Prescription Birth Control Explained



There are many different types of birth control on the market, and it can be confusing to understand which is the right fit for you.. In this article I am going to review the pros and cons of each main type of prescription birth control.

Below lists the most common types of prescription birth control:

1. Combination low dose birth control pills

What:

This is the most common and most popular type of birth control I see in practice. You take one pill daily at the same time everyday. 

Hormones:

Estrogen and progestin

Pros:

  • Minimally invasive
  • Low chance of breakthrough bleeding (unless you are on the lowest of the low birth control)
  • Can help acne
  • Can prevent mood swings
  • You know when you are getting a period every month
  • Lighter and shorter period, or possibly no period if very low dose

Cons:

  • It must be taken daily
  • Not appropriate for those who can’t tolerate estrogen
  • Can cause spotting in between periods (more so on very low dose)

Recommendation:

I recommend this form of birth control for women who want shorter, lighter periods, and to also help control bad acne. This is the least invasive of the birth control methods and so is a great option for those who have never taken birth control pills.



2. Progestin only birth control (aka “mini-pill”)

What:

This is an oral birth control that is taken daily and must be taken at the same time everyday. 

Hormones:

Progestin only

Pros:

  • Option if you can’t take estrogen containing products (ex. history of breast cancer, blood disorder)
  • Can take while breastfeeding

Cons:

  • Higher chance of breakthrough bleeding
  • Need to take at exact time everyday

Recommendation:

I don’t necessarily recommend this unless there is a reason that you can’t take estrogen. I’ve had many complaints from patients about the breakthrough bleeding and having to take it at the exact same time everyday.



3. Patch

What:

This is bandaid like patch that you stick on your body (ex. butt or stomach) for three weeks, then take it off for a full week.

Hormones:

Estrogen and progestin

Pros:

  • You don’t have to remember to take a pill everyday
  • Cycle control, meaning you know when you are going to get a period

Cons:

  • Having to wear it on your skin
  • Possibility of more pronounced side effects such as weight gain

Recommendation:

This is a good option for women who forget to take a pill or don’t want to take a pill daily. I haven’t had too many patients who choose this option, but those who have it tend to not have many complaints. The number one complaint I’ve heard is weight gain with this type of birth control.



4. Vaginal ring

What:

This is a combination hormonal birth control ring that you insert in the vagina similar to the way you insert a tampon. It stays in the vagina for three weeks, then it is taken out for a week.

Hormones:

Estrogen and progestin.

Pros:

  • You don’t have to remember to take a pill everyday
  • Cycle control, you know when you will get a period

Cons:

  • Leaving a ring in your vagina
  • Possible for the ring to fall out

Recommendation:

I haven’t had too many patients who have used this type of birth control, but patients who I’ve had that used it liked it. The main reaction I get from patients when I discuss this form of birth control is that they don’t like the idea of having the ring in the vagina at all times (with the exception of the last week where it is not inserted).



5. Injectable

What:

This is a shot that is given to your every 90 days by your healthcare provider. It is typically only to be used for a couple of years due to possible bone mineral loss with extended use.

Hormones:

Progestin

Pros:

  • Option for those who can’t or don’t want to take estrogen
  • You don’t have to take a pill everyday
  • Decreases menstrual flow, or may stop menstrual flow

Cons:

  • You have to get a shot every three months
  • Might cause loss of bone mineral density
  • Possibility for greater side effects such as weight gain

Recommendation:

I haven’t had too many patients want this medication due to having to get a shot every three months and due to possible weight gain. That being said, the few patients I’ve had who did use this form of birth control liked that they didn’t have to worry about birth control for 3 months. 



6. Progestin IUD

What:

An IUD is a device that is inserted into the uterus, and remains there for several years. This type contains low dose progestin that is mostly released locally to the uterus to deliver its effects of preventing pregnancy.

Hormones:

Progestin 

Pros:

  • Low dose birth control
  • Good for women who can’t tolerate estrogen
  • Don’t have to worry about taking birth control for several years
  • Can have while breastfeeding

Cons:

  • Does not help control acne
  • Cramping with insertion, cramping may persist for several months
  • Possibility of spotting throughout the month

Recommendation:

This is my favorite form of birth control because it only contains low dose progestin, and most of this progestin acts locally in the uterus, with very little going into the blood stream. This is probably not a good option for women who want to take birth control to help with acne, I have had patients tell me that their acne came back or got worse when using this form of birth control.




7. Copper IUD

What:

The copper IUD is a device that is inserted into the uterus and can remain there for several years. It should be checked at least yearly for placement, other than that there is nothing that needs to be done.

Hormones:

100% hormone free, no hormones, only copper.

Pros:

  • No hormones, so if you are someone who can’t tolerate estrogen or progesterone this is the best option
  • You don’t have to worry about taking birth control for several years
  • Can used when breastfeeding

Cons:

  • Does not help with acne
  • Likely to have heavier and longer periods
  • Cramping with insertion, cramping may persist for several months
  • No cycle control

Recommendation:

This is my second favorite form of birth control because it does not contain any hormones, and because it can stay in for so long without you having to do anything. It is not my number one choice because of the heavier, longer periods which virtually every patient I’ve seen has reported as a side effect. Other than that, patients report really liking this form of birth control.



8. Implant

What:

A small device is surgically inserted into your arm and can stay there for 3 years. After 3 years it must be removed, but it can be replaced with a new device at the time it is removed.

Hormones:

Progestin

Pros:

  • You don’t have to take birth control daily
  • May cause shorter periods

Cons:

  • Must be surgically placed
  • Must be removed surgically after 3 years
  • Chance of the device traveling throughout the body
  • May have spotting 

Recommendation:

This is probably the last form of birth control I would recommend. Unless this is your only option, I don’t generally recommend this form of birth control, mostly due to the fact of how invasive it is and I’ve heard of several instances of the device traveling to different areas of the body and having to be retrieved with surgery. Another top complaint from patients about this device is that it seemed to be associated with weight gain, and did nothing to help acne or made acne worse.

Main take aways..

Above are the most common forms of reversible, prescription birth control that I see in practice. I listed the most common pros/cons of each from personal experience, but there may be other reasons a certain birth control may not be right for you. It always a good idea to have a thorough consult with your healthcare provider before choosing which form of birth control is good for you.

References

  1. https://health.cornell.edu/sites/health/files/pdf-library/MiniPills.pdf
  2. https://www.mayoclinic.org/tests-procedures/depo-provera/about/pac-20392204
  3. https://www.plannedparenthood.org/learn/birth-control/birth-control-patch
  4. https://www.mirena-us.com/about-mirena/
  5. https://www.paragard.com/
  6. https://www.nexplanon.com/what-is-nexplanon/




About the author: Sarah-Kate Rems is an Ivy-league trained Board-Certified Family Nurse Practitioner licensed in California with an expertise in women’s health and preventative healthcare. She considers nutrition and exercise to be the basis of well-being and is a strong advocate for daily physical activity and maintaining a healthy diet. Sarah-Kate is also a co-founder of The Mindful Tech Lab

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