birth control guide

The Contraception Guide

Information about contraception can make your head spin. There are so many kinds of birth control available today (yay!), and what works for one woman may not work for another. In my work with patients I’ve always advocated for an individualized review of risks and benefits so that each woman can choose the best form of birth control for her needs. This contraception guide will provide you with the info you need to have a more informed conversation with your doctor to get the best birth control for you. 

Your Guide to Contraception

My intention is that this contraception guide will help clear up some of the confusion, help you get informed, and help you have a more productive conversation with your doctor. In it you’ll find information like what contraceptives are available today, when you can start taking birth control, whether contraceptives are safe, and what exactly emergency contraception is. 

What are the different types of contraception?

Let’s jump right in with the most pressing question: What contraceptives are available today? Deciding what contraceptive method to use is a deeply personal choice, and it isn’t just about preference. 

Contraceptives aren’t all created equal, and while (for example) an IUD might work great for one woman, that doesn’t mean it’s great for all women across the board. It’s important to find the best contraception for YOU, the individual. 

Birth control was developed to prevent pregnancy. However, you’ve probably noticed that women are prescribed it for just about everything from acne to headaches to long periods and conditions like endometriosis and PCOS. I talk about alternatives to birth control for symptom management in Beyond the Pill. I encourage you to give it a read before jumping on birth control to manage symptoms.

You can also grab a free copy of my birth control guide to help you stay safe on or off of birth control.

With that said, let’s talk about the options available to you. Get ready, because this is a long list!

Hormonal and Non-Hormonal Contraceptives:

Use the list above to help you navigate the article. You can click on any of the above methods to go directly to that section of the article.

Hormonal Based Contraceptives

It’s important to understand that hormonal contraceptives deliver synthetic hormones to your system that impact every system and every cell of your body. Every cell of your body has receptors for these hormones and just like your natural hormones can elicit changes, so can these synthetic birth control hormones.

In addition, coming off of hormonal birth control of any kind can result in post-birth control syndrome, a collection of signs and symptoms that arise after discontinuing birth control. You can read more about post-birth control syndrome here.

The Birth Control Pill

Usually, when women and doctors say “the pill” they are referring to the combination pill, which contains estrogen (ethinyl estradiol) and progestin. It is important to note that there are two kinds of birth control pills—combination and progestin-only (also called the mini-pill). 

The hormones that are found in the pill are not identical to those your body makes. Progestin, the synthetic version of progesterone, is structurally different than the progesterone produced by the ovaries. It also doesn’t provide the same benefits that natural progesterone does for your mood, water retention, brain health, etc.

The conventional pill comes in packs of 28 pills with active and placebo (inactive) pills. Active pills contain hormones, and placebo pills do not. 

The number of active and inactive pills per pack depends on the brand. Some brands have 21 days of active pills, and seven days of placebos. Others have 24 days of active pills, and four placebos. Bleeding occurs during the placebo week. Note, this is not a period, this is a withdrawal bleed from a medication.

For women who want to skip their period all together, the continuous or extended cycle birth control is what is recommended. These pill packs have 84 active pills and 7 inactive. There are also pills out there with zero placebo and all active hormone in the pack. 

Monophasic vs Multiphasic

The combination birth control pill comes in monophasic and multiphasic dosages. 

  • Monophasic is the same dose of estrogen and progestin in each active pill.
  • Multiphasic pills have hormone doses that vary. 

How Does The Pill Work?

The pill essentially works by shutting down brain signaling to the ovaries, which prevents ovulation. There are other ways in which it can help prevent pregnancy, which I’ve written about here: How Do Birth Control Pills Work?

What Are Low Dose Birth Control Pills?

Low dose refers to pills that contain less than 50 micrograms of ethinyl estradiol, which is common among modern pills prescribed. It is important to understand that while the newer generations of pills have lower estrogen compared to the original formulations, it is still enough hormones to alter your brain hormones.

How Effective is The Pill?

With typical use (the way most women us it), the pill is about 91% effective at preventing pregnancy. With perfect use it is 99% effective, which I would guess is the stat you’re more likely familiar with.

