The pill and the IUD. Can you identify any other form of contraceptives? If you had to scratch your head, you’re not alone. Before walking into my first appointment with my gynecologist, I was understandably daunted and a tad clueless, but what I didn’t expect was to leave the office feeling the same way. I was given two options, the pill and the IUD, which felt… well…limited. And then there was the large list of side effects, possible complications and failure rates; it all felt very overwhelming. But, at the same time, every woman out there was doing it, so I should be OK, right?
Wrong.
According to KFF, a nonprofit foundation that conducts healthcare research, only 30% of women using contraception said they felt they were given enough information before choosing a method, and because of that, 25% of those women said they had chosen wrong. This can only mean one thing: women’s healthcare education is not a priority, and that is a systemic issue! A lot of women out there are not at all happy or satisfied with the pill or the IUD. Rather, many are actually miserable! But these discussions are not given proper attention and still remain very stigmatized. And while this article alone does not have the power to take apart and fix the system that has normalized women suffering in silence, I’m hoping it can help ease you into the vast and very personalized world of birth control and show you that there are many options out there for YOU. Hint: you shouldn’t have to accept the pain.
This guide is divided into two categories: hormonal and non-hormonal methods. There are advantages and disadvantages to both, so keep that in mind when deciding what method may be best suited for your body and lifestyle.
PSA: I am not a doctor and am not qualified to give formal medical advice. Consult with your doctor before choosing a method.
Hormonal:
The pill
- 93% effective on average (99% if used perfectly)
- Maintenance level: high
This is the method most people think of when they hear the term “birth control.” It’s true this method has been around for ages; the FDA approved it in 1960, and it is still to this day the most commonly prescribed form of contraception in the U.S. There are two types of pills available: progestin-only pills and combination pills (combined oral contraceptives). POPs contain only one hormone known as progestin and are considered slightly less effective than the combination pill. With the exception of Slynd, this type of pill must be taken within the same 3-hour time frame daily. COCs are the more common type and have two hormones: estrogen and progestin. Unlike POPs, Combination pills do not need to be taken at the same time daily.
Why you might love it:
- Worry-free sex. You and your partner don’t have to stop and worry when things get hot and heavy, given that you use it as prescribed.
- Other benefits. Preventing pregnancy may be your main goal, but the pill has other perks as well. You may notice reduced menstrual cramps and lighter, more regular periods (especially with COC), and if you struggle with acne, you may see improvements in that department as well.
- If at any point you DO want to get pregnant, all you gotta do is stop taking it. It’s that simple!
What you may want to consider:
- Effectiveness of preventing pregnancy depends on how stringent you are with its use. The pill must be taken daily in the same time frame as the day before. If you are forgetful this method may not be ideal for you!
- Negative side effects: spotting in between periods are common, as well as sore breasts, nausea and headaches. These symptoms commonly last two to three months since beginning the pill, but if they are severe or last longer, you may want to consider other options.
- Some women report weight gain, but it is largely due to fluid retention from receiving estrogen, not increased body fat percentage.
[Hormonal] Intrauterine Device (IUD)
- 99% effective
- Maintenance level: low
The intrauterine device, commonly referred to as an IUD, is a type of contraceptive known as long-acting reversible contraception (LARC). It is a T-shaped piece of plastic that is inserted into your uterus (not as scary as it sounds!) and requires a separate appointment with your gynecologist for insertion. There is both a hormonal and non-hormonal type of this method available. The brands that do contain hormones are Skyla, Liletta, Mirena and Kyleena, and the differences have to do with the level of levonorgestrel (a type of progesterone) released.
Why you might love it:
- After insertion, your job is done! Mirena and Skyla work for up to eight years, Kyleena works up to five years and Skyla works for up to three years. No matter whatbrand you decide to go with, there is no upkeep required. Out of sight, out of mind!
- Very effective. These bad boys are more than 99% effective at preventing pregnancy, which should give you at least a little bit of peace of mind!
- No user error. You can be forgetful with no consequences.
- You might have lighter periods (or stop getting them altogether) and have reduced menstrual cramps, which is a huge plus in many people’s books.
- It is a form of emergency contraception. If you get the Mirena or Liletta IUD inserted within five days of unprotected sex, there is a 99% effectiveness rate against pregnancy.
What you may want to consider:
- Your body has to get used to a foreign object like an IUD, so side effects are likely. Spotting and irregular periods are the most common and may last around three to six months as your body is adjusting.
- Pain during insertion varies, but it’s a valid concern. Some have told me it was only a mild pressure in their lower abdomen (similar to a really strong menstrual cramp), but my experience was a little more intense. Cramping after insertion can also be quite harsh for a couple days, so it’s a good idea to plan your appointment around your days off so you can properly rest.
- A small percentage of women have reported a reduced sex drive after receiving a hormonal IUD.
