Scheel, 37, started on a birth control pill called Ortho Tri-Cyclen at age 15 in hopes of lessening her severe period cramps, but then she gained weight and her periods stopped completely. When she was 21, her cramps came back, so she switched to Depo-Provera, an injection. At 32, her doctor put her on Jolessa, another pill, but it didn’t alleviate her painful cramps at all, so after about a year, she switched back to Depo-Provera.
Scheel’s story is not unusual. Many women are often prescribed several different types of birth control before they find one that addresses the symptoms they need it to, while causing as few side effects as possible.
Other women, concerned about side effects, may forgo hormonal contraception and opt for nonhormonal options like copper intrauterine devices or condoms. Here’s what you need to know when choosing your method of contraception.
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“The Pill”
The phrase “the pill” usually refers to hormonal birth control, which often comes in the form of a daily pill you swallow, but there are other ways to get the same drug. You can use options such as
- Daily pills (you swallow)
- Vaginal ring
- Patch
- Injections
There are two types of birth control pills: the combined oral contraceptive pill, which contains estradiol and progestin and the progestin-only pill. Most birth control pills contain both hormones.
Progestin-only pills may be safer for women who are at risk of cardiovascular disease or who have a history of blood clots. They may cause unpredictable breakthrough bleeding.
Currently, all birth control pills require a prescription, but one brand of progestin-only pill, the Opill, which has been used for 50 years, may become available over the counter in the second half of 2023.
The combination of estrogen and progestin prevents you from ovulating or releasing an egg. Both the combination and progestin alone thicken your cervical mucus and thin the lining of your uterine wall, which work to reduce the likelihood that a sperm will enter the cervix and implant on the cervical wall.
For some women, birth control pills they may be used to treat symptoms such as acne, irregular bleeding or painful periods. For those with conditions like polycystic ovary syndrome (PCOS), they can help regulate bleeding and reduce your risk of endometrial cancer.
If used perfectly, the pill is thought to be about 99% effective. However, based on real life usage (some people may miss taking a pill, for example or not take them at the exact same time every day) nine out of every 100 women who use either progestin-only pills or those with both estrogen or progestin get pregnant each year.
Progestin is also available as a shot you get every three months, called Depo-provera. Out of 100 women who use this shot each year, six get pregnant.
Read more about the side effects of birth control pills.
Is Weight Gain a Side Effect of Birth Control Pills?
Cells in many parts of your body—even your skin—respond to the hormones that birth control medications contain, so there can be a wide range of different side effects.
The injection, often called the Depo shot, has been shown to make about 25% of women who take it gain weight, but large studies haven’t found consistent evidence that most other forms of hormonal birth control lead to users putting on pounds. Still, birth control affects everyone differently and many women who use contraceptives do report gaining weight.
Some Birth Control Stops Periods
Some brands of birth control will allow you to skip your period for up to a year at a time, though you may experience occasional spotting or unpredictable breakthrough bleeding.
If you take daily pills, most packs come with three weeks’ worth of pills that contain hormones and one week of placebo pills. During the placebo week, you’ll get your period. Some women choose to skip this week to prevent their periods.
Read more about hormonal birth control pills.
Long-Acting Hormonal Birth Control
Rather than take a pill every day, some women opt for long acting hormonal birth control methods, which include small devices implanted in the uterus or under the skin of the arm. These devices release the hormone progestin (which is similar to progesterone, a hormone you make naturally). Like birth control pills, they prevent pregnancy by blocking the release of eggs from your ovaries and by thickening the mucus in your cervix, making it difficult for sperm to implant.
Fewer than 1% of women using long-acting hormonal birth control get pregnant, but if you do, you need to see your doctor right away. You have a heightened risk of experiencing an ectopic pregnancy. Other side effects include breakthrough bleeding, headaches, acne, and more. Many women report cramping and abdominal pain during insertion and removal, both of which must be done by a doctor in an office setting.
Read more about long-acting reversible contraceptives.
Non-Hormonal Birth Control
For women who don’t want to take hormones or who have experienced side effects when doing so, there are several non-hormonal options. Bear in mind, however, that these also can come with side effects.
Phexxi Gel
Phexxi is a gel that you apply using a tampon-like applicator up to an hour before sex. The gel lowers the pH of your vagina, making it difficult for sperm to thrive. On its own, the gel is 86% to 93% effective, but it can also be used with other birth control methods like condoms and oral contraceptives.
Spermicide
Spermicide is a gel similar to Phexxi that you apply to your vagina using your finger or an applicator before sex. The gel prevents sperm from finding and fertilizing an egg. Out of every 100 women who use spermicide without barrier methods, 28 get pregnant each year. Using spermicide alongside a diaphragm or condom reduces that number to 12-23 women.
Copper IUDs
Copper IUDs are a type of long-acting reversible birth control. A healthcare provider will insert it into your uterus, where it stops sperm from being able to swim to an egg. Side effects include heavy and painful periods, though they typically become less problematic after three to six months. When you no longer want to use the IUD, you’ll need your healthcare provider to remove it. Less than 1% of women who use copper IUDs get pregnant each year.
Condoms and Other Barrier Methods
Condoms, diaphragms, and birth control sponges create physical barriers that prevent sperm from coming in contact with an egg. According to the American College of Obstetricians and Gynecologists (ACOG), barrier methods of birth control are not quite as effective as other strategies. Out of every 100 women who use barrier methods regularly, 18 to 28 will become pregnant each year.
Read more about non-hormonal birth control methods.
Cycle Tracking
You can also use cycle-tracking apps to predict the days on which you’re most and least likely to conceive and plan accordingly. There are other methods of tracking your cycle as well, including tracking the consistency of your cervical mucus each day or by taking your temperature each day. Twenty-four out of every 100 women who use these methods to prevent pregnancy get pregnant each year. Two out of three couples who use them in hopes of getting pregnant (without fertility problems) are able to conceive, according to the American Academy of Family Physicians.
Surgery
Of course, for those who know they never want kids, or have finished having them, there are surgical options. Men can get vasectomies (more than 99% effective), and women can get tubal ligations (2.64% of women still got pregnant within a year of the procedure). Women will still menstruate and men will still ejaculate after these procedures but no eggs or sperm will be released.
Emergency Contraception or Plan B
Emergency contraception is a pill you can take after having unprotected sex or if you suspect your usual contraption may not have worked (for example if your condom broke). There are two types: levonorgestrel, approved by the FDA in 1999, sold under a variety of brand names including Plan B One-Step, which can be taken immediately after intercourse and up to 72 hours after; and ella (ulipristal acetate), which requires a prescription because its manufacturer didn’t apply for over-the-counter (OTC) status. It can be taken up to five days after unprotected sex. They both work by preventing ovulation or preventing sperm from fertilizing an egg. As of February 2023, Plan B is available in all 50 states.
Side effects of emergency contraception include nausea, cramps, and irregular bleeding.
Read more about the morning after pill.
How Effective Is Plan B?
If you use emergency contraceptives within five days of having had intercourse, they can prevent up to 95% of pregnancies, according to the World Health Organization.
Medication Abortion: Mifeprex and Misoprostol
Medication abortion requires two pills. The first blocks progesterone, a hormone required for the fetus to develop, and the second empties your uterus. After taking the second pill, you’ll likely experience symptoms like you’re having a heavy, crampy period. In fact, if you don’t, you should see your healthcare provider because you may still be pregnant. You may also experience side effects such as headaches and diarrhea.
Read more about the side effects of medication abortion.
Regulations on both medication abortion and dilation and curettage abortion procedures vary from state to state. Federal courts have made rulings that could ban one or both of these pills.