There are a lot of pills to choose from and no evidence that different versions, including generic, are less effective at preventing pregnancy.

The pill does not protect against the transmission of sexually transmitted infections (STIs).  In fact, in two systematic reviews it was found that using the pill was positively correlated with chlamydia infection. The good news was that there appeared to be no association between pill use and the contraction of syphilis, herpes, trichomoniasis, and gonorrhea. Pelvic Inflammatory Disease (PID) also doesn’t seem to be higher in pill users.

There also appears to be a decreased risk of Bacterial Vaginosis (BV) while on the pill, but an increased risk of yeast vaginitis (yeast infection)

Can I Use The Birth Control Pill?

As I discuss in chapter 8 of Beyond the Pill, the following are considered “unacceptable health risks” and are a contraindication to starting the combination pill per the Centers for Disease Control and Prevention, as well as, The World Health Organization.

  • Age ≥35 years and smoking ≥15 cigarettes per day
  • Venous thromboembolism (blood clot in the vein)
  • History of stroke
  • Thrombogenic mutations (genetic variations like Factor V Leiden that lead to increase clot risk)
  • Ischemic heart disease (coronary heart disease)
  • Current breast cancer
  • Cirrhosis (liver disease)
  • Hepatocellular adenoma or malignant hepatoma (liver cancer)
  • Complicated valvular heart disease (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis)
  • Migraine with aura
  • Diabetes mellitus of >20 years duration or with nephropathy, retinopathy, or neuropathy
  • Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and hypertension)
  • Hypertension or commonly known as high blood pressure (systolic ≥160 mmHg or diastolic ≥100 mmHg)

According to the CDC and the WHO, the following conditions are ones in which the “risks do not outweigh the benefits” and therefore, the pill should not be used. 

  • Age ≥35 years and smoking <15 cigarettes per day
  • History of breast cancer
  • Gallbladder disease
  • High blood pressure (systolic 140-159 mmHg or diastolic 90-99 mmHg)
  • High blood pressure controlled with medications
  • History of blood clot
  • Inflammatory bowel disease
  • Malabsorptive bariatric surgery*

*This limits nutrient absorption and the pill is a highly nutrient depleting drug. Any condition where nutrient absorption is an issue can prove to be problematic while on birth control.

Benefits of Birth Control Pills

The pill has a high efficacy rate of pregnancy prevention. The following are other benefits associated with birth control pill use:

  • Decreases the amount of blood loss, which can reduce anemia
  • Decreased length of a bleed
  • Decreased pain with bleeding (dysmenorrhea)
  • Decreased risk of ovarian cancer
  • Decreased risk of endometrial cancer
  • Ability to stop having a period
  • Decreased acne outbreaks (in some women)
  • Decreased occurrence of ovarian cysts (some women experience an increase)
  • It can help in the management of endometriosis
  • It helps some women with menstrual migraines (some get worse)
  • You decide when you bleed
  • Suppresses androgens, which can be helpful symptom management in PCOS
  • Prevent unwanted hair growth 

Disadvantages of Birth Control Pills

I wrote a whole book on the pros and cons of all forms of hormonal birth control called Beyond the Pill. The intention of this book is to educate, empower, and help you stay safe if you choose birth control. It's important to note that some of these issues listed below also accompany other forms of hormonal birth control.

Here are some of the disadvantages I discuss that your doc may not have talked to you about:

