We’ve all been that person sitting in our OBGYN’s office and handed a 3-fold pamphlet that gives us endless birth control pill options to choose from — none of which have descriptions that make it any easier for us to know which one is right for our body.
Often we rely on friends, family, or Dr. Google to point us in the right direction, which can be helpful, but at the end of the day, everyone’s body and personal preferences are so different. The decision can be overwhelming, to say the least.
Aside from the birth control pill, there are dozens of other birth control methods such as IUDs, barrier methods like condoms and cervical caps, natural methods like fertility awareness via basal body temperature, and more.
The pill, however, is one of the most common forms of birth control in the United States given its convenience, efficacy, non-invasive nature, and flexibility of options. According to the Guttmacher Institute, of the 62% of women who use contraception, 26% use the pill.
How does the birth control pill work?
All birth control pills use synthetic versions of naturally occurring hormones, like estrogen and progestin, to prevent pregnancy. You have to take them consistently and at the same time daily for them to be fully effective.
They work by inhibiting the release of eggs from your ovaries (aka, shutting down ovulation), making your cervical mucus thicker so it's more difficult for sperm to pass through, and thinning out the lining of your uterus so it’s less receptive to the implantation of a fertilized egg.
Progestin alone can accomplish all three, but it doesn’t fully stop ovulation. Adding estrogen to the mix makes it more effective by fully shutting ovulation down.
Depending on your genetics, current health, and medical history, taking oral estrogen can be a risk factor, which is why it’s essential to always discuss these topics with your doctor before making a final decision.
How do I know which birth control pill is right for me?
The key to knowing which birth control pill is right for you is carving out time to reflect on your age, current health conditions, familial and personal health history, and lifestyle needs with a physician, as well as weighing the pros and cons of each.
Birth control tests like this one that tests your hormone levels and DNA can help you find the right birth control for your body’s biology so you can skip the potential trial and error process.
All in all, the best birth control pill for you is the one that’s most effective with the least amount of risk based on your medical history and current state of health.
Below, we’ll break down the different kinds of birth control pills, so you can be aware of your options before heading to the doctor's office.
Combination birth control pills
Combination pills are the most commonly prescribed birth control pills and contain both estrogen and progestin. The conventional combination pill follows a standard dosing schedule and includes 21 days of active pills (hormones) and 7 days of inactive pills (no hormones), in which you bleed during the week of inactive pills.
Pros of conventional combination pills:
Generally, combination pills can be a great choice if you have severe PMS, painful cramping, heavy bleeding, or are looking to take birth control for acne purposes or endometriosis relief.
So, if you’re taking birth control for reasons beyond pregnancy prevention, they can definitely be the way to go.
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Cons of conventional combination pills:
The only downside of conventional combination birth control pills is the potential side effects that can come with them. These may (or may not) include:
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Nausea
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Bloating
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Headaches
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Spotting or bleeding between periods
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Mood changes
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Loss of libido
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Breast tenderness
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Risk of blood clotting, heart attack, or stroke if you’re a smoker, have a history of high blood pressure, hypertension, cardiovascular disease, diabetes, or other chronic health ailments
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Can worsen symptoms of migraine or trigger them
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It can’t be used at the same time as certain medications and supplements
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It can’t be used while breastfeeding
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Potential weight gain
Monophasic combination pills vs. Multiphasic combination pills
Combination pills in the United States are typically broken down into two distinctions: Monophasic combination pills and Multiphasic combination pills. This has to do with how much estrogen and progestin are included in each active pill.
Monophasic combination pills have the same amount of estrogen and progestin in each active pill. Not only are these more straightforward and easy to use, but the benefits may also include consistent hormone levels, regular menstrual cycles, fewer hormonal fluctuations and side effects, and clearer cycle control if you want to skip or delay a period. The only potential downside is, since they provide the same hormone levels throughout your cycle, they may not be as suitable for people with specific hormone-related concerns or symptoms.
Multiphasic combination pills, on the other hand, have different ratios of estrogen and progestin in each active pill, which mimic the hormonal fluctuations in the natural menstrual cycle. This can potentially reduce side effects such as spotting or mood swings, as well as offer more tailored symptom management when it comes to things like PMS or cramps. One con here is that multiphasic combination pills are less commonly offered, more complicated to use, and there is less scheduling flexibility, since missing or taking the pills out of order can affect their efficacy.
