Gerald Hurowitz, M.D.·Published 25 May 2012·11 min read
Key points
Birth control effectiveness can be an important part in your decision to choose a certain contraceptive method.
- Will you still use a condom to protect against STDs?
Normally a woman becomes pregnant when an egg released from her ovary (the organ that holds her eggs) is fertilized by a man's sperm.
These are pills that contain only one hormone (progestin).
Birth control effectiveness can be an important part in your decision to choose a certain contraceptive method. Yet, birth control effectiveness greatly depends on whether or not you use your contraceptive reliably and correctly. If you want high levels of birth control effectiveness, you can’t allow yourself to become careless with your chosen method - this means use it always and use it the right way! Even though no birth control method is fool-proof, believe it or not, there are certain steps that you can take to increase your birth control effectiveness:
Are you taking, or considering taking, a birth control pill? Nearly 12 million U.S. women do. And though you may simply call it "the pill," there are many different types of birth control pills.
Each type of pill has pros and cons. But first, make sure that this form of contraception is right for you.
Here's what to consider.
2 Questions to Ask Yourself First
- Will you still use a condom to protect against STDs? Male condoms offer the best protection against STDs. With all other methods of contraception, you should also use a condom. - How likely are you to forget pills now and then? The answer matters, because it affects how well the pill works. "You should swallow a pill at the same time every day, whether or not you have sex," the FDA's web site states.
When taken correctly, the pill is highly effective at preventing pregnancy. But that phrase "when taken correctly" is key.
About 8% of women who take the pill become pregnant unintentionally each year. In most of those cases, the women forgot to take pills. Yet when used perfectly - every day at the same time of day - only 1 in 100 women have an unintended pregnancy during the first year of using the pill.
So yes, the pill works. But it's not ideal for women wanting a contraception method that they don't need to think about.
How Does Hormonal Contraception Work?
Normally a woman becomes pregnant when an egg released from her ovary (the organ that holds her eggs) is fertilized by a man's sperm. The fertilized egg attaches to the woman's womb (uterus), where it receives nourishment and develops into a baby. Hormones in the woman's body control the release of the egg from the ovary and prepare the body to accept the fertilized egg.
Hormonal contraceptives (the pill, the patch, and the vaginal ring) all contain a small amount of synthetic estrogen and progestin hormones. These hormones work to inhibit the body's natural cyclical hormones to prevent pregnancy. Pregnancy is prevented by a combination of factors. The hormonal contraceptive usually stops the body from releasing an egg from the ovary. Hormonal contraceptives also change the cervical mucus to make it difficult for the sperm to find an egg. Hormonal contraceptives can also prevent pregnancy by making the lining of the womb inhospitable for implantation.
Written and revised by
Gerald Hurowitz, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.
A new option for hormonal contraceptives is extended-cycle pill use; the first one approved is called Seasonale. Seasonale contains the same hormones as in other birth control pills, but they are taken in a longer cycle to reduce the number of yearly menstrual periods from 13 periods a year to only four periods a year. Therefore, women menstruate only once each season.
Seasonale contains the same combination of two hormones commonly used in other hormonal contraceptives, and are in low doses taken continuously for 12 weeks followed by one week of inactive pills which causes a menstrual cycle.
What Are Mini Pills?
These are pills that contain only one hormone (progestin). They do not contain estrogen and may be prescribed in women who are breastfeeding or in women who experience nausea with estrogen.
How Do Mini Pills Work?
Mini pills work by thickening the cervical mucus so the sperm cannot reach the egg. The hormone in the pills also changes the lining of the uterus, so that implantation of a fertilized egg is much less likely to occur. In some cases, mini pills stop ovulation (the release of an egg). A pill is taken every day.
How Effective Are Mini Pills?
If mini pills are used consistently and correctly, they are about 95% effective - somewhat less effective than standard birth control pills.
"It's a very effective method for women who remember to take their pill each and every day at around the same," says Elizabeth Micks, MD, an instructor and fellow in family planning at Oregon Health and Science University.