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Did your doctor ask about your #guthealth before prescribing the pill? How about your family history of autoimmunity? These are two of many questions I ask women before prescribing the pill.⁠ ⁠ WHY?⁠ ⁠ Because we've now come to understand that the use of the pill for 5 years or more is associated with a 300% increased risk of crohn's disease if you have a family history.⁠ ⁠ There is also an increased risk in ulcerative colitis, but in those studies the women were also smokers so it isn't totally clear if this is JUST a pill thing because of that.⁠ ⁠ As I talk about in the Gut Check chapter of Beyond the Pill, one potential reason for this may be because the pill causes intestinal hyper permeability, what is more commonly known as leaky gut.⁠ ⁠ "Oral estrogen has been shown to modify intestinal permeability, a critical step in the pathophysiology of inflammatory bowel disease." PMID: 26658991⁠ ⁠ The pill also leads to nutrient deficiencies, which directly impact the gut.⁠ ⁠ Here's what I wrote in #BeyondthePill (yes, the following is straight out of my book):⁠ ✨ Use of the pill can lead to a zinc deficiency.⁠ ✨ Deficiencies in zinc are associated with an increase in gut permeability.⁠ ✨Zinc has been shown to be beneficial in healing intestinal permeability in patients with Crohn’s, an autoimmune condition that pill users are at increased risk for.⁠ ✨Signs of a zinc deficiency include thin, brittle nails that may have white spots, a tendency to get sick easily, and difficulty smelling or tasting.⁠ ✨Supplementing with zinc as part of a multivitamin or prenatal can help. Typical doses are about 15 to 30 milligrams daily, although doses as high as 75 milligrams have been used in studies to repair the intestines.⁠ ✨Doses of zinc above 40 milli- grams per day can increase proteins that prevent copper absorption and create a deficiency, causing anemia that is not responsive to iron and low neutrophils, a type of white blood cell.⁠ ⁠ If you've ever used birth control, please check out Beyond the Pill.⁠ ⁠ I also have an article on how birth control may be behind those gut issues (hello #sibo, yeast overgrowth, dysbiosis). LINK IN BIO @DRJOLENEBRIGHTEN Cont. 👇🏼

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Common Myths About Birth Control Pills

  • It regulates your cycle. Nope, it shuts down your reproductive system preventing your brain and ovaries from talking. This is a win if you don’t want to ovulate and don’t want a baby. 
  • It fixes your period. This is confusing because you bleed less and have less cramps so it feels like a fix…until you get off. While on the pill, you do not have a period. That’s the fix. It deleted your period. 
  • It will hurt my future fertility. Look, this is a valid concern to have and at the same time, we don’t have evidence to support the idea that it would keep you from getting pregnant in the future. There are other mechanisms at play that need to be considered that may impact your fertility, but the pill (at this time) has not been shown to directly cause infertility. 

Progestin-Only Pill (Mini-pill)

The mini-pill differs from combination birth control in two ways:

  • It contains progestin only (whereas combination pills contain progestin and estrogen)
  • Every pill is active (there are no placebo pills)

Typically, women are prescribed the mini-pill if an underlying medical condition makes taking estrogen dangerous (see list above). This is commonly used in postpartum women. Additionally, some women opt for the mini-pill to avoid some of the side effects associated with combination birth control pills. 

Because progestin-only oral contraceptives contain only progestin, it is advised to take them within the same 3 hour window every day. And while some women on combination pills choose to skip the placebo pills altogether, this is not an option for those on the mini-pill because all the pills are active pills (i.e. all 28 of them contain hormone).

With typical use, the mini-pill is around 91-99% effective at preventing pregnancy. Progestin-only pills do not protect against the transmission of STIs.

How Does The Mini-Pill Work?

Progestin is effective at thickening cervical fluid and preventing sperm from traveling to the potential egg. You can read more about how both combination pill and progestin only work in this article. 

It is really important that you understand that progestin is found in the majority of contraceptive methods, which means if you're experiencing issues from this hormone then you may also have issues with other forms of birth control.

Birth Control Implant (Implanon & Nexplanon)

The implant is a small rod inserted into the upper arm just under the skin that releases progestin. You will need to visit a medical practitioner to have the implant inserted…and removed. The removal part can be a big issue for some women whose insurance changes or doesn’t cover the procedure. 

You can watch Cat’s interview about having the implant placed, the side effects that followed and how she has struggled to get it removed.

By releasing progestin, the implant prevents ovulation, and thickens cervical mucus so that sperm cannot reach the eggs. Implants also have a long lifespan, lasting up to four years. 

Implants are 99% effective at preventing pregnancy. They do not protect against the transmission of STIs.