The Implant
- 99% effective
- Maintenance level: low
Similar to its sibling the IUD, the implant (also known as Nexplanon) is a low-maintenance LARC method that has an insertion process, but this one is in your arm instead of your uterus. It looks like a tiny plastic matchstick and is inserted under the skin of your upper arm.
Why you might love it:
- This is another extremely effective method at preventing pregnancy (99%, to be exact).
- Get-it-and-forget-it! The implant can last for up to five years.
- Since the implant only contains progestin, no estrogen, which makes it accessible to more people.
- Similar to the hormonal IUD, the progestin released by the implant can reduce cramps and lighten/stop your period.
- Insertion is reported to be considerably less painful, if at all, when comparing it to IUD insertion.
What you may want to consider:
- Many reported to have spotting in the first six to 12 months, as well as breast pain, headaches, nausea, acne and weight gain, but these are less common.
The shot
- 96% effective
- Maintenance level: medium
The birth control shot (also known as Depo-Provera) is an injection that contains the hormone progestin. In order for this method to be as effective as possible, you must get this shot every three months which totals to four times a year. It’s one of the less popular methods, but if you want a method that is less of a commitment, this may just be it!
Why you might love it:
- While it is generally less effective than the LARC methods (since user error is involved), it is still more effective than the pill.
- It won’t be on your mind when you’re with your partner. Similar to the pill, there is no interruption needed with this method.
- When there’s hormones involved, say bye to your pesky period. This method is also known to lighten periods, even completely stop them for 50% of users.
- The shot is known to help protect you from uterine cancer and ectopic pregnancy.
What you may want to consider:
- Side effects of the shot are most similar to those of the implant. Irregular periods and spotting within the first two to three months after your first shot is to be expected. Other reported symptoms include weight gain, headaches, nausea, sore breasts and depression.
- Consistency is key! Getting the shot every 12 to13 weeks is crucial in ensuring this method is effective. Being 2 weeks late is enough for your doctor to ask you to take a pregnancy test. Keep this in mind if you have a hard time making or keeping appointments.
- If you decide you are ready to get pregnant, it can take a little longer. It can take nine to 10 months to conceive after stopping receival of the shot.
The ring
- 93% effective
- Maintenance level: medium
The birth control ring seems intimidating to many, but it’s simple to use! The ring is a small, flexible ring that you insert inside your vagina once a month, and it does its thing by releasing… you guessed it…progestin and estrogen. There are two kinds available, NuvaRing and Annovera, and both require slightly different steps. The NuvaRing lasts for up to five weeks before you have to replace it with a new one. The Annovera lasts for an entire year, but must be taken out every three weeks (for seven days) before being put back in.
Why you might love it:
- When used right, again depending on what type of ring you have, this method is extremely effective at preventing pregnancy.
- Privacy please! No doctor appointments needed, you can take full control of your birth control in the privacy of your own home.
- It makes your periods regular, more predictable, and in some cases lighter.
- It can help prevent acne and ectopic pregnancy.
- If the time feels right and you decide you do want to get pregnant, all you have to do is take out the ring and pregnancy is possible almost immediately.
What you may want to consider:
- Scheduling is key! Having an app or writing down your changing days is something to consider here as the effectiveness of this method depends on whether you are using it correctly and timely.
- Side effects may include spotting, nausea, sore breasts and headaches. It is also not out of the ordinary to experience some vaginal wetness when using the ring.
- The rings contain estrogen, which is not for everyone, especially those with current or past medical conditions.
The Patch
- 93% effective
- Maintenance level: medium
The birth control patch is a sticky little patch that you can wear on your butt, belly, back or upper arm. Like the pill, it releases the hormones progestin and estrogen through your skin, so if you are afraid of the insertion process that comes with methods like the IUD or even the ring, you may enjoy the external aspect of the patch. There are currently two methods of the patch that are available: Xulane and Twirla.
Why you might love it:
- If used correctly, the patch is 99% effective at preventing pregnancy. (93% accounts for user error.)
- The patch may help in regulating your period, eliminating very heavy periods and easing your menstrual cramps.
- Privacy! Like the ring, you are in the driving seat of administering your birth control. No doctor appointments needed.
- You can get pregnant right after stopping use.
What you may want to consider:
- Some medications can make the patch less effective. This includes some antibiotics, some HIV medicines, and anti-seizure medicines. Read the full list here.
- There are potential side effects as with any hormonal method. This can include headaches, nausea, sore breasts, irregular periods, spotting, and specific to the patch, itchiness, dryness, and swelling on the area of the skin where the patch is placed.
- You have to be on top of your schedule. A new patch has to be placed every week on the same day, and on week four, you must be patchless. Follow the directions of whatever specific brand of patch you are using.
Non-hormonal:
A study conducted by OnePoll found that 69% of women between the ages of 18 and 50 were unaware that non-hormonal birth control options existed! A scary thought, so let’s get into it.