Common conventional combination pill brand names include:
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Monophasic (many of which are low-dose options as well): Apri, Aranelle, Balziva, Estrostep Fe, Kariva, Reclipsen, Solia, Yasmin, Yaz, Ocella, Estarylla, Previfem, Sprintec
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Multiphasic: Azurette, Mircette, Caziant, Enpresse, TriNessa, Velivet, Cyclessa, Aranelle, Tri-Norinyl, Leena, Kariva, Viorele
Extended-cycle pills
Also called continuous birth control, extended-cycle pills contain fewer inactive (no hormone) tablets in a pack.
For example, some 3-month continuous birth control packs contain 84 active pills and 7 inactive pills so you only get your period 4 times a year. Other continuous birth control packs have no inactive tablets, meaning you don’t get your period at all.
Pros of extended-cycle pills:
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Reduced frequency of periods
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It can help alleviate cramps, bloating, and heavy bleeding
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More stable hormone levels, which can help prevent mood swings due to hormonal fluctuations
Cons of extended-cycle pills:
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Breakthrough bleeding/spotting
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Delayed return of fertility and consistent menstrual cycles
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Potential side effects of conventional combination pills such as breast tenderness, headaches, nausea, mood changes, or decreased libido
Common extended-cycle pill brand names include: Lybrel, Jolessa, Seasonale, Seasonique, Quasense, Introvale
Low-dose birth control pills
Also known as low-dose combination pills, these contain lower levels of estrogen compared to traditional combination pills. They typically contain 20-25 mcg of estrogen compared to 50 mcg (or more) of estrogen in traditional combination pills. They also contain progestin but in the same quantity as traditional combination pills.
Some low-dose options are also offered as extended-cycle so you have fewer or no periods in a year.
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Pros of low-dose pills:
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They’re still equally as effective in preventing pregnancy, while potentially reducing the risk of certain side effects associated with higher doses of estrogen-like headaches, nausea, blood clots, or cardiovascular complications
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They’re great for people who are sensitive to estrogen in general
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You don’t have to take it at exactly the same time every day like the progestin-only mini pill for it to be fully effective, as it allows for a slightly longer dosage window
Cons of low-dose pills:
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They may not provide the same level of cycle control or symptom relief from things like PMS and heavy periods as regular-dose pills
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You still may experience some of the tradeoffs from traditional combination pills like mood changes, low libido, nausea, or breast tenderness
Common low-dose pill brand names include: Apri, Aviane, Levora, Levlen-21, Ortho-Novum, Lo/Ovral, Yasmin, Yaz, Mircette, Alesse
Progestin-only birth control pills
Also known as the mini-pill, these only contain progestin, which is a synthesized version of the naturally occurring hormone, progesterone. Unlike combination and extended-cycle pills, they don’t contain any estrogen.
Pros of progestin-only pills:
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Safer option if you have a prior history of chronic health issues such as diabetes, high blood pressure or cholesterol, cardiovascular issues, etc.
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A better option for those who are sensitive to estrogen
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Shorter return to regular menstrual cycles once you stop
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Can be used during breastfeeding
Cons of progestin-only pills:
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They must be taken at the same exact time daily to be maximally effective (even delaying them by a few hours can decrease their effectiveness)
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Slightly higher failure rate than the combination pill
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They don’t provide non-contraceptive benefits like acne reduction or PMS relief
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Breakthrough bleeding/spotting
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Fatigue
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Headaches
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Ovarian cysts
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Decreased libido
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Potential drug and supplement interactions that make it less effective
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Potential weight gain
Common progestin-only pill brand names include: Camila, Errin, Heather, Jencycla, Jolivette, Micronor, Norethindrone, Nor-QD, Nora-BE, Norlyda, Ortho-Micronor, Ovrette, Provera
Questions to ask your doctor before deciding on a birth control pill
It’s essential to have an open conversation with your healthcare provider when deciding which birth control pill is right for you, especially to be sure there aren’t any drug interactions or risk factors involved. Consider these questions ahead of time and make sure they’re brought into discussion with your physician before landing on a firm conclusion:
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Do I have any existing health conditions, specifically any that would put me at risk when consuming oral estrogen?
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Am I experiencing anything new with my health right now? How might my age play a role in landing a tailored option?
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Which medications and supplements am I currently taking?
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Have I gotten a DNA and, or hormone test to inform how my body may best respond to this type of medication?
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What’s my current lifestyle like and what are my general preferences around convenience?
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Am I looking to take the pill for reasons beyond pregnancy prevention like acne, PMS, or heavy period relief?
It's also worth noting that birth control pills don't protect against sexually transmitted infections (STIs), so using condoms alongside the pill is a good idea if you're not in a monogamous relationship. Remember, knowledge is power when it comes to your body; use it wisely!
Caroline McMorrow is a Content Strategist at Rescripted.