Implanon is no longer available in the US. Nexplanon is what is currently available.

Nexplanon and Implanon Side Effects

Local Side Effects

  • Bruising, pain, swelling where implant was inserted
  • Infection at the insertion site
  • Erythema or redness 

Systemic Side Effects

  • Headaches
  • Longer, shorter or missing periods
  • Changes in breast or breast pain
  • Weight gain
  • Acne
  • Emotional lability (exaggerated changes in mood)
  • Abdominal pain
  • Nausea

Birth Control Shot (Injection) Depo-Provera 

The birth control shot is administered every three months. It contains the hormone progestin, which helps prevent pregnancy. Unlike IUDs and implants, the shot can be taken at a clinic or at home. 

With typical use, the birth control shot is 94% effective at preventing pregnancy. The injection does not protect against the transmission of STIs.

Birth Control Shot Side Effects

  • Irregular bleeding, continuous bleeding
  • Headache
  • Weight gain
  • Mood changes
  • Dizziness
  • Bloating
  • Loss of libido (girl, this side effect can come with every one of the hormonal birth control options)
  • Bone loss

IUD (Intrauterine Device)

IUDs are small, T-shaped devices that are inserted into the uterus (by a medical practitioner—please do not try to insert it yourself!). There are two types of IUDs: hormonal and non-hormonal. 

Hormonal IUDs contain progestin, a synthetic version of progesterone. Read more about hormonal IUDs here. 

Copper IUDs do not contain any hormones. Read more about non-hormonal IUDs here.

One marked benefit of choosing IUDs is the fact that they last a long time. Progestin IUDs can last up to six years, and copper IUDs up to 12 years! Note, the copper IUD is FDA approved for 10 years, but research suggests it is effective up to 12 years.

IUDs are 99% effective at preventing pregnancy. They do not protect against the transmission of STIs.

IUD Types

  • Paragard (non-hormonal copper IUD)
  • Mirena
  • Kyleena
  • Skyla
  • Liletta

I know, all the hormonal ones have such cute names.

Birth Control Patch

The transdermal patch resembles a bandage, and is stuck to the belly, butt, upper arm, or back. Like the combination pill, it releases both estrogen and progestin. The patch must be changed weekly, and worn for three consecutive weeks. Then, a week must be taken off from the patch. Once the week is up, a new patch must be applied, and the cycle repeated. 

With typical use, the patch is 91% effective at preventing pregnancy. The patch does not protect against the transmission of STIs.

Birth Control Patch Side Effects

  • Clots, heart attack, stroke
  • Liver cancer
  • Gallbladder disease
  • High blood pressure
  • Abnormal bleeding
  • Breast pain or tenderness
  • Headaches, migraines
  • Abdominal pain
  • Uterine cramping
  • WEight gain
  • Skin irritation
  • Nausea and vomiting
  • Acne
  • Muscle spasms
  • Fatigue
  • Dizziness
  • Diarrhea and changes in digestion
  • Vaginal infections or changes in discharge
  • Fluid retention
  • Changes in mood

Birth Control Vaginal Ring (NuvaRing)

The vaginal ring is similar to the combination pill in that it contains estrogen and progestin. It is a small ring inserted into the vagina for three weeks, and then removed for a week. 

With typical use, vaginal rings are around 91% effective at preventing pregnancy. They do not protect against the transmission of STIs.

NuvaRing Side Effects

  • Vaginal irritation, itching, discharge
  • Vaginal infections
  • Headache
  • Nausea & vomiting
  • Stomach aches, abdominal cramps
  • Bloating
  • Fatigue
  • Dizziness
  • Breast pain, swelling tenderness
  • Weight gain
  • Changes in appetite
  • Anxiety, nervousness
  • Hair loss on head
  • Increased hair growth on body
  • Hyperpigmentation of skin (melasma)
  • Irregular bleeding
  • Loss of libido 

When To Contact Your Doctor After Starting Hormonal Birth Control

If you experience any of the following after beginning hormonal birth control, please contact your physician immediately:

  • Severe chest pain or feeling a heaviness in your chest
  • Sudden shortness of breath, coughing blood
  • Persistent lower leg pain
  • Sudden, severe headache 
  • Migraine with an aura
  • Sudden blindness (partial or complete)
  • Difficulty speaking
  • Numbness in any part of your body
  • Swelling of face, tongue, throat
  • Hives
  • Trouble swallowing
  • Severe pain in lower abdomen
  • Bloating or heaviness in lower abdomen 
  • Fatigue, changes in energy
  • Changes in mood
  • Difficult sleeping
  • Fever, night sweats
  • Yellowing of skin or eyes
  • Changes in bowel movements
  • Dark colored urine
  • New breast lump
  • Heavy or prolonged bleeding
  • Concerns that a contraceptive device may have shifted
side effect of birth control
Hormonal Birth Control Benefits and Side Effects

Non-Hormonal Contraceptives

I’ve written in detail about non-hormonal birth control in this article and invite you to visit it for a deeper dive into this topic. Please note that the non-hormonal IUD is included in the above discussion about IUDs.

Diaphragm

Diaphragms are non-hormonal silicone structures inserted into the vagina before vaginal intercourse. They have to be used in conjunction with a spermicide in order to prevent sperm from reaching an egg. 

With typical use, the diaphragm is 88% effective at preventing pregnancy. Diaphragms do not protect against the transmission of STIs.  

Sponge

The birth control sponge is a piece of plastic foam that must be inserted into the vagina prior to intercourse. The sponge is similar to the diaphragm in that it prevents sperm from entering the uterus. But while spermicide must be manually applied to a diaphragm, the sponge releases spermicide. 

With typical use, the sponge is 76% effective at preventing pregnancy—this is not a high percentage. Additionally, the sponge does not protect against the transmission of STIs.

Female Condom

A female condom is similar to a male condom, except it is inserted into the vagina before sex. It is also easier to obtain than other methods of birth control, because it is available at pharmacies. 

With typical use, female condoms are only 79% effective at preventing pregnancy. However, when used in the vagina (or anus), female condoms help protect against the transmission of STIs.

Condoms

A thin barrier of latex, lamb-skin, or synthetic fibers that is placed over an erect penis. With correct use, condoms are 98% effective; with typical use, it’s about 85% effective.

You can read more about condoms here.

Sterilization (Tubal Ligation)

A tubal ligation blocks off the fallopian tubes, thus preventing sperm from reaching any eggs. A ligation is typically performed on women who have already given birth, and are sure they do not want to have more children. 

Unfortunately, for women of childbearing age who have not had any children, a tubal ligation can be very difficult to come by—even if you are 100% certain that children are not in the cards for you. Often, visiting multiple doctors is required in order to find one willing to perform the procedure. I know it sounds crazy, because this decision should be ours and ours alone, but sadly, this is not the case.    

Tubal ligations are 99% effective at preventing pregnancy, and are a permanent option. However, a woman may decide to have the ligation reversed. A tubal ligation does not protect against the transmission of STIs.

Post-tubal ligation syndrome

Post-tubal ligation syndrome is a set of conditions that can develop following the tubal ligation procedure. Like, post-birth control syndrome, this condition is denied by many providers despite it being a documented phenomenon in the medical research

It appears that women who were on the birth control pill are more likely to experience PTLS, which begs the question if the symptoms are part of post-birth control syndrome or isolated to PTLS.

Long term Side Effects of Tubal Ligation (Post-Tubal Ligation Syndrome Symptoms):

  • Irregular or heavy periods (period problems)
  • Hot flashes, night sweats
  • Chronic fatigue
  • Join pain or sore muscles
  • Weight gain
  • Loss of libido 
  • Headaches
  • Pelvic pain
  • Memory loss, deficit
  • Anxiety
  • Mood swings
  • Difficult sleeping
  • Vaginal dryness
  • Increase in PMS symptoms
  • Early menopause

Fertility Awareness Method

The fertility awareness method is a completely natural, hormone-free alternative to conventional birth control. It involves tracking your menstrual cycle daily. By doing this, you can figure out at which point in the month you’re fertile, and avoid sex on those days. 

