As collegiettes, we form countless love-hate relationships—with chocolate, Facebook, the gym, trashy TV shows, tequila… all the stuff that brings us pleasure and pain in one fell swoop. While in theory we could vow to cut ties with all these guilty pleasures, there is one source of love-hate that is often much more complicated to deal with: birth control. From dealing with prescriptions to potential side effects, birth control can come with some unwanted consequences, affecting girls in varying ways to different degrees.
What some birth control users don't realize, however, is that there are multiple methods of contraception out there and every girl reacts differently to each one. Even within each method, there are numerous brands and varieties that are not exactly the same. Whether you are unhappy with your current birth control or are looking to start birth control but don't know where to begin or what to expect, here’s the low-down on each method—with input from experts and real collegiettes—so that you can find the one that best suits you.
So you want to go on birth control or switch methods. Where do you begin? According to Dr. Traci Brooks, Director of Adolescent Health Services at Cambridge Health Alliance, “the starting point should be if she is interested in hormonal vs. non-hormonal contraception.” She explains that some women “just don't want outside hormones in their bodies,” or they may have illnesses or be taking medications that interfere with hormonal contraception. Illnesses such as kidney and liver diseases and certain medications used to treat seizures, diabetes, depression, and HIV are a few examples of what cannot be mixed with the hormones in birth control. You can check out a more comprehensive list here, but your health care provider will be able to determine whether nor not you’re able to use hormonal contraception.
Hormonal contraception—which includes options such as the Pill, ring, patch, and shot (we’ll get more into what these are in a bit)—contain estrogen, progestin, or a combination of these two pregnancy-preventing hormones. Birth control that contains only progestin is a good alternative for women who can’t intake estrogen (e.g., breastfeeding mothers, cigarette smokers over the age of 35, and women with high blood pressure or extreme migraines), but women who cannot or do not want any hormones in their birth control must opt for non-hormonal methods. With the exception of the copper IUD (again, read on to learn what this is), non-hormonal methods—particularly barrier methods such as condoms, diaphragms, and cervical caps—“tend to be less effective than hormonal methods because of ‘user error,’” Dr. Brooks says.
Rozalyn Yannaccone, Women's Health Nurse Practitioner at Bucknell University, explains that the effectiveness of the method is the most important factor for collegiettes to consider when choosing their birth control. “When I talk to students, I tell them all the options and the effectiveness of every option. If someone absolutely doesn't want to get pregnant then they need to choose the most effective method,” she says.
So what are the most effective methods? Yannaccone asserts that the less someone has to do to ensure that their birth control works every day, the less room there is for user error, or mistakes (such as a condom breaking, missing a pill, or forgetting to put a new ring in on the right day) that decrease the birth control’s effectiveness. “There is a new idea of what the most effective birth control methods are: LARC, or long acting reversible contraception,” Yannaccone says. LARC methods include the shot, the implant, and IUDs, all of which are described in depth below. “Long acting options are the ones that are going to give you really really good protection. It’s the direction that birth control is moving,” Yannaccone says.
Some final elements collegiettes must consider—especially if they want their birth control to be as effective as possible—are their personal preferences and lifestyle. “Perhaps someone who has very erratic hours may not do well with a pill that has to be taken at the same time every day, for example,” Dr. Brooks says.
Now that you know what to consider, let’s go over what your options actually are.
Daily, Weekly, & Monthly Methods
What is it?
The Pill is exactly what it sounds like—a pill, taken once daily. There are tons of different brands of the Pill. Each brand differs in hormones, price, and potential side effects, so you have to know the details to be able to choose the right one for you.
- Estrogen vs. progestin-only: if you are unable to intake estrogen, which your health care provider can determine, then you’ll want a progestin-only pill.
- Levels of hormones: each brand differs in the levels of estrogen and progestin they contain, varying from very low dose to high dose. Finding the right dose is usually a matter of trial and error.
- 21 vs 28-day packs: for 21-day packs, one pill is taken every day for three weeks, then none are taken during the fourth week (when you get your period), and then a new pack is started. The 28-day packs contain 7 extra pills that do not contain hormones (they are “reminder” pills or placebos), so you take a pill every day for 28 days and then start a new pack.
- Name brand vs. generic: Many name brand pills have generic counterparts. Generic versions are typically cheaper, and according to Yannaccone, just as effective. “Most insurance companies prefer you use the generic brands,” she says. If you are being prescribed a generic brand, Yannaccone advises that you ask to get a specific generic brand each time, rather than just any generic version of a particular name brand pill, to ensure that you are getting the same level of hormones every month.
- Extended cycle pills: some brands of the Pill are known as extended cycle pills because they contain fewer inactive pills, causing you to get fewer (usually only a few times a year) or shorter periods. Some brands contain no inactive pills, meaning you never get your period. Yannaccone assures us that these pills should not affect fertility and that if girls are not worried about getting their period less frequently, then it’s “not a problem… some extended cycle pills like Seasonale and Seasonique are excellent for women who get menstrual migraines or have a problem with heavy bleeding,” she says. Read this awesome HC article to learn more about this kind of pill and whether or not it’s right for you.
What do all of these differences mean? Different side effects and experiences for every girl.
Annie from the University of Chicago has been on four different brands of birth control and found that while some of the brands gave her nausea, her current brand has left her side-effect-free because it has a different hormonal composition than the others.
“A lot of girls I know have quit the Pill in general because the brand they were on made them really sick, so they were afraid to take up another brand and try again,” Annie says. “But what a lot of these girls don't remember is that because each Pill has a different composition, there will probably be another brand that works perfectly fine for them and the one faulty brand shouldn't scare them away from considering the Pill as a contraceptive.”
So if the first brand you try turns you into a crampy, bloated, moody monster, you shouldn't necessarily swear off the Pill forever—you might just need to try a different brand. How long should you wait it out before switching? “Most women adjust very easily to the Pill. I normally tell my patients that if they experience side effects their body will adjust by the third cycle. Spotting and bleeding or breast tenderness might persist for a few cycles. If by the third cycle they're still symptomatic, they might need a different pill,” Yannaccone says. “No one wants to stay on the Pill if they're nauseated, so that's something that I'll have them return for much earlier- sometimes within the first few weeks.”
Remember, as with all of these contraceptive methods, switching brands or methods is a relatively easy process. Yannaccone assures that when switching, “sometimes you have to use a backup [method of birth control, like a condom] for a couple of days… but it’s usually pretty easy to do that.” Just consult with your health care provider about making the switch to determine exactly when and how to do so.
How much does it cost?
Typically $15-$50 per month, according to Planned Parenthood.
Is it right for you?
“The Pill can actually give you very good protection, but you have to take it consistently every day,” Yannaccone says. She explains that current brands of the Pill are “not that forgiving, so if a woman misses 2 pills she is more likely to get pregnant.” Progestin-only pills must be taken at the exact same time every day, but pills with both estrogen and progestin should still be taken at around the same time to increase effectiveness and ensure that hormone levels remain consistent. “It's best to take [the Pill] no more than two hours before or two hours after your regular pill time,” Yannaccone says.
“Everyone who knows me is aware that I do not mess around with the Pill—I have an alarm on my phone!” Kelsey from Boston University says. “If you're going to forget [to take] the Pill, I suggest a different form of birth control.”
As long as you’re organized, conscientious, and diligent with taking your pill every day, and you find a brand that works for you, you’ll be good to go on the Pill. For the more absent-minded collegiettes, other options may better suit you.