Birth control methods that don't require daily action on the woman's part, such as intrauterine devices (IUD) and contraceptive implants, have significantly lower failure rates.
If you've answered those questions and decided that you want birth control pills as your form of contraception, here are the options.
Types of Pills
There are two main types of birth control pills: combination pills and progestin-only pills. Most pills are available in both a 21-day or a 28-day pack. They are often classified on the amount of estrogen and/or the amount and type of progestin.
Breastfeeding as Birth Control Breastfeeding as Birth Control at a Glance
- Sometimes called LAM (Lactational Amenorrhea Method) - A natural way to prevent pregnancy after giving birth - Effective, safe, convenient, and free - Lasts for up to six months after giving birth
Is Breastfeeding as Birth Control Right for Me?
All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you.
Women who have just given birth may use continuous breastfeeding as a method of birth control. Here are some of the most common questions we hear women ask about using breastfeeding as birth control. We hope you find the answers helpful.
Combination pills. These contain the hormones estrogen and progestin. Most birth control pills are combination pills. They're equally effective at preventing pregnancy - again, when taken correctly. They may also have other benefits, including:
- Shorter, lighter, more regular, and less painful periods - May reduce the severity or frequency of menstrual migraines - Can improve bleeding and pain associated with endometriosis and fibroids - May improve acne - Can lower risk of ovarian and uterine cancer - Can lower risk of pelvic inflammatory disease - May improve bone density in the years just before menopause
All combination pills slightly raise the risk of heart attacks, stroke, and blood clots that start in a leg vein but could travel to other parts of the body - including the lungs, which could be fatal. That risk rises if you're a smoker older than 35.
{pagebreak}
Women who smoke and are older than 35 should not take any type of combination birth control pill, according to the FDA. Other factors - such as being obese or having a family history of heart disease - also make those clots more likely. So consider your overall risk.
Still, those clots are rare, overall.
"Somewhere on the order of two to four more women per 10,000 might experience a nonfatal [blood clot]," says Sarah Prager, MD, MAS, an assistant professor of obstetrics and gynecology at University of Washington Medical Center.
Morning-After Pill (Emergency Contraception)
Morning-After Pill (Emergency Contraception) at a Glance
- Birth control you can use to prevent pregnancy up to five days (120 hours) after unprotected sex - Two kinds of emergency contraception — morning-after pill and IUD insertion - Safe and effective - Available at health centers and drugstores - Costs vary from $10 to $70 for the morning-after pill and up to $500 for IUD insertion
Is Emergency Contraception Right for Me?
Accidents happen — that's why we have emergency contraception (also known as the morning-after pill). Did you have intercourse without using protection? Did you forget to use your birth control correctly? Did the condom break, leaving you worried about becoming pregnant? If so, emergency contraception might be a good choice for you. Here are some of the most common questions we hear women ask about emergency contraception. We hope the answers help you decide if it is right for you.
The FDA advises women not to take any combination birth control pills if they have a history of blood clots, heart attack, or stroke.
The FDA has reviewed recent observational studies on whether certain combination pills that contain drospirenone (a synthetic version of progesterone or a progestin) carry a higher risk than other pills of deep vein thrombosis (DVT) or pulmonary embolism - two rare but serious blood clots. Based on that review, the FDA states that it has concluded that drospirenone-containing birth control pills "may be associated with a higher risk for blood clots than other progestin-containing pills." Pills containing drospirenone include Beyaz, Gianvi, Loryna, Ocella, Safyral, Syeda, Yasmin, Yaz, and Zarah.
Progestin-only pills (also called the "mini pill"). These pills are most commonly used by nursing mothers, women with pre-existing risks for blood clots, or other conditions that prevent them from taking estrogen.
If you don't take them at the same time every day, they may not work. Being as little as three hours late could result in ovulation.
This type of pill works for nursing mothers because continuous breastfeeding already protects against pregnancy, and the mini pill simply provides added security. "Nursing moms have lower fertility. The mini pill's efficacy may be unacceptably low in women who have normal fertility," says Andrew Kaunitz, MD, who is associate chair of the ob-gyn department at the University of Florida College of Medicine in Jacksonville, Fla.
