How to Choose a Birth Control Option If You’re Worried About Side Effects

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Choosing birth control can feel intimidating, especially if you’re worried about more serious side effects. You may have heard horror stories about the risk of organ perforation when using intrauterine devices or claims that contraceptives are associated with migraines . However, extreme side effects are rare and usually only occur if you already have a medical condition that may have caused them.

As far as common side effects go, the good news is that since there are so many options on the market, there is likely a form of birth control that minimizes the effects you are most concerned about. The bad news is that there is no hard scientific evidence to predict how certain birth control pills will affect a particular person.

What is the likelihood of side effects from contraceptives?

The lists of side effects on the package can look long and daunting, like the 21 possible side effects listed on the label of Yaz, the popular birth control pill: irregular periods, headaches, changes in the menstrual cycle, fatigue, nausea, bloating, mood swings. , breast tenderness, cramps, weight changes, and avoidance of serious side effects such as depression, blood clots, strokes, and heart attacks. Other common side effects of most forms of hormonal birth control include the chance of changes in your appearance, such as worsening (or improving) acne, changes in hair growth patterns, or swelling in your arms and legs.

More serious side effects, such as blood clots and an increased risk of deep vein thrombosis or stroke, are usually associated with previous risk factors such as smoking, obesity or a family history, says Dr. Brett Worley, assistant professor of obstetrics and gynecology at the University. Ohio State University.

Fortunately, doctors agree that current research debunks two oft-cited links to birth control: it causes depression in people who weren’t previously depressed, and weight gain.

“I tried my best to try to figure out if hormonal contraceptives cause depression,” says Worley, author of a 2018 meta-analysis on the topic. “I haven’t been able to find anything convincing to suggest that one directly causes the other.”

Current research also refutes the link between hormonal birth control and weight gain, with the exception of the Depo-Provera shot.

“Most studies show that there is no difference in weight among women using hormonal methods of contraception,” says Dr. Amy Bryant, assistant professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. “In this country, people gain weight over time.”

However, this does not mean that you should ignore the other side effects of birth control. If you’re unhappy with how you’re feeling after three to four months, Bryant recommends revisiting your doctor to find the best solution.

“Unfortunately, despite years of research and significant progress, we don’t have a perfect birth control method that works for everyone or works equally well for everyone,” she says. “I’m trying to emphasize that none of these options are permanent, so if it doesn’t work for you, we’ll try something else.”

Bryant adds that the key to choosing the best birth control for you is knowing what you want from the product: more regular periods, better skin, or a pregnancy prevention method you never have to think about.

Here’s a breakdown of what we know about the side effects of popular hormonal birth control options on the market to make that choice a little easier.

Side effects of the pill

There are several brands of oral contraceptives , but they all work in the same way. Combination pills contain both estrogen and progestin—a synthetic version of the hormone progesterone—but you can also choose progestin-only “mini pills.” When taken correctly, the pill is 99% effective , but when taken irregularly, this figure drops to 91%.

Why you might choose them : Many women choose the pill because of its simplicity, reliability, and the fact that it regulates the menstrual cycle, Bryant says. Combination birth control pills are also the only FDA-approved hormonal treatment for acne. You can get pregnant right after you stop taking the pills.

Why not choose it: The pill is user dependent, meaning you need to remember to take it every 24 hours for it to be fully effective. People whose lifestyles don’t fit this pattern may want to explore other birth control options, Bryant said. Patients who smoke or are at risk for heart attack, liver disease, or breast cancer should also consult their physician before taking estrogen- containing tablets.

Long-acting reversible contraceptives (LARKS)

The popularity of the intrauterine device (IUD) and the Nexplanon arm implant has increased over the past decade as the technology of these devices has improved, from 3.7% of contraceptive users in 2007 to 10.6% in 2017 . Both birth control options contain only progestin, but the amount varies depending on the device.

Nexplanon is the only arm implant currently on the market and releases 35 to 45 micrograms (mcg) of progestin per day in its first year, but IUDs come in different sizes and release different levels of progestin. The most common are:

• Mirena , which releases 20 micrograms of progestin per day.
• Kailina , which releases 17.5 micrograms per day.
• Liletta , which releases 18.6 micrograms per day.
• Skyla , which releases 14 micrograms per day.
• ParaGuard is a copper IUD and the only non-hormonal IUD option on the market.

Why you might choose it : The IUD and Nexplanon are 99% effective for the first few years of use (LARCS lasts between three and twelve years, depending on the brand). People choosing LARC often want to “set it and forget it,” Worley said. After removal, you can immediately become pregnant.

Why not choose it: to insert the IUD, the doctor or nurse must pass the applicator tube through the cervix into the uterus. This can cause mild or severe spasms. One in 20 IUD users also experience expulsion, where the IUD exits the uterus on its own. ParaGard users also often experience more heavy periods and cramps, and users of hormonal IUDs tend to experience a change in bleeding patterns—be it lighter periods, more frequent bleeding, or no periods at all.

Depo-Provera Shot

Depo-Provera injection is a progestin injection given by a nurse or doctor every 12 to 14 weeks to prevent pregnancy. If doses are administered regularly, the vaccination is 99% effective . But because some people skip appointments, the overall efficiency is 94%.

Why you might choose it: This shot is popular with people who want the effectiveness of long-acting birth control but don’t want to insert a device, Bryant says.

Why not choose it: If you don’t like needles or don’t think you can keep getting re-injection appointments, you might want to consider other options, Bryant said. In addition, she added, due to the high supply of hormones, the vaccine is the only hormonal birth control option that correlates with some weight gain .

patch and ring

Although the patch and NuvaRing are not as popular as other hormonal contraceptives, they are available as alternatives to hormonal contraceptives. Both deliver a combination of estrogen and progestin. The patch is changed once a week, NuvaRing – every three weeks. Both the patch and the ring are 99% effective when used correctly, but due to user error, this overall rate drops to 91% for each.

Why you might choose it: Both are effective alternatives to the pill, which are still short-acting but require less involvement than oral contraceptives, Bryant says.

Why not choose it: since both of them are not permanent fixtures, you should remember to change them in time and double check that neither of them has fallen or moved before you start intercourse.

This article was originally published in 2020 and updated on September 1, 2023 to reflect Lifehacker’s current style.