Best birth control pill: How to choose

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Best birth control pill: How to choose

If you're considering taking birth control pills, you may have various options. To help choose the best birth control pill for you, consider the following questions.

What are the different kinds of birth control pills?

There are two different kinds of birth control pills — combination birth control pills, which contain estrogen and progestin, and minipills, which contain only progestin.

Combination birth control pills come in different mixtures of active and inactive pills, including:

  • Conventional pack. Conventional packs usually contain 21 active pills and seven inactive pills or 24 active pills and four inactive pills. Bleeding occurs every month during the week when you take the last four to seven inactive pills.
  • Continuous dosing or extended cycle. These combination birth control pills typically contain 84 active pills and seven inactive pills. Bleeding generally occurs only four times a year during the week when you take the last four to seven inactive pills. Formulations containing only 28 active pills — eliminating bleeding — also are available.

Combination birth control pills also come in different formulations, including:

  • Monophasic. In this type of combination birth control pill, each active pill contains the same amount of estrogen and progestin.
  • Multiphasic. In this type of combination birth control pill, the amounts of hormones in active pills vary.

Combination birth control pills that contain less than 50 micrograms of ethinyl estradiol, a kind of estrogen, are known as low-dose pills. Women who are sensitive to hormones may benefit from taking a lower dose pill. However, low-dose pills may result in more breakthrough bleeding — bleeding or spotting between periods — than do higher dose pills.

The minipill doesn't offer as many choices. There's a single mixture and formulation, and all the pills in each pack are active.

How do different kinds of birth control pills work?

Combination birth control pills suppress ovulation — keeping your ovaries from releasing an egg. Combination birth control pills also thicken cervical mucus and thin the lining of the uterus (endometrium) to keep sperm from reaching the egg.

The minipill thickens cervical mucus and thins the endometrium — preventing sperm from reaching the egg. The minipill also sometimes suppresses ovulation. Unlike combination birth control pills, the minipill doesn't contain estrogen. The progestin dose in a minipill is also lower than the progestin dose in any combination oral contraceptive pill.

Are all kinds of birth control pills appropriate for everyone?

Birth control pills aren't appropriate for everyone.

Your health care provider may discourage use of combination birth control pills if you:

  • Are breast-feeding
  • Are older than age 35 and smoke
  • Have a history of blood clots, stroke, or breast, liver or endometrial cancer
  • Have a history of deep vein thrombosis, pulmonary embolism or heart disease
  • Have kidney, liver or adrenal gland problems
  • Have migraines with aura
  • Have diabetes-related complications, such as a damaged retina (retinopathy)
  • Have blood-clotting problems
  • Are about to be immobilized for a prolonged period due to major surgery
  • Have unexplained uterine bleeding
  • Are taking St. John's wort or anticonvulsants

Your health care provider may discourage use of the minipill if you:

  • Have breast cancer
  • Have unexplained uterine bleeding
  • Are taking medications that contain anticonvulsants or anti-tuberculous agents

Be sure to talk to your health care provider about any health conditions you have or any medications you're taking before taking the combination birth control pill or the minipill.

How effective are different kinds of birth control pills?

An estimated 8 out of 100 women who use combination birth control pills for one year will get pregnant.

An estimated 1 to 13 out of 100 women who use the minipill for one year will get pregnant. Given the low dose of progestin, the failure rate of the minipill in highly fertile women is higher than that of other hormonal contraceptive methods.

What if I forget to take my birth control pill?

Combination birth control pills are most effective when taken at the same time every day. If you miss an active combination birth control pill, take it as soon as you remember — even if it means taking two active pills in the same day. Take the rest of the pack as usual, and use a backup method of contraception for seven days. If you miss a pill, you may experience breakthrough bleeding. If you miss more than one active pill, take the last pill you missed right away. Take the rest of the pack as usual, and use a backup method of contraception for seven days.

Timing is even more important for the minipill. For maximum effectiveness, you must take each pill at the same time every day. If you take the minipill more than three hours later than usual, avoid sex or use a backup method of birth control for at least two days. If you miss a minipill, take the missed pill as soon as you remember — even if it means taking two pills in one day. Use a backup method of birth control for at least two days.

If you've missed birth control pills of any type and had unprotected sex, consult your health care provider about emergency contraception.

What are the pros and cons of each type of birth control pill?

Combination birth control pill

  • Pros. Reduces the risk of ovarian and endometrial cancers, ectopic pregnancy, ovarian cysts, and iron deficiency anemia. Offers relief from premenstrual syndrome and severe menstrual cramps. Provides shorter, lighter and more predictable periods or, for continuous dosing or extended cycle pills, fewer periods each year. Improves acne. Can decrease the risk of postmenopausal hip fracture.
  • Cons. Doesn't offer protection from sexually transmitted infections (STIs). Increases the risk of deep vein thrombosis, pulmonary embolism, heart attack, stroke and cervical cancer. Can raise blood pressure and cause nausea, bloating, breast tenderness, mood changes, headaches, decreased libido, an increase in vaginal secretions, breakthrough bleeding or spotting, and changes in contact lens tolerance.

Minipill

  • Pros. Can be used during breast-feeding. Doesn't carry the side effects of birth control pills containing estrogen. Can be taken if you have certain health problems, including a high risk of heart disease, blood clots, or a history of high blood pressure or migraines. Offers a quick return to fertility if you hope to get pregnant.
  • Cons. Doesn't offer protection from STIs. Can cause irregular menstrual bleeding, ovarian cysts, depression, weight gain or loss, decreased libido, headache, nausea, breast tenderness, fatigue, or acne. If you conceive while taking the minipill, there's a slightly higher chance that the pregnancy will be ectopic — when the fertilized egg implants outside of the uterus, usually in a fallopian tube.

What's the bottom line?

You have many options for birth control. If you choose to take birth control pills, work with your health care provider to decide which type of birth control pill is best for you.

Last Updated: 2010-01-23
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