Art by Marta Pucci
Here are all of your hormonal birth control options
Choosing a method that’s right for you
Top things to know
Hormonal Birth Control (HBC) comes in six different delivery systems.
All types of HBC prevent pregnancy effectively and the best method for you will be the one that suits your lifestyle and needs.
Tracking with Clue can help you determine if the HBC you’re using is right for you.
Hormonal methods of birth control contain either progestin or a combination of both progestin and estrogen. Hormonal birth control options include the implant, the intrauterine device (IUD), the shot, the pill, the ring and the patch. These methods of birth control have high rates of efficacy, but if you choose a method that is difficult for you to use correctly, it could lead to unintended pregnancy (1).
All hormonal birth control works to prevent pregnancy by preventing ovulation or thickening cervical mucus, and many do both (1). Depending on the method of hormonal birth control, there may be additional factors that help to protect against pregnancy (1).
Non-hormonal birth control options include the copper IUD and barrier methods like the condom, cervical cap, diaphragm, sponge and sterilization. You can read more about them here.
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Choosing a hormonal birth control
The best birth control for you is one that works for your lifestyle, that you’ll be able to use correctly and consistently (1). It’s likely that over your lifetime you’ll want to try more than one method of hormonal birth control, so it’s good to familiarize yourself with what’s available and the risks and benefits of each method (1).
The first question most people ask when investigating birth control options is, “Will it work?” but there are other considerations as well, including cost, convenience and discretion.
Tracking your birth control usage, along with your physical and emotional symptoms, can help you determine if a hormonal birth control is right for you. And, if you’re using a method that needs to be changed like the patch or ring, Clue can send you a notification that it’s time. For pill users, you can sign up to get a as a reminder to take your pills.
If you plan to become pregnant within the next couple of years, you’ll want to check out how quickly you can return to fertility based on the method you’re using (methods vary from immediate return to fertility to less than one year). Also keep in mind that no form of hormonal contraception offers protection from sexually transmitted infections (STIs)—but using a condom with a hormonal birth control even further reduces your risk for pregnancy while also protecting from STIs (6).
Let’s take a look at different forms of hormonal birth control, how they are delivered and how effective they are.
The pill
Unintended pregnancy in first year of use: 9% typical use, 0.3% perfect use (1)
Used by almost 23% of people aged 15 to 44 at risk for pregnancy in the US (1)
Oral contraceptives are also called “the pill.” Birth control pills have been in use since the 1960s (1) are the most common form of hormonal contraception in the United States (2).
There are three types of pills with different combinations of hormones. The first is the cyclic combination oral contraceptive (COC). People who use this pill as prescribed have monthly bleeding that mimics a monthly period. The second type is the extended use COC pill. When taken as directed, a person experiences less menstrual-like bleeding. There’s also the progestin-only pill (POP), which is estrogen-free (3).
The benefits of the pill include it’s rapid reversibility (cycles return within a few months), regulation of menstrual bleeding, decreased menstrual blood loss, decreased menstrual pain, decrease in frequency of menstrual migraine and decreased endometriosis symptoms (1). Because the hormones in the pill suppress ovulation, its use is also associated with decreased premenstrual syndrome (PMS), decreased ovarian cysts, decreased risk of ovarian cancer and decreased risk of fibrocystic breast changes and cysts (1).
Birth control pills must be taken each day to achieve the highest level of efficacy (1). Some people think this is a disadvantage to this method. Research shows that more than half of people using the pill forget to take one or more each month (4). Because of the daily use of pill packs, this method might not be a good choice for people who need to conceal their contraceptive use (1).
The patch and ring
Unintended pregnancy in first year of use: 7% typical use, 0.3% perfect use (1)
Used by 2.3% of people aged 15 to 44 at risk for pregnancy in the US (1)
The patch is similar to the pill in that it contains estrogen and progesterone (1). Instead of taking a pill every day, however, the patch is made of thin plastic that is placed on the skin of the buttocks, arm, abdomen or upper torso and delivers hormones through the skin. The patch should be placed on clean, dry skin and needs to be replaced weekly (5). Typically, the patch is used for three consecutive weeks, followed by one week during which no patch is worn (1). Benefits of the patch include the convenience of once-a-week dosing and a rapid return to fertility for those who stop the method to become pregnant, (1). Some reported side effects of the patch include skin reactions, breast discomfort, headache and nausea (1).
