Hormonal Birth Control: What Are My Options?

Welcome to part 2 of our birth control series! In part 1, we explored the side effects of hormonal birth control (HBC). In this article, we’re breaking down how HBC works, what methods exist, and what you need to know about them.

We’ve all heard of the pill, but we might not know as much about the other hormonal contraceptives on the market. Among the most effective birth control available, most work by shutting off your natural hormonal cycle, inhibiting ovulation and preventing pregnancy.

There are two types of HBC: combination and progestin-only. Combination HBC contains both synthetic estrogen and synthetic progesterone (called progestin), while progestin-only formulations contain – you guessed it – only synthetic progesterone. These forms of HBC do not contain any synthetic estrogen. 

Combination and progestin-only HBC can be administered through different methods. The three main types of combination HBC are:

• The birth control pill, commonly referred to as “the pill”

• The vaginal ring, also known as the NuvaRing

• The birth control patch 

Progestin-only options come in the form of:

• Hormonal IUDs (intrauterine device)

• The “mini-pill,” a progestin-only daily pill

• An implant called Nexplanon

• A shot or injection called Depo-provera

Having so many options is both empowering and overwhelming. We’re not always sure where to get our information from: our doctors are usually our first stop, but they can speed through explanations and leave us feeling more lost than when we walked in. Social media inundates us with tips (some of which are reliable) but short clips and sound bites don’t give us enough actionable information. 

Consider this your information cheat-sheet for HBC. We’ll introduce you to the most commonly used types and explore some of their benefits and side effects.

Combination HBC

The Pill 

The combination birth control pill is one of the most widely used types of HBC. This method contains both synthetic estrogen and progestin. It’s taken daily, so your body is supplied with a steady dose of both hormones to inhibit ovulation and prevent pregnancy. 

With perfect use the pill is 99% effective. But sticking to a strict schedule can be tough, so average efficacy is closer to 91%. This means that it must be taken every day, at the same time, for peak efficacy. Missing a day or two or taking the pill at different times can lead to hormonal fluctuations and occasionally, an unwanted pregnancy. 

Many opt for the pill out of convenience and (barring user-error) reliability. However, there are many notable side-effects and it doesn’t protect against STIs.

The Vaginal Ring

You might have heard of the brand name, “NuvaRing.” This is a plastic ring that contains both synthetic estrogen and progesterone. It’s inserted into the vagina for 3 weeks, and then removed for a week.

Like the pill, it’s between 91-99% effective, depending on consistency of use. If the ring is inserted for less than 3 weeks, left in for more than 4 weeks, if it slides out and is not replaced within three hours, or the unopened package is exposed to too much light or heat, the product can become less effective. 

It doesn’t require daily attention, but does have similar side effects to the pill. It can also cause vaginal infection, irritation, irregular discharge and itching and it doesn’t protect against STIs. 

“Alarmingly, about 40 women have died from using the NuvaRing and upwards of 2000 lawsuits have been filed against the company. People report blood clots, depression, liver tumors, suicidal ideation and other potentially life threatening consequences. If you’re thinking of trying the NuvaRing or are already on it, consult your doctor and consider doing your own research on the risks and benefits. ”

The Birth Control Patch

The patch is usually placed on the belly, butt, upper arm or back and changed weekly. It contains both synthetic estrogen and progesterone which are absorbed through the skin. Its efficacy ranges between 93-99%, depending on how closely use-instructions are followed. Not changing the patch on time, letting the patch fall off or using certain medications can lower efficacy. As with other combination HBC options, it doesn’t protect against STIs. 

Progestin-only HBC

Hormonal IUDs 

Hormonal intrauterine devices are small T-shaped instruments that are inserted into the uterus by a doctor. They only contain progestin, though different IUD brands contain different amounts. Mirena (the most commonly used) contains 52mg, Liletta also uses 52mg, Kyleena uses 19.5mg while Skyla only uses 13.5mg. 

Insertion is quick, but often extremely painful and rarely anesthetized. However, it’s about 99% effective and can last up to 6-8 years. Though it doesn’t protect against STIs and causes the same side effects as other HBC options, many are attracted to this ‘set-it-and-forget-it’ method. 

The Mini-Pill

This oral pill is taken daily but unlike the combination birth control pill, it does not contain synthetic estrogen. People that experience migraines or other symptoms on the pill will often try the mini-pill in order to avoid estrogenic side effects. 

Like the pill, it’s between 91%-99%+ effective, depending on how consistently it's used, and it doesn’t protect against STIs. It’s also missing a placebo week, so every pill in the pack is “active.”

The Birth Control Implant

Also called Nexplanon, this is a matchstick sized rod that gets implanted into the skin of the upper arm. It’s a progestin-only method that, like an IUD, is about 99% effective at preventing pregnancy and lasts for up to 5 years. It also does not protect against STIs. 

Depo-Provera

The birth control shot is injected into the arm or butt, every three months by a professional. Depo-provera is 96% effective and contains 150mg of progestin. 

Side effects can include irregular or missing periods, depression, acne, and weight fluctuations. Notably, fertility may not return for 9-24 months once injections have stopped. This is a serious consequence that’s not often highlighted in educational materials. Additionally, Depo can lead to significant bone mineral density loss. As a result, it should not be used long-term, meaning longer than two years. 

How do I choose?

There are so many kinds of HBC – so how do I choose? Is one better than another?

In terms of preventing pregnancy, they’re all pretty effective. The combination pill is by far the most common, but if you’ve had adverse reactions to it you may need to try a progestin-only option like the mini-pill or the IUD. 

The decision will depend on your schedule and priorities. If taking a pill at the same time every day doesn’t fit into your lifestyle, consider a patch that you change weekly or an IUD that stays in for years. Side effects are also important to consider. For some, the benefits of the pill outweigh the consequences, while others are profoundly impacted by the synthetic estrogen. If you’re looking to conceive in the short-term, Depo-provera might not be the best option. But remember, there’s no “right” choice – it just depends on your body, your time commitments and goals. 

“At R&R, we aren’t “for” or “against’’ any types of birth control. Our only goal is to provide resources that empower you to decide what’s best for your body. ”

And there you have it! Your quickie guide to the different types of hormonal birth control. If you would like to learn more about non-hormonal birth control options click here.