11 Forms Of Birth Control And Their Side Effects

Birth control is a way to prevent pregnancy, and it comes in many forms. Some forms of birth control might have beneficial side effects, such as making periods lighter, and people may take them for reasons other than preventing pregnancy.

Birth control varies in terms of its permanence. The permanent option is sterilization, including tubal ligation and vasectomy (a procedure that can be reversible), which alters the tubes that carry either sperm or eggs, rendering them ineffective for reproduction.

Another option is a long-acting reversible contraceptive method, such as an IUD or hormonal implant. Many people choose these options or a short-acting hormonal contraceptive, such as the hormonal birth control pill, patch, ring or shot. Both long-acting and short-acting birth control work by either preventing ovulation or preventing sperm from reaching an egg in order to stop a pregnancy from occurring.

If you don’t want to use one of these methods, there are barrier methods, including condoms, diaphragms,vaginal pH modulators or spermicides, all of which are designed to prevent sperm from reaching an egg.  Other birth control methods don’t involve using any kind of added protection, such as menstrual cycle tracking. These types of birth control won’t necessarily have the same side effects as certain forms of hormonal birth control but rely more on the user to use a method before every act of intercourse or track menstrual cycles daily.

The cost and accessibility of different types of birth control varies. The Affordable Care Act does require insurance plans to cover all FDA-approved methods of birth control, without co-pay, including the hormonal birth control pill, IUDs and tubal ligation procedures.  Medicaid covers birth control as well. For those who are uninsured, reproductive health clinics may be able to provide free or low cost birth control options.

There are dozens of hormonal and non-hormonal forms of birth control available. Keep in mind that some have a higher effectiveness rate than others (note that all effectiveness rates listed below are according to Planned Parenthood unless otherwise indicated).

Hormonal Birth Control Pills (Oral Contraceptives)

One of the most common types of birth control are hormonal birth control pills, or oral contraceptives. There are two types: combination birth control pills and progestin-only birth control pills, or the mini pill. The hormones in these pills taken every day work to prevent pregnancy by either stopping ovulation and/or by thickening cervical mucus and preventing sperm from reaching an egg. If you take them as guided, every day at the exact same time, they have a 99% effectiveness rate.

IUDs

An intrauterine device (IUD) can be inserted into the uterus by a healthcare provider, and is effective for anywhere from three to 12 years, touting an effectiveness rate of 99% on its own. There are two types: a hormonal IUD, typically made of plastic that releases a progestin hormone slowly over time, and a non-hormonal IUD, made of plastic and copper. Both types work similarly, by essentially blocking sperm from reaching an egg, either through thickening cervical mucus (hormonal) or creating an inhospitable environment for sperm inside the uterus (non-hormonal).

Vaginal Rings

There are two different types of vaginal rings. One is left in for three weeks before it is removed and replaced with a new ring one week later. A newer version of the vaginal ring allows the user to use the same vaginal ring for one year, 13 cycles total, by inserting the soft, squishy ring each cycle directly into the vagina for 21 days and removing it for seven days (in order to have a menstrual period), explains Yen Hope Tran, D.O., an OB-GYN at Memorial Care Orange Coast Medical Center in Fountain Valley, California. It also works 99% of the time if used exactly as directed, and functions by both preventing ovulation and thickening cervical mucus, making it more difficult for sperm to enter the uterus.

Hormonal Patches

The hormonal patch works similarly to the vaginal ring and hormonal birth control pills: It releases hormones that prevent the release of eggs and prevent a sperm meeting an egg by thickening cervical mucus. You stick one new patch directly on your skin (you can apply it anywhere other than the breasts) weekly, and it’s considered 99% effective at preventing pregnancy if you do not apply it late, meaning that you must apply it on the exact same day each week.

Hormonal Birth Control Implants

A hormonal implant is placed under the skin by a health care provider in order to prevent pregnancy for up to three years. It releases a progestin-only hormone to stop ovulation from occurring and also thicken cervical mucus, similar to other hormonal options of birth control. The implant is highly effective at preventing pregnancy with efficacy of 99%.

Depo-Provera Shots

Another option is an injection called Depo-Provera which is given every three months. Like other hormonal methods, the shot prevents pregnancy mainly by stopping ovulation and thickening cervical mucus to prevent sperm from reaching an egg. If you follow up with the shots and get them in a timely manner, the effectiveness rate is 99%. Currently the shots are only approved for administration by a health care provider but research is being done to test whether patients can safely give one type of the shot to themselves at home, similar to insulin or other subcutaneous (under the skin) self-injections.