The ring delivers estrogen and progesterone through a circular piece of plastic that’s placed in the vagina (1). Usually, the ring is inserted and left inside the vagina for three weeks, followed by one week during which no ring is used (1). Some advantages of the ring include rapid return to fertility for users who want to become pregnant, convenience of weekly insertion, and the ability to remove it for a brief amount of time (3 hours) without compromising efficacy (1). Some ring users report vaginal discomfort, and others experience nausea, breast tenderness, or changes in libido. As with some other hormonal contraceptives there may be a risk of blood clots with the ring, but more research is needed.
The shot
Unintended pregnancy in first year of use: 4% typical use, 0.2% perfect use (1)
Used by 3.5% of people aged 15 to 44 at risk for pregnancy in the US (1)
The shot is also called the injectable contraceptive. A commonly used version of this contraceptive contains only the progestin depot medroxyprogesterone acetate, and is administered every three months (1). The shot is reversible, but a return to fertility may be delayed until the effect of the last injection wears off (1).
Some people like the shot because it is available without estrogen, is only taken every one to three months and does not require cooperation from sexual partners (1). Some other benefits include absent or light bleeding, decreased cramps and PMS symptoms, reduced endometriosis pain and decreased risk for pelvic inflammatory disease (PID) and endometrial and ovarian cancer (1).
The shot has some potential disadvantages. Some people find that their bleeding becomes unpredictable enough that they discontinue using the shot (1), others may not like that their bleeding stops entirely. The relationship between the shot and weight changes is unclear, and it could be that some users are more likely to gain weight than others (1). More research is needed to determine whether and how the shot impacts mood (people interested in this method but worried about the role of hormonal contraception in depressive symptoms could mention this to their healthcare provider) (1). People who use the shot long-term can experience a loss in bone density, but it’s generally reversible (1). Some people find it difficult to return to a clinic every three months to receive the next dose (1).
The implant
Unintended pregnancy in first year of use: 0.1% typical use, 0.1% perfect use (1)
Used by 3.5% of people aged 15 to 44 at risk for pregnancy in the US (1)
The hormonal implant is the most effective form of hormonal birth control (1). The implant is a thin rod that is inserted under the skin in the upper arm (1). It lasts for three years, at which point you can return to a clinic to have a new rod implanted (1). The implant is progesterone-only and contains no estrogen (1). Potential advantages include the convenience of this set-it-and-forget-it type method, its discreet appearance, decreased menstrual pain and rapid reversibility (1). Because it’s effective for three years, the implant is cost effective (1). In research studies, fewer than 20 percent of people have the implant removed early because of side effects (1).
Insertion of the implant is an in-office procedure that causes a small proportion of people to experience some swelling, bruising, and pain (1). Removal of the implant is also an in-office procedure and usually takes less than two minutes on average (1). Some disadvantages of the implant include the possibility of unpredictable bleeding, headache, weight gain, acne and breast pain (1). Some research shows that it is associated with reduce interest in sex, but other work shows that it is related to improve sexual function (1).
Hormonal IUD
Unintended pregnancy in first year of use: 0.1-0.8% typical use, 0.1-0.6% perfect use (dependent on dose) (1)
10.5% of people aged 15 to 44 at risk for pregnancy in the US use either the hormonal or copper IUD (1)
The IUD is a small T-shaped implant placed inside the uterus. It must be placed by a healthcare provider in an in-office procedure. The IUD is highly effective, doesn’t contain estrogen, is convenient set-it-and-forget-it method, discreet, rapidly reversible, long lasting and has high rates of satisfaction among people who use it (1). It also reduces period pain and bleeding and can offer protection against PID (1). Hormonal IUDs come with differing doses of hormones and the length of their use varies from three to seven years based on the dose (1).
Some potential disadvantages include unpredictable changes in menstruation, cramping at the time of insertion, and some concerns about weight gain (1). In rare cases, a pelvic infection can happen after IUD insertion and there is a small chance that the IUD will “fall out,” with an even smaller chance that it will perforate (poke through) the wall of the uterus (1).