What's in That Pill Packet?
Combination birth control pills come in different phases, depending on whether the level of hormones in the pills changes throughout the month.
- Monophasic (one-phase) pills contain the same amount of estrogen and progestin in all of the active pills. Alesse, Loestrin, Ortho-cyclen, Seasonale, and Yaz are a few examples. Each active pill in the pack is the same. If you forget to take a pill one day, you take it as soon as you remember, and then take your next pill at your regularly scheduled time.
- Biphasic (two-phase) pills change the level of hormones estrogen and progestin once during the menstrual cycle. Examples include Kariva and Mircette Ortho-Novum 10/11.
- Triphasic (three-phase) pills contain three different doses of hormones in the active pills. Those levels change every seven days during the first three weeks of pills. This was the first type of birth control pill. Examples include Cyclessa, Ortho Tri-Cyclen, Nortel 7/7/7, Enpresse, and Ortho-Novum 7/7/7.
- Quadraphasic (four-phase) pills. The hormone levels in these pills change four times per cycle. Natazia is the only quadraphasic pill on the U.S. market.
{pagebreak}
Multi-phase pills (biphasic, triphasic, or quadraphasic) have two disadvantages, compared to monophasic pills:
- They can be trickier to take. The more phases in the cycle, the more complicated the instructions are about what to do if you miss a day. Those instructions vary by pill. - Be careful not to start the next pack late. Except for Natazia, Kariva, and Mircette, all multi-phase pill cycles include seven hormone-free days. Starting the next pack late means more than a week without hormones, making pregnancy more likely. One of the most common ways women become pregnant on the pill is to start the next pack late.
Extended-Cycle, Continuous-Cycle Pills
Extended-cycle pills and continuous-cycle pills mean fewer periods, or even no periods. They include Introvate, Jolessa, Lybrel, LoSeasonique, Seasonale, and Seasonique.
Women may wonder if it's safe and healthy to skip periods. When a woman isn't taking oral contraceptives, a menstrual period is necessary after ovulation to shed the lining that's built up in her uterus.
Any birth control pill, regardless of cycle length, stops ovulation, so the lining of the uterus does not thicken - and there is nothing to shed. So though you do have several planned days of bleeding on most pills, it's not really a menstrual period.
"Women often refer to the bleeding as menstruation, but in the case of birth control pills, it's withdrawal bleeding [from the hormone-free interval]," Kaunitz says. "So it's OK for women using hormonal birth control to bleed less often."
Longer cycles of pills simply cause this withdrawal less frequently, and many doctors encourage patients to try it.
"For a patient that wants to start birth control pills, I say, ‘And how about we miss periods, too?' I think that's appealing to more and more women," Micks tells WebMD.
But there are some drawbacks:
- You may be more likely to experience breakthrough bleeding than with other types of pills. - It may be harder to tell if you get pregnant, because you're having fewer (or no) periods. - Extended-cycle and continuous-cycle pills are not available in generic form. But doctors often instruct patients on how to adjust generic pills containing seven placebo pills for extended or continuous use. This will require a prescription for more than 12 packs per year.
Pill Safety
Each woman is different and may have different experiences with the various types of birth control pills. Some side effects may include:
- Light bleeding or "spotting" between periods. Spotting may be most common in pills with higher estrogen doses and cycles with higher numbers of active pills. - Nausea - Breast tenderness - Weight gain
But unwanted side effects tend to go away in time, so gynecologists recommend patients stay with a pill for three to six months before quitting because of side effects.
Combination pills may not be right for you if you have:
- Risk factors for blood clots, stroke, or other cardiovascular conditions, such as women over 35 who smoke - Had liver or breast cancer, although it has no impact on future risk for breast cancer - Migraines with aura
Remember, although birth control pills make pelvic inflammatory disease less likely, they don't protect against sexually transmitted infections.
Once you start the pill, be careful with other prescription and over-the-counter drugs. The following medications can interfere:
- Antibiotics - Certain seizure medications - Certain HIV medications - St. John's wort
News
News
News