[Non-Hormonal] Intrauterine Device (IUD)
- 99% effective
- Maintenance level: low
As previously mentioned, the IUD has both hormonal options available as well as a non-hormonal option known as Paraguard. Instead of releasing progestin and estrogen, the Paraguard IUD is coiled in copper wire to essentially repel sperm. It does everything the other IUDs do, just hormone-free!
Why you might love it:
- IUDs are one of the most effective forms of contraception, and this goes for both the hormonal and non-hormonal varieties. Once inserted, it is 99% effective at preventing pregnancy.
- You’re protected for over a decade. (Yes, you read that correctly.) Paraguard is effective in your uterus for up to 12 years, making it the longest IUD method available.
- No maintenance required. Once you get past insertion (and possibly a couple of days of not so fun cramps) your job is done, and you can forget all about birth control for the next decade.
- Hormone-free. If you currently have or have dealt with any medical issues in the past, hormonal birth control may not be an ideal option for you. You also may just be a person who doesn’t like the idea of introducing more hormones into your body, which is totally valid! The copper IUD allows you to use an effective LARC method with the same peace of mind as its hormonal counterparts.
- It is also a form of emergency contraception. If you get the Paraguard inserted within 5 days of unprotected sex, there is a 99% effectiveness rate against pregnancy.
- If pregnancy is something you decide you’re ready for, all you gotta do is schedule an appointment with your doctor. Once your IUD is removed, you can get pregnant almost immediately.
What you may want to consider:
- While no hormones are involved, there are still side effects. Instead of lighter periods and reduced menstrual cramps, Paraguard is known for causing much heavier periods and more intense cramps. These symptoms may last anywhere between 3-6 months after insertion and should get better over time.
- Insertion might not be a walk in the park. Like the other IUDs, insertion may range from uncomfortable to painful and are usually accompanied with aching and cramps for a couple days after. This is all normal, but something to keep in mind.
Condom
- 87% effective
The condom. We all know and love it because not only does it protect from unwanted pregnancy, but it also prevents the transmission of STDs! Talk about killing two birds with one stone. There are many types of condoms available. Deciding on a type can be based on personal preference or the preferences of you and your partner. It’s important to note that every type of condom protects you from getting an STD except the lambskin condom. It is also very important to note that while condoms are a form of contraception, it is not the most effective method largely due to user error.
Why you might love it:
- Two-in-one! Condoms are extremely important for the practice of safe sex. While this article is not about STDs, it is important to note that condoms do not just act as a contraceptive but also prevent transmission of STDs (with the exception of lambskin condoms).
- No side effects! Besides irritation caused by latex or specific lube (which is rare), condoms are extremely safe to use.
- Cheap and convenient. Condoms don’t require a trip to the doctor or a prescription. Many health centers even offer them for free!
What you may want to consider:
- Mistakes can happen, especially in the heat of the moment. While condoms are 98% effective when used perfectly, “perfection” can be heard to achieve each and every time you and a partner engage in some mutual fun. In order to fall into the 98% effectiveness category, it’s important to be familiar with how to correctly use and dispose of a condom. Breakages can also occur, although infrequently. To account for these mishaps, most people like to double up on protection (using a condom with another method), but if you are planning on only using a condom, it’s important that you (and your partner) are well versed in the condom instruction manual.
- Must be used every time you have sex. This can interrupt fun time with your partner, but is the only way for this method to be effective.
Internal condom
- 79% effective
Also known as female condoms, these are little plastic pouches that are placed inside the vagina instead of going on the penis. They also offer STD protection and if used perfectly are 95% effective at preventing pregnancy.
Why you might love it:
- Two-in-one! Condoms are extremely important for the practice of safe sex. While this article is not about STD’s, it is important to note that condoms do not just act as a contraceptive but also prevent transmission of STD’s (with the exception of lambskin condoms.)
- Latex-free. Internal condoms are hypoallergenic and larger than male condoms, which has been said to make them more comfortable than male condoms.
- By wearing an internal condom, you can take control of your sexual health.
What you may want to consider:
- They’re not as effective as other types of birth control. With perfect use, internal condoms are 95% effective, but accounting for user error makes them closer to 79% effective.
- They can take some getting used to. Putting one on takes practice and may feel weird at first, but it is important to learn how to use one to maximize its effectiveness.
I hope this guide makes the vast world of birth control seem a little less intimidating. There are so many options out there, and it’s important to note that not all of them are covered in this guide. But the message I want to drive home is that birth control is not meant to make you suffer. There is a method out there that will make you feel your most comfortable and confident self every day. It’s okay if it takes a couple of tries.
~ Love Nessa
*Note – Unless otherwise stated, information sourced from: https://www.plannedparenthood.org/learn/birth-control