Barrier Methods

Barrier methods are non-hormonal methods of birth control that do not involve taking any pills, shots or any insertion procedures by a health care provider. These include external condoms, internal condoms (previously known as “female condoms,” which are inserted into the vagina prior to intercourse), diaphragms or cervical caps. All barriers work by keeping sperm from reaching an egg. These methods are between 86% and 98% effective at preventing pregnancy when used consistently and correctly every time you have sex, and condoms are the only birth control method that can also protect against sexually transmitted infections (STIs).

Non-Hormonal Gel

A newer form of non-hormonal contraception is Phexxi, a gel you can use right before or up to an hour before sex, without having to take any kind of daily, weekly or monthly birth control. Here’s how it works: “When semen enters the vagina, it raises the vagina’s pH levels from its typical range of 3.5 to 4.5 to a range of 6.5 to 7.2.,” explains Dr. Tran. “This increase in pH is what allows sperm to move and swim up the reproductive canal [in order to reach an egg and cause pregnancy].” Phexxi keeps the vaginal pH at its normal level, even when semen is introduced, making the environment of the vagina inhospitable to sperm. To insert the gel into the vagina, there’s a tampon-like device for one-time use. The gel then starts working immediately and lasts up to an hour for each act of vaginal sex, adds Dr. Tran. Phexxi is 93% effective when used consistently and correctly. Phexxi can also be used with barrier methods or any method other than the vaginal ring to increase effectiveness and has lubricating properties, so additional lubrication is not needed.

Withdrawal

The “pulling out” method is pretty well-known as a “DIY” method of birth control: It involves withdrawing before ejaculation, and is typically used without a condom. It’s about 96% effective with perfect use and 80% effective with typical use^[1]Contraceptive Failure Rates. ContraceptiveTechnology.org. Accessed 4/19/2022. .

Cycle Tracking

Tracking your monthly cycle—also known as natural family planning or fertility awareness—is another form of birth control that involves tracking menstruation, cervical mucus and/or basal body temperature to predict ovulation and peak fertility days in order to avoid sexual activity, and therefore pregnancy, on those days. Effectiveness is highly dependent on the methods of cycle tracking (tracking menstruation, cervical mucus and/or basal body temperature) and ranges from 76-99%.

Vasectomy or Tubal Ligation

Permanent forms of birth control include surgical procedures like a vasectomy or tubal ligation. A tubal ligation involves blocking or tying off the fallopian tubes so that eggs will not be able to be fertilized or transported to the uterus. A vasectomy is a surgery that blocks the vas deferens, the tubes that carry sperm, preventing sperm from being released into the ejaculate and potentially meeting with an egg. While a tubal ligation is often not successfully reversible, a vasectomy reversal is possible and typically has successful outcomes. Both methods should only be considered if you are certain you do not want future pregnancies.

Each form of hormonal birth control could affect each person very differently and side effects vary widely from one method to another.

Hormonal Birth Control Pills, Patch and Vaginal Ring

Common side effects with these methods of birth control, according to Sophia Yen, M.D., an OB-GYN and founder and CEO of birth control company Pandia Health and a Forbes Health Advisory Board member, include:

• Nausea
• Headaches
• Irregular or decreased menstrual bleeding
• Increased breast size or breast tenderness
• Mood changes
• Vaginal irritation (for the vaginal ring)

You can avoid nausea or any gastrointestinal side effects by taking your birth control pill with your largest meal, taking it at the same time every day and making sure that other medications you might be taking don’t have any interactions with birth control, says Dr. Yen.

There are some positive side effects of birth control pills, too, according to Dr. Yen. Because ovulation is decreased, taking hormonal birth control can lower your risk of ovarian and endometrial cancers.

The one-year vaginal ring has a lower estrogen output, and is generally recommended for people over 30, explains Dr. Yen. This estrogen level might be too low for you if you’re under 30, based on your natural hormone levels.

The hormonal patch may be less effective for people who are overweight or obese. The hormonal concentration of the original patches were a concern due to a potential increase in the risk of blood clots. “Twirla [another newer hormonal birth control patch] was specifically created to address that concern and has lower hormones,” says Dr. Tran.

Hormonal IUD

This type of birth control may result in the following side effects, according to Dr. Yen:

• Acne
• Lighter or skipped periods
• Cramping or irregular spotting, particularly in the months following placement
• Mood changes

IUD placement requires a pelvic exam, which can be painful. If the device is placed incorrectly, it may be expelled out the vagina (making it ineffective) or perforate through the wall of the uterus and end up inside the abdomen. This can require a surgical procedure and general anesthesia to remove.

