Deciding to start birth control pills can feel like a major step. With so many options available, it’s easy to feel overwhelmed. How do you know which pill is right for you? Understanding the different types of pills, how they work, and what factors to consider can empower you to make an informed decision with your healthcare provider.
This guide will walk you through the various types of birth control pills, their benefits, and potential side effects. By the end, you’ll have a clearer picture of your options and be better prepared to discuss them with a doctor to find the perfect fit for your body and lifestyle.
How Do Birth control Pills Work?
Birth control pills are a form of hormonal contraception taken daily to prevent pregnancy. They primarily work in three ways:
- Preventing Ovulation: The hormones in the pills stop your ovaries from releasing an egg each month. Without an egg, fertilization cannot occur.
- Thickening Cervical Mucus: The hormones make the mucus on the cervix thicker, which makes it difficult for sperm to swim through and reach an egg if one were released.
- Thinning the Uterine Lining: The pills also thin the lining of the uterus (the endometrium), making it less likely for a fertilized egg to implant.
When taken correctly and consistently, birth control pills are over 99% effective at preventing pregnancy. However, with typical use, which accounts for missed pills or inconsistent timing, their effectiveness is closer to 93%.
The Two Main Types of Birth Control Pills
All birth control pills fall into one of two main categories: combination pills and progestin-only pills. The primary difference between them is the type of hormones they contain.
Combination Pills
As the name suggests, combination pills contain two synthetic hormones: estrogen (ethinyl estradiol) and progestin. These are the most common type of birth control pills prescribed. Most packs contain 21 to 28 pills. The last seven pills in a 28-day pack are typically placebo (or “sugar”) pills that contain no hormones. Taking these placebo pills allows you to have a withdrawal bleed, which is similar to a period.
Combination pills are further divided into different categories based on their hormone dosage.
Monophasic Pills
In a monophasic pill pack, each active pill contains the same dose of estrogen and progestin. This consistent hormone level makes them a straightforward option, and some people find they experience fewer side effects like mood swings.
Multiphasic Pills
Multiphasic pills (including biphasic and triphasic) have varying doses of hormones throughout the pill pack. The hormone levels change every seven days or so. The goal of these pills is to more closely mimic the natural hormonal fluctuations of a menstrual cycle, which may help reduce side effects for some individuals.
Extended-Cycle Pills
These pills are designed to reduce the frequency of your periods. Packs typically contain 84 active pills followed by seven placebo pills, meaning you would only have a period four times a year. Some brands offer packs that eliminate periods altogether for a full year.
Progestin-Only Pills (The “Minipill”)
Progestin-only pills, often called the “minipill,” contain only the hormone progestin and no estrogen. They are a great alternative for individuals who cannot or should not take estrogen due to certain health conditions, such as a history of blood clots, high blood pressure, or being a smoker over 35. They are also often recommended for those who are breastfeeding.
Unlike combination pills, every pill in a progestin-only pack is active. There are no placebo pills, so you may not have a regular period, or your period might be lighter or more irregular. It’s crucial to take the minipill at the same time every day—even a delay of just three hours can decrease its effectiveness.
Choosing the Right Pill for You
With several options available, choosing the right birth control pill is a personal decision that should be made in consultation with a healthcare provider. Here are some key factors to consider during that conversation.
Your Medical History and Health
This is the most important factor. Your doctor will need a complete picture of your health to prescribe a safe option. Be sure to discuss:
- Cardiovascular Health: If you have a history of blood clots, stroke, heart disease, or uncontrolled high blood pressure, combination pills may not be safe for you. The estrogen in these pills can slightly increase the risk of blood clots.
- Migraines: If you experience migraines with aura, your doctor will likely recommend a progestin-only pill, as estrogen can increase the risk of stroke in this group.
- Smoking: If you are over 35 and smoke, combination pills are not recommended due to a significantly increased risk of cardiovascular events.
- Other Conditions: Inform your doctor about any history of breast cancer, liver disease, or diabetes.
Side Effects
All hormonal birth control can cause side effects, especially during the first few months as your body adjusts. Common side effects include:
- Nausea
- Headaches
- Breast tenderness
- Spotting between periods
- Mood changes
These often subside after 2-3 months. If they persist or are severe, your doctor might suggest switching to a different pill with a different hormone formulation.
Non-Contraceptive Benefits
Birth control pills are often prescribed for reasons beyond pregnancy prevention. They can help manage a variety of health issues. If you struggle with any of the following, mention it to your doctor:
- Acne: Some combination pills are FDA-approved to treat acne.
- Heavy or Painful Periods: The pill can make periods lighter, shorter, and less painful.
- Irregular Periods: The pill can regulate your menstrual cycle.
- Endometriosis and PCOS: Hormonal birth control is a common treatment for managing symptoms of these conditions.
- Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD): The pill can help alleviate severe PMS or PMDD symptoms.
Lifestyle and Consistency
Your daily routine is another important consideration.
- Combination Pills: Offer a bit more flexibility. If you miss a pill, you’re generally still protected as long as you take it as soon as you remember.
- Progestin-Only Pills: Require strict adherence to the same time each day. If you have a chaotic schedule or tend to be forgetful, the minipill might not be the most reliable option for you.
Your Next Steps
Navigating the world of birth control pills doesn’t have to be a solo journey. The best first step is to schedule an appointment with a trusted healthcare provider, like a gynecologist or a general practitioner. They can assess your individual health profile, listen to your concerns, and help you find a pill that aligns with your body’s needs and your life’s demands.
Remember that finding the right fit can sometimes involve a bit of trial and error. Be patient with your body and maintain open communication with your doctor. The goal is to find a method that makes you feel safe, comfortable, and in control of your reproductive health.