With perfect use, the fertility awareness method is about 95-99% effective. When used like the average person, that percentage drops to 76% to 88%. This method does not protect against the transmission of STIs.

Learn more about Fertility Awareness Method here.

Femtech Devices and Apps

These are digital devices that leverage mathematics for predicting fertility to help women avoid or plan for pregnancy. This non hormonal birth control is 93-98% effective.

Currently the FDA has approved Natural Cycles as a contraceptive device. Daysy fertility monitor works via the same technology

Essure (Coil)

Essure is a metal coil placed in the fallopian tubes. Following placement scar tissue forms around the coil, which blocks the egg from traveling through the fallopian tubes and reaching the uterus for implantation.

Since the introduction of the coil women began complaining of multiple side effects, including the metal traveling to other sites, which went largely ignored for years. It was only have sales substantially plummeted that Bayer decided to remove it from the US market. Yes, you read that right, the device wasn’t removed because it caused harm, but rather because of sales.

I do not recommend this method of contraception be considered by any woman.

Essure, like other Bayer contraceptives, comes with an FDA black box warning

hormone free birth control
Non-Hormonal Birth Control Options to Discuss with Your Doctor

How does emergency contraception differ?

Emergency contraception (also called the morning-after pill) is used to prevent pregnancy if you forget to use birth control, or if you think your chosen birth control may have failed, or if you have a whoops 🤷. 

Thank goodness we have Plan B. Because sex happens. Mistakes happen. Oh and don’t forget, judgement is a choice. 

They are so named because they are not used regularly to prevent pregnancy, like other forms of birth control (e.g. the pill or the patch). Instead, they are taken as more of a once-off, to ensure pregnancy does not occur. 

While emergency contraception is regarded as safe, it is better to choose another method of birth control, and to use that regularly and diligently instead. This will spare you a whole lot of stress. 

When should the emergency contraceptive pill be taken?

Emergency contraception can be used in a few situations:

  • You are not on birth control and had vaginal intercourse
  • You forgot to take your pill, get your shot, etc. 
  • You didn’t use a condom
  • You used the wrong lube with a condom
  • The condom broke or slipped off post-ejaculation (semen may have entered the vagina)
  • Your partner didn’t pull out on time
  • You thought you weren’t in your ovulatory window, but then signs of fertility were present
  • You were raped or forced to have unprotected sex

There are two emergency oral contraceptive options to choose from, a pill with ulipristal acetate or one with levonorgestrel. The former is effective for five days after unprotected sex, and its effectiveness does not diminish as the days pass. However, this pill requires a prescription. 

Ulipristal acetate, known more commonly as Ella, does require a prescription, but fortunately you can get a consult online and prescription sent within 24 hours. Whether you take it on day one or day five, this pill is just as effective. 

The pill with levonorgestrel should be taken within 72 hours of unprotected sex. The sooner it’s taken, the more effective it is. This emergency pill is available over the counter, so it’s much easier to come by. 

The levonorgestrel pill goes by PLan B, My Way, After Pill, and Take Action. When you pick this up over the counter, be sure to have a chat with the pharmacist about what to expect and ask any questions you may have. It can be super nerve wracking to go into a pharmacy and ask for this pill, so be sure to write down the questions you have ahead of time so you don’t forget. 

Emergency Contraception Side Effects

Unlike other hormonal contraceptives, the side effects of the morning after pill tend to be short-lived, lasting about a couple of days. 

  • Nausea or vomiting*
  • Dizziness
  • Headache
  • Breast tenderness, breast swelling
  • Irregular or heavy bleeding
  • Lower abdominal pain or cramps
  • Fatigue 

*If you vomit within 2 hours of taking it, please contact your licensed health care provider to ask if you should take a second dose

It should stop you from getting pregnant if taken as directed. However, it should not affect you from getting pregnant in the future. 

Copper IUD for Emergency Contraception

The copper IUD can also be used for emergency contraception. Having an IUD placed within 120 hours after unprotected sex or in other words, within 5 day is the most effective emergency contraception. 

