxic shock syndrome.
How it works: Women put a foam, cream, jelly, film, or tablet containing sperm-killing nonoxynol-9 into their vagina.
How long it lasts: One act of intercourse
Pros: Easy to insert. Lubricates vagina.
Cons: Must be put in 5 to 90 minutes before sex and left inside for at least 6 to 8 hours after. May cause irritation, allergic reactions, and infections. Can increase risks of HIV.
How it works: You insert the gel into your vagina via applicator immediately before or up to 1 hour before sex.
How long it lasts: One act of intercourse
Pros: Easy to insert. Lubricates vagina.
Cons: Must be put inside the vagina 15-60 minutes before sex. If you have sex more than once within the hour, you must use another applicator. May cause irritation, allergic reactions, and infections.
Morning-after pill (Next Choice, Plan B, Plan B One-Step)
How it works: Stops an egg from leaving the ovary. May also prevent an egg from getting fertilized or attaching to the uterus lining.
Effectiveness: Prevents pregnancy in 7 out of 8 women who would have otherwise gotten pregnant.
When it works: Up to 3 days after having unprotected sex or birth control failure
Need to see a doctor? No, if you're 18 or older; maybe, if you're not
Pros: You can buy Plan B One-Step without a prescription. Next Choice and Plan B are available over-the-counter if you're 17 or older.
Cons: Not meant for regular birth control. If you're under 17, you may need a prescription. May cause nausea, vomiting, belly pain, fatigue , and headache.
How it works: Blocks a hormone to stop or delay the ovaries from releasing an egg. May also prevent the egg from attaching to the uterus lining.
Effectiveness: Prevents pregnancy in 6 or 7 out of every 10 women who would have otherwise gotten pregnant.
When it works: Within 5 days of having unprotected sex or birth control failure
Pros: Can be taken later than other forms of emergency contraception . May be more effective than other emergency contraception if you're overweight .
Cons: Not meant for regular birth control. Requires a prescription. May cause headache, nausea, belly pain, menstrual cramps, fatigue , or dizziness. Use only birth control methods without hormones for the next 5 days.
The Kinsey Institute: "Choosing the Right Contraceptive Method."
Dailard, C. The Guttmacher Report on Public Policy, December 2003.
FDA: "Birth Control: Medicines to Help You."
UpToDate: "Pregnancy rate (percent) during first year of use of contraceptives" and "Emergency Contraception."
American Sexual Health Association: "Birth Control Method Comparison Chart."
Center for Young Women's Health: "Contraception: Success and Failure Rates of Contraceptives."
Guttmacher Institute: "Contraceptive Use in the United States."
CDC: "Effectiveness of Family Planning Methods."
Association of Reproductive Health Professionals: "Choosing a Birth Control Method."
American Academy of Family Physicians: "Progestin-Only Contraceptives."
Office on Women's Health, U.S. Department of Health and Human Services: "Birth Control Methods Fact Sheet."
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