What birth control method is best? A look at hormone and hormone-free, plus risks and benefits

Published February 15, 2022

Published

illustration of a woman considering birth control options

Choosing a birth control method is an important, personal decision. With so many options, it can be confusing to know what's best for your health and lifestyle. What you choose at this point in your life may be different than what you need later on. 

Because different types work in different ways, having an open conversation with your doctor will help you make an informed decision with your health in mind. To help bring some clarity, here's an overview of hormonal and nonhormonal birth control methods, their risks and benefits.

Hormonal birth control methods

Combination pill

Birth control pills are not all the same. Their formulas and composition vary. The combination pill contains an estrogen and progestin combo. When used as directed, pills are about 99% effective.

Progestin only minipill

The minipill has progesterone only and can be a good option for women who can't take estrogen, like women with a history of deep vein thrombosis (DVT) or those who are breastfeeding. Used as directed, the minipill is 99% effective.

Patches

The transdermal contraceptive patch releases combination hormones, is over 99% effective and works the same way as birth control pills. The patch is replaced once a week and worn for three weeks, with no patch on the fourth week. 

Progesterone intrauterine device (IUD)

Once placed in the uterus by a doctor, an IUD provides long-lasting birth control. Mirena® is one IUD option that is approved for preventing pregnancy up to seven years. It also treats heavy periods for up to five years. Over 99% effective, it can be removed by your doctor anytime. Some women who don't qualify for use of birth control pills or injection may qualify for an IUD.

Vaginal ring

Also known as the NuvaRing®, the vaginal ring is a hormone combination like the combo pill. It's worn for three weeks and replaced every fourth week. There are monthly and yearly options available. The ring is 96% to 99% effective when used correctly.

Progestin injection

Also known as Depo-Provera®, the injection releases progestin into the buttocks or arm and is 96% effective. Shots must be taken every 12 weeks to remain fully protected.

Implant

Also known as Nexplanon®, the implant releases progestin. It is a single, thin rod inserted under the skin of the upper arm. Implants are 99.95% effective and must be replaced every three years.

Risks and benefits of hormonal birth control methods

Benefits include:

  • Pregnancy prevention if taken as directed, without intercourse interruption
  • Some relief of period pain, heavy periods and menstrual headaches
  • Fewer skin breakouts and mood changes 
  • A decrease of circulating testosterone in women with polycystic ovarian syndrome (PCOS) when taking a combo hormonal pill
  • More flexibility with combo hormonal methods to manipulate the time of your period and perhaps skipping a period

Risks include:

  • No protection against sexually transmitted infections (STDs) or HIV
  • May be affected by certain medicines
  • May delay the return of normal menstrual cycles
  • May cause irregular periods or spotting
  • May cause weight gain, breast tenderness, headaches or irritability

Heightened risks with combination hormone methods

Birth control methods that contain estrogen can increase the risk of blood clots, deep vein thrombosis (DVT), heart attack, hypertension and stroke. Women who smoke or have a severe liver disorder, particularly those over the age of 35, are advised not to use any birth control method that contains estrogen.

Certain drugs could interact with hormonal methods or reduce their effectiveness

"The most common question I get in this area is about antibiotics," says Kelsie Cabrera, DO, Nebraska Medicine obstetrician and gynecologist. "Rifampin is the only antibiotic that has been shown to decrease hormone birth control effectiveness. Depending on the hormonal method, the most common drug interactions occur with birth control pills. These include antiseizure and some anti-HIV medications, Saint John's wort and certain antifungal medications." 

Nonhormonal birth control

Copper IUD

Paragard® is a hormone-free, copper IUD that is over 99% effective. Once inserted by a doctor, it provides pregnancy prevention for 10 years. The copper IUD may also be placed right after childbirth, can be removed anytime and may be used in women with certain medical conditions.

Vaginal gel

Phexxi® is a relatively new, on-demand birth control method. It prevents pregnancy by taking advantage of the vagina's natural acidity and sperm's vulnerability to acidic environments. A prefilled applicator is inserted immediately before or up to one hour before vaginal intercourse. When used perfectly, Phexxi® is 93% effective.

  • Gel can be combined with other birth control methods but is not recommended for use with vaginal rings
  • Side effects may include burning, itching, discomfort or pain
  • There is a slight risk of bladder inflammation, kidney infection or urinary tract infections 
  • Gel is not recommended for people with a history of recurrent UTIs or urinary tract abnormalities

Barrier methods

Barrier methods are the least effective overall (18 to 28 pregnancies per 100 women per year). Pregnancy prevention is highly dependent on correct usage if spermicide is used and if more than one method is used together. These include male or female condoms (90% effective), diaphragms (80% to 95% effective), cervical caps (86% effective) and sponges (76% effective). To be the most effective, barrier methods need to be used properly, fit well and used with a spermicide. Male condoms are the only method that helps to prevent STDs.

Regular checkups and screenings are necessary for every phase of life. When considering what birth control method may be right for you, your doctor will most likely:

  • Perform an exam and review your health history
  • Discuss any health risks that may rule out certain options
  • Have a conversation about all your options, along with risks and benefits
  • Discuss how long you desire birth control, family planning goals and what may fit your lifestyle

Ready to discuss what birth control options may be right for you? Call 800.922.0000 to make an appointment.