When to start taking birth control

If you are sexually active, it’s a good idea to start using a form of birth control. This is the safest way to prevent an unplanned or unwanted pregnancy. 

Depending on the form of contraceptive you choose, your doctor may advise a specific time that is best to start.

I recommend all women track their menstrual cycle symptoms for 1-3 months and have baseline lab testing before beginning hormonal contraceptives. Continuing to track symptoms and having labs repeated in 6-8 months of starting birth control (sooner if you have symptoms) is an important step to understand your individualized response to this medical intervention. 

Which of the contraceptive methods is right for me?

Feeling a bit overwhelmed? I get it—this is a lot of information to take in. But it’s so important that women know what all their choices are before making a decision on what contraceptive method to choose. 

Use this information to have an educated discussion with your licensed health care provider about which method is best for you.

After all, depending on our health, lifestyle, personality, and preferences, what works well for one woman may not work for another. 

Your Personal Health History and Family History

Certain health conditions may exclude some women from taking the combination birth control pill. If you have a history of blood clots or unexplained vaginal bleeding, for example, it’s recommended that you avoid the pill. 

In addition, as I talk about in Beyond the Pill, a personal or family history of depression or anxiety may put you at greater risk of experiencing this side effect while using hormonal birth control. 

Lifestyle

Do you have a crazy busy schedule? Like 30 things on your to-do list at any given time? Or maybe a very unpredictable travel schedule. In that case, maybe a low maintenance contraceptive method, like an IUD, is worth considering. 

Personality

Are you the type of person with reminders for absolutely everything on your phone? Super organized? The pill or mini-pill would work well for you, because there is a smaller chance you’ll forget to take it every day. 

Scatterbrained? Maybe something that just needs to be taken care of weekly, monthly, or every few years would work best. 

Preference

Some women just hate taking pills. For others, the thought of inserting a contraption into the uterus can cause instant dizziness. It’s important to figure out which method you’re most comfortable with. 

Will taking contraceptive pills cause harm to my health?

While the pill is an effective means of preventing pregnancy, there are numerous side effects associated with it. In Beyond the Pill, I discuss how these side effects range from unpleasant to downright dangerous. It’s vital that you understand all the facts before making the decision to start taking the pill. 

Side effects associated with the pill include:

  • Hormonal imbalance (e.g. unusually light or heavy periods and short cycles)
  • Digestive problems, such as leaky gut and gut dysbiosis
  • Loss of energy (due to potential thyroid or adrenal dysfunction)
  • Hair loss
  • Dry skin
  • Depression and anxiety
  • Loss of libido
  • Vaginal dryness
  • Painful intercourse
  • Chronic infections
  • Nutrient depletion (e.g magnesium and folate)
  • Increased risk of blood clots
  • Increased risk of heart attack
  • Increased risk of stroke
  • Increased risk of certain cancers
  • Can trigger autoimmune disease (e.g. Crohn’s Disease)

Please see the list above on other hormonal birth control side effects. 

Contraceptive implant or injection – the facts

The birth control implant and injection are similar in a couple of ways: They both release progestin, and are effective for long periods of time. And since they only contain progestin, the implant and injection are good options for women who are unable to take birth control with estrogen (like the combo pill). 

For women looking for a long-term birth control solution, the implant may be the better choice. This is because while the injection works for about three months, the implant is effective for up to four years

However, like any hormonal birth control, both the implant and the injection come with side effects. 

Side effects of the contraceptive implant include:

  • Altered periods (periods may become irregular, or unusually short, light, or heavy)
  • Acne
  • Nausea
  • Headache
  • Tender breasts

Side effects of the birth control shot include:

  • Altered periods (periods may become irregular, or unusually short, light, or heavy)
  • Weight gain
  • Thinning bones (this appears to resolve itself once the injection is stopped)
  • Tender breasts
  • Headache
  • Acne
  • Mood changes
  • Libido changes

Choosing between copper IUD and hormonal IUD

Both prevent pregnancy, so if that is your main objective, then you may want to opt for the copper IUD. There are benefits to using progestin based IUDs, but there are also natural remedies that can be used as well. It’s all about what is best for you!

