Which Method of Birth Control is Right for You?

Deciding on a method of birth control can be complicated. There are many options, and everyone you talk to seems to have an opinion about the best—and worst—choices.

The truth is that no contraceptive method is perfect for everyone, but with such a variety of choices out there, you can find one that works for you. Here’s a rundown of the most popular birth control methods, how they work, and who they’re best for.

• How it works
  Most birth control pills are known as combined oral contraceptives because they contain a combination of two hormones—estrogen and progestin. These hormones mainly prevent pregnancy by preventing ovulation, which is the release of an egg from one of the ovaries. The Pill also thickens cervical mucus, which makes it harder for sperm to enter the uterus. There is also a progestin-only birth control pill, known as the “mini pill.”
   
• What you need to know
  One of the reasons that birth control pills are so popular is that they have many other health benefits beyond contraception. For instance, studies show that taking The Pill can lower your risk of ovarian cysts and ovarian cancer. Plus, some women take The Pill to help regulate their heavy or irregular periods or to treat their acne.
  
  There are different formulations of birth control pills so it can sometimes take some trial and error to land on the right one for you. You might find that a certain one causes some spotting between periods, or that your emotions feel out of whack and you’re crying more or feel depressed. Sometimes, The Pill can make you feel nauseated. Usually, by switching you to a different formulation, we can eliminate these side effects.
  
  If you’re postpartum and breastfeeding and want to take The Pill, the best option is the mini pill, which contains only progestin. That’s because the estrogen in the other birth control pills can decrease your milk production. The Pill is not recommended if you smoke, or if you have a history of clotting problems, such as deep vein thrombosis or a pulmonary embolism. It’s also not a good choice for women who have high blood pressure or chronic migraines. Taking The Pill if you have any of these conditions can increase your risk for stroke.
  
  The effectiveness of The Pill is based on taking it every day at roughly the same time. So if you’re the kind of person who doesn’t always remember to take your vitamins every day, The Pill is definitely not for you.

• How it works
  Depo-Provera is an injection of progesterone in your arm or buttock that lasts for three months. The progesterone in the injection prevents pregnancy by stopping ovulation, thickening cervical mucus, and thinning the lining of the uterus.
   
• What you need to know
  Depo-Provera is another good option if you don’t want to have to remember to take a pill every day. Because it doesn’t contain estrogen, it’s also ideal for women who are postpartum and breastfeeding, since it won’t interfere with milk production.
  
  Unlike the IUD and the implant, fertility doesn’t necessarily quickly return once you stop getting the Depo-Provera injections. For some women, it can take up to a year to get pregnant. For that reason, I don’t recommend it for women who think they want to try to get pregnant in the next six to nine months.

• How it works
  The NuvaRing is a flexible plastic ring that you insert in your upper vagina. The ring continuously releases estrogen and progestin into your bloodstream to prevent ovulation and also thickens the cervical mucus to make it less permeable to penetration by sperm. You keep the ring in place for 21 days and then remove it for 7 days, which is when you get your period. Then you insert a new ring.
   
• What you need to know
  If you want a method of birth control that doesn’t require you to take a pill every day, but you’re not interested in using an IUD or another long-acting method, this is an ideal solution. It’s easy for you to insert yourself and it sits so high up in your vagina that you won’t feel it. Because the formulation of hormones is similar to The Pill, it will make your periods lighter and less painful. But you might also experience similar side effects to those of The Pill, including mood symptoms and risk of deep venous thrombosis. If you are a smoker or have a clotting disorder, the NuvaRing is not the right option for you.

• How it works
  Ortho Evra is a highly effective form of estrogen-progestin contraception. It works the same way as The Pill and the vaginal ring—inhibiting ovulation, changing cervical mucus to make it less permeable for sperm, and thinning the endometrial lining to make it less favorable for implantation.
   
• What you need to know
  The patch is simple to use—you wear it on the skin of your arm, belly, back or buttock for three weeks, remove it for one week (at which time you will menstruate) and then replace it with a new one. The patch is not available in a “very low dose of estrogen” as is The Pill, and this method is contraindicated in women with clotting disorders, smokers, and people with abnormal liver function.

• How it works
  Barrier methods of birth control act as barriers to keep sperm from reaching an egg. Some methods (condoms, sponges and spermicides) can be purchased over the counter, while others (diaphragm and cervical cap) must be prescribed by a healthcare professional.
   
• What you need to know
  Barrier methods are actually the least effective form of birth control, and that’s mainly because of what’s known as user efficacy. In order for a barrier method to work correctly, you need to use it correctly each and every time you have sex. For this reason, I don’t usually recommend barrier methods to my patients.
  
  However, while condoms aren’t as effective as other methods at preventing pregnancy, they are very effective at protecting you from sexually transmitted diseases (STDs). None of the other methods can do that. If you’re worried about getting an STD, using a condom every time you have intercourse will help lower your risk.

Dr. Gianni Rodriguez Ayala is a board-certified OB/GYN and assistant professor at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

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