Non-Hormonal IUD

Side effects of non-hormonal IUDs, according to Dr. Yen, may include:

• Heavier menstrual bleeding
• Cramping

Because a copper IUD has no hormones stopping ovulation, your periods should continue in their regular frequency but the IUD could cause the periods to be heavier and more painful. But, if you’re someone who doesn’t have much period pain or heavy periods, it could be the right choice for you. Also, if you have health conditions (including a history of breast cancer or blood clots) and are not able to take hormonal birth control, a copper IUD could be a good option, adds Dr. Yen.

Hormonal Birth Control Implant

There are a couple of potential side effects for birth control implants, says Dr. Yen:

• Mood changes
• Acne
• Lighter or skipped periods
• Pain or bruising at the insertion site

Side effects for the arm implant seem to be similar to other forms of birth control. But in terms of effectiveness, the hormonal birth control implant has the least room for error compared to most other forms of hormonal birth control, says Dr. Yen (once it’s inserted in your arm, it can’t move, and you don’t have to remember to take it).

Depo-Provera Shot

The hormonal birth control shot might induce some of the following effects, according to both Dr. Yen and Dr. Tran:

• Increased appetite
• Bone density issues
• Missed or irregular periods
• Mood changes
• Sore breasts
• Headaches

Non-Hormonal Gel

Side effects with Phexxi can include:

• Urinary tract infections (UTIs)
• Yeast infections
• Bacterial vaginosis (BV) infections
• Vaginal burning, itching and discharge

While most people don’t experience infections with Phexxi (in fact only 2% of participants in clinical trials discontinued due to side effects), these side effects are worth considering if you’re already prone to these types of infections and have them recurrently.

Tubal Ligation

Most of the side effects associated with a sterilization procedure involve the recovery from surgery. One less common risk could be an ectopic pregnancy that occurs within the fallopian tubes, says Dr. Yen, but this is not common.

Other Forms of Birth Control (Barrier Methods, Withdrawal, Cycle Tracking)

There are no marked side effects of barrier methods (besides a potential allergic reaction to the material in the condoms), the withdrawal method or cycle tracking. However, the main “side effect” is a higher risk of pregnancy, Dr. Yen points out. With the majority of these methods, there’s a much higher probability of people who will get pregnant as opposed to other hormonal birth control or non-hormonal birth control methods.

Beyond more minor side effects like sore breasts, certain birth control methods might pose greater health risks you should know about. For example, a common health risk of hormonal birth control pills, patches and rings are an increase in the probability of stroke, blood clots, higher cholesterol levels and high blood pressure, says Dr. Tran. Though your risk of a blood clot with use of hormonal contraception (if you don’t have any other risk factors) is only about one in 3,000^[2]Women’s Health. National Blood Clot Alliance. Accessed 3/29/22. and lower than your risk of blood clots during pregnancy.

The Depo-Provera shot may increase the risk of bone density loss with prolonged use though this loss is usually reversed when you stop the method. All hormonal methods have the potential to cause mood changes or worsen depression in some people. But in most cases, the benefits of birth control do outweigh the more rare risks.

The short answer is yes, according to Dr. Yen—birth control in general should be safe for most people to use on a long-term basis, and some forms of birth control even have the possible benefits of lowering your risk of certain kinds of cancer. “It’s all a risk-benefit decision: How bad would it be for you to get pregnant?” says Dr. Yen. “Pregnancy has a high morbidity and mortality rate, can take away from your bone health and is taxing on the person who has to carry the pregnancy.”

If there’s an extended period of time in which you don’t want to be pregnant, you should stay on birth control, says Dr. Yen. However, if you do experience severe forms of any of the above side effects or health risks such as blood clots or severe depression, you should bring this to your doctor’s immediate attention in order to switch forms of birth control or get off birth control altogether.

First, talk to your doctor about what type of birth control is right for you. “I usually talk to patients first, asking them about how frequently they have periods, for how long, the amount of bleeding and if there’s any pain with periods,” says Dr. Tran.

Your healthcare provider will also want to know more details about your reproductive intentions, including whether and when you might want to become pregnant in the future and lifestyle, such as whether you are able to remember to take a pill at the same time every day. They will also want to know about any specific medical conditions you have which might make some methods of birth control less safe for you than others. Based on your age, weight and height, and all of the information you’ve given, your doctor can help you to narrow down the options based on your preferences. “Then we go over the risks and benefits of each potential type of birth control before we pick one form of contraception for them,” says Dr. Tran.

When it comes to other non-hormonal options, people who have frequent or recurrent UTIs likely shouldn’t rely on non-hormonal gels or diaphragms as their form of birth control.

It may take some trial and error to find the right birth control method for example, (there are 40 different types of birth control pills, Dr. Yen points out), but you can work with your doctor and ask specific questions to make sure the form of birth control you choose is right for you.