Reasons to choose the Paragard copper IUD

  • If you want to avoid the use of synthetic hormones
  • You want to maintain your natural monthly menstrual cycle 
  • You would like long term birth control
  • You’re in need of emergency contraception

Reasons to choose the progestin hormonal IUD

  • Reduce or eliminate your monthly flow
  • Prevent anemia that is due to heavy menstrual bleeding
  • Reduce period pain (aka dysmenorrhea)

What about natural contraception methods, and how safe are they?

Quite a few natural fertility awareness methods (FAMs) exist, and their effectiveness depends largely on how diligent you are with tracking your cycle.

Examples of fertility awareness methods include:

  • Symptothermal method: Track cervical secretions and basal body temperature to determine on which days of the month intercourse should be avoided. First year pregnancy rate of 1.8% with proper use. 
  • Standard days method: Do not have sex from Day 8 to Day 19 of your cycle. This study of 500 women showed that the pregnancy rate was <5 per 100 with correct use. 
  • Cervical mucus/ovulation method: Evaluate cervical mucus several times daily to figure out when you’re fertile. With correct use, 3% of women typically become pregnant. Note that this method has a pretty high failure rate with typical use. 
  • TwoDay method: Avoid sex when any cervical mucus is present. When used correctly, this method has a 3.5% pregnancy rate

Of course, the greatest risk with any of these methods is pregnancy. They all require different time commitments, but one thing FAMs have in common is that they require you to be in tune with your body, rather than taking a backseat to your fertility. With that being said, FAMs work wonderfully when used correctly. The low pregnancy rates associated with each one is testament to that. 

The other big risk with natural contraceptive methods is that there is no protection against STIs. Ladies, be careful and be smart. If you are having sex with a new partner, or just generally want to be on the safe side, wear a condom, or ask your partner to wear one. 

If you're considering FAM, I encourage you to meet with a FAM educator.

What methods are available to men?

There are currently only two contraceptive options available to men, condoms and vasectomies. You can read up about what happened to the male birth control trial here.

Condoms cover the penis, so when a man ejaculates, his semen is caught in the condom. It therefore does not enter the woman’s body. Male condoms also provide protection against STIs. 

A vasectomy is sort of the male equivalent of a tubal ligation. A man will typically only get a vasectomy if he is sure he doesn’t want more/any children. 

Men have fewer hoops for them to jump through if they want a vasectomy compared to women seeking tubal ligation. Regardless of their age or whether or not they are already a parent, this procedure is available. 

A vasectomy involves the cutting and sealing of the vas deferens (the tube responsible for transporting sperm to the urethra). Vasectomies are a very effective form of birth control. They are also reversible. 

What Next?

Remember, I am a doctor, but I’m not your doctor. Take this info with you to your next doctor’s visit to ensure you get the best birth control for you! Birth control is so individualized that it is best to meet one-on-one with a doc who can guide you in your decision. 

If you’re considering using birth control for symptom management, I want to encourage you to grab a copy of Beyond the Pill, where I teach you about your hormones and how to balance them naturally. 

You can also grab a free copy of my birth control guide here, which will also provide you with nutrition information to support your hormones on or off of birth control. 

I’d love to hear from you! What’s your experience with birth control been?

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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is one of the leading experts in women’s medicine and is a pioneer in her exploration of the far-reaching impact of hormonal birth control and the little known side effects that impact health in a large way. In her best selling book, Beyond the Pill, she shares her clinical protocols aimed at supporting women struggling with symptoms of hormone imbalance, including Post-Birth Control Pill Syndrome and birth control related side effects. A trained nutritional biochemist and Naturopathic Physician, Dr. Brighten is the founder and Clinic Director at Rubus Health, an integrative women’s medicine clinic. She is a member of the MindBodyGreen Collective and has been featured in prominent media outlets such as Forbes, Cosmopolitan, ABC news, and the New York Post. Read more about me here.