Birth Control - The Pill

Imagine that you're standing all alone on a football field. You can choose to stand anywhere you want to, but once you pick your spot, you can't move again.

Now imagine that, somewhere over by the entrance, about a million people are massed and waiting, about to be released onto the field. They're participating in a contest and the first one to touch you wins a brand new HDTV, a trip to Tahiti, and their very own pony. Granted, they're all blindfolded. But once they're free to run around the stadium's enclosed space, how long do you really think it will take for one of them—or 20 of them—to slam right into you?

That, in a nutshell, is sex—from the perspective of an egg. When you think about it that way, it's almost tempting to reverse the old adage about conception. Having a baby isn't a miracle: Preventing one is.

Without any means of contraception, the average sexually active woman of childbearing age would have an 80-85 percent chance of getting pregnant within a year. In most cases, those odds are going to catch up to you eventually. Luckily, we live in a time where women who don't want to have a baby have access to reliable means of contraception, many of which can be more than 90 percent effective in preventing pregnancy.

On the other hand, we also live in a time where there are so many options that it's easy to end up overwhelmed. And that can lead to women making decisions that maybe aren't the best ones for them, simply because they don't have time to weed through all the information. If you've ever picked your contraceptive method because it was the only one you knew about or because that was what all your friends used, you may not be using the one that’s best for you. We're breaking down almost every form of birth control available, to help you understand what it does, how well it works, and who can benefit the most.

The Pill

What it does: The pill you're probably most familiar with is also called a “combination pill,” because it releases two different synthetic hormones into your body. Together, the artificial hormones work by preventing you from ovulating—releasing a mature egg cell from your ovaries. They have some other effects, as well, including thickening the mucus around your cervix, which makes it more difficult for sperm to actually get inside your uterus.
What it doesn't do: Protect you from sexually transmitted diseases. The pill also doesn't work 100 percent of the time. It's rare—the failure rate is lower than 2 percent if used correctly—but some women can and will get pregnant, even if they're following instructions to the letter. On the plus side, getting pregnant while on the pill isn't harmful to you or the fetus.

How to get it: You need a prescription. However, you don't need a parent's permission. Although most medical professionals encourage underage patients to talk to their parents about health choices, there are no state or federal laws requiring it. According to a 2005 article in the Journal of the American Medical Association, 60 percent of teenagers who visited a family planning clinic say their parents knew about the visit.
Is it reversible? Yes. Your body begins to return to normal hormone levels (and with that, normal ovulation) after a couple of days off the pill. Once you stop taking it, your chances of getting pregnant become about the same as a woman who's never used hormonal contraception.

Side effects: The most common are breast tenderness, nausea, weight gain, mild headaches, and changes to mood or sex drive. For most women, these disappear after the first three months. If they don't, you and your doctor may be able to manage them by switching to a pill with a different types or amounts of hormones.
Who can benefit the most: Women who tend to be detail-oriented. In order to use the pill correctly and keep your risk of pregnancy at a minimum, you need to know and follow its use instructions pretty closely. That usually means taking the pill at the same time every day, knowing exactly what you're supposed to do if you miss a pill or two, and following lifestyle recommendations like not smoking (mixing cigarettes and the pill greatly increases your risk of heart attack and stroke).

Who should consider a different method: Smokers, definitely. Also: women who have to use specific antibiotics or other prescriptions.

If you're over the age of 35, you should also check with your doctor to make sure that you don't have any of the health complications that can make the pill less effective and more dangerous. Most older women can continue using the pill without problems, but if you are diabetic or obese, for instance, the pill might not be for you.

You might not know: Combination pills can differ a lot from one brand to another. For instance, Yasmin—one of the newer pills on the market—is the only one that uses a specific type of progestin called drospirenone. This new progestin has been shown to work better for some women who have unacceptable side effects while using other pills. On the downside, though, drospirenone can also cause potassium to build up in your bloodstream, leading to possible complications. Women with a history of jaundice and kidney or liver diseases should not take this medication.

The Mini-Pill

What it does: The mini-pill is “mini” because it contains only progestins, as opposed to the combined pill that adds synthetic estrogen as well. Because of this, mini-pills work in a slightly different way. They put a damper on ovulation, but only in about half the women who take them. Instead, most mini-pill users stay childless because the pill builds up and thickens the mucus on their cervixes, making it difficult for sperm to get anywhere near the egg. In addition, mini-pills can also change the lining of the uterus so that eggs can't attach themselves. It might have an effect on the fallopian tubes as well, making eggs move slower on their way to the uterus.

What it doesn't do: STD prevention. Remember, we're talking about a hormonally based suppressant of the reproductive system functioning—not a physical barrier that prevents fluid and sperm from touching you. Without a barrier, you have no way to lower your risk of diseases like HIV, chlamydia or herpes.

How to get it: Prescription. Remember, as with most other prescribed contraception methods, your health care provider will probably require you to come in once a year for a routine pap smear and pelvic examination in order to get the prescription renewed.

Is it reversible? Very much so. Because it doesn't always affect the process of ovulation, the contraceptive effect of the mini-pill begins to wear off as soon as the hormone levels drop low enough for the cervical mucus to return to normal. This starts happening in as soon as 24 hours. If you stop taking mini-pills, you can be back into baby-making mode in a day or so.

Side effects: Mini-pill users often report problems with irregular periods or so-called “breakthrough bleeding” that happens when they shouldn't be on their period at all.
Who might benefit most: Women who can't handle the estrogen in the combination pill. This includes nursing mothers (estrogen can inhibit milk production; mini-pills don't), smokers (without estrogen, the risk of heart attack and stroke are much lower), and women who suffer from sickle-cell anemia (again, no estrogen means a lower risk of blood clots).

Who should consider a different method: Anyone who can't keep to an extremely tight schedule. Don't kid around with this one. If you aren't the well-organized type, mini-pills may not be for you. The effects of these pills wear off faster than those of combined pills, making it vitally important the mini-pill is taken same time, every day.

Injections & Implants

What it does: Like the mini-pill, both injections and implants contain only progestins—and no synthetic estrogen. Because of this, they have slightly different effects than the more common combination pill, which primarily works by stopping ovulation. Instead, injections and implants thicken the mucus that covers your cervix. This forms a protective barrier that sperm can't penetrate easily. At the same time, the progestins will also stop ovulation for some women. It can also change the makeup of the lining of your uterus, making it difficult for eggs cells to find a place to stick.

So why not just take the mini-pill? Frankly, injections and implants are less of a hassle to take correctly—and because of that, they have higher rates of effectiveness. Unlike the pill, where there is a possibility for human error every day, injections and implants only require you to show up at the right time at your doctor's office or clinic. Otherwise, what you do has no effect on how well they work. In most cases, both implants and injections are more than 99 percent effective.

What it doesn't do: As with all hormonal methods, there's no inherent protection against STDs. Implants and injections also can't be switched on and off easily. In the case of injections, you have to wait for the hormones to slowly leave your system before you become fertile again. If you change your mind on implants, you have to undergo a minor surgical procedure.

How to get it: Prescription only. In fact, these types of birth control can only be administered by a trained professional. The most common injection is called Depo-Provera, and must be taken every three months. An implant called Implanon, which was approved by the FDA in July 2006, can be used for up to three years at a time.

Is it reversible? Yes. But again, switching gears isn't as simple as stopping a pill. In the case of injections like Depo-Provera, it might take six months or more before you return to normal fertility. You can get pregnant very quickly after removing Implanon, but it must be removed by a medical professional. If you happen to get pregnant while on Depo-Provera, it's likely that your baby will experience low birth weight. However, there is no evidence of any long-term problems.

Side effects: Weight gain and acne are common, as are irregular periods—particularly during the first year of use. In addition, research has shown a link between Depo-Provera use and loss of bone mineral density. Research also suggests a possible increased risk of acquiring sexually transmitted infections. To see if you're comfortable with the side effects before you commit to the long haul, have your doctor, nurse practitioner, or physician's assistant prescribe a pill that uses the same type of progestin for a couple of months.

Who might benefit most: Women who don't want to bother with taking a pill every day, particularly if they know they don't want to become pregnant for a long time (if ever), but aren't interested in sterilization. The injection can also be extremely helpful for women who, for whatever reason, are concerned about their privacy. It’s the only type of birth control that exhibits no indication of use. There's nothing to feel under your skin and no external pills or devices to find.

Who should consider a different method: Women who aren't comfortable with irregular and/or nonexistent periods. If you have personal or cultural feelings favoring monthly, predictable periods, this may not be the method for you.