There are a lot of pills out there. But when people talk about the Pill, you know exactly what they mean. When it was first approved by the FDA in 1960, the contraceptive pill was not only a huge step in preventing unwanted pregnancy, it was also a huge step in the women’s liberation movement. Fast-forward 50 years, and it’s still the most popular hormone-based birth control on the market – so much that the words “birth control” are almost synonymous with that little circular pack of pills. But these days, we have more options. So many, in fact, that it can all get pretty confusing. But don’t worry – if you’re considering getting birth control (but don’t know where to start), if your busy lifestyle has you struggling to remember to take a pill at the same time every day, or if you’re just confused or curious, Her Campus is here to give you a run-down of a few of the lesser-known hormonal birth control methods.
So what is the deal with all those other kinds? Is getting a shot or putting a little square sticker on your arm any better or worse than popping a daily pill? The truth is, all hormone-based birth control methods can have side effects, and you just can’t know how they will affect you until you try it. But the potential benefits (think cost-effectiveness, simplicity, and fewer periods) are enough reason to do a little research. Whatever method you pick, you owe it to yourself, (and your feminist ancestors who fought to get those first packs of pills on the market 50 years ago), to know what’s out there before you decide.
The patch (Ortho Evra)
Essentially a little square sticker of hormones that you attach to your body, the patch has been around for a few years, but isn’t quite as well known as the Pill. But of all the methods covered here, the patch is probably the most similar to its popular predecessor. Like the Pill, it uses the hormones estrogen and progestin to prevent pregnancy, and it’s about as effective as the Pill when used correctly. Also like the Pill, the patch needs to be replaced on time (once a week) to be the most effective. The biggest difference is how much you have to remember to do – if taking a pill at the same time every day is a problem for you, replacing a patch once a week could be a good alternative. “I wanted to be on birth control to regulate my periods but was terrible at swallowing pills, so I wanted to try an alternative,” says Rachel, a senior at Northeastern University who was on the patch for about a year. “I liked that I didn’t have to remember to do anything; it was simply on my back and all I had to do was switch it three times a month.”
Lisa Jackson-Moore, M.D., an OBGYN working in North Carolina, says the patch’s slightly higher levels of estrogen can sometimes cause different side effects. “Sometimes in my experience, when folks are starting the patch, they tend to be more prone to having bleeding irregularities more so than when the Pill starts,” she says, “but usually that resolves within a couple of cycles.”
But while the patch could be an easy solution, its constant presence and visibility are often a drawback. “The patch tended to slip around and wasn’t exactly comfortable,” Rachel says. “Mostly I’d forget about it, but sometimes the glue that held the patch on would stick to my clothes or jeans, which was pretty aggravating at times.” A few other possible side effects exist, too. “Sometimes folks will have a reaction to the actual patch itself, but that’s pretty rare,” Jackson-Moore says. “For the most part, if you have a young active woman, the patch should stay on, so that shouldn’t be an issue.”
While Rachel ended up switching to the Pill once she realized that the pills aren’t hard to swallow, there are aspects of the patch that she misses. “In all fairness, despite the alarm on my phone, I’m pretty terrible at remembering to take my pill, so I miss the patch in that sense. But having something sticky on my back wasn’t always my favorite, especially in the summer months when I was in a bikini or tank top!”
Pros:Less to remember than the Pill, often causes more regular, lighter, or shorter periods, inexpensive ($15 to $50 a month).
Cons: Stickiness, visibility, can be less effective for larger women.
Vaginal ring (Nuvaring)
The Nuvaring is a small, flexible ring that you insert into your vagina once a month, taking it out for the last week so that you can have your period as usual. It’s about as effective as the Pill or the patch. But with even less to remember than the patch, the Nuvaring might be a good choice for busy or forgetful college women. “I was struggling to remember to take a pill everyday consistently and as soon as I mentioned this to [my doctor], she recommended the Nuvaring,” says Jessica, a sophomore at Carnegie Mellon University. And even though the Nuvaring uses the same hormones as the patch and the Pill, the hormones in the Nuvaring are concentrated in the pelvis, meaning they don’t affect other body systems as much. “I’ve found that some women who didn’t do so well with the birth control pills tend to have less side effects with the ring,” says Jackson-Moore.
While the possibility of the Nuvaring slipping or falling out is real, it’s actually pretty rare. “I never had any problems; it slipped out maybe once in 3 years,” Jessica says. You can even keep the Nuvaring in during sex, and it should stay in place. “In a young college woman who hasn’t had any children, probably it falling out is less of an issue,” says Jackson-Moore. “It’s pretty easy to use, and it’s very easy to place. You don’t have to worry that you’ve put it in incorrectly. It’s pretty idiot-proof, I think.” Especially for a busy college woman, the Nuvaring is often a good alternative to the daily pill. “I find in young women who are in school, probably methods like the Nuvaring are more attractive to them because it’s easy to use and the side effect profile is really good,” says Jackson-Moore.
Pros:Less to remember than the patch or the Pill, fewer side effects, invisible, inexpensive ($15-$50 a month).
Cons:Possibility of slipping out
Intrauterine Device (IUD)
The IUD is a small, T-shaped device that a doctor inserts into the uterus. The most common kind, Mirena, releases the hormone progestin, but also works by directing sperm away from the egg. If your body reacts strongly to estrogen-based birth control, your doctor might recommend a progestin-only method like the IUD. One of the newest forms of birth control, an IUD is also one of the most effective methods – largely because it’s so simple. No patch, ring or pill to keep track of: Just get it inserted once and you’re done for sometimes up to 12 years. “I don’t have to worry about picking up a prescription or about getting refills,” says Jessica, who switched from the Nuvaring to an IUD after her sister got one. “And it lightens your period tremendously – which was the biggest selling factor for me because I suffer from painful ones.” Jackson-Moore says this is a big benefit of the IUD for many women. “If you have a young woman who’s had really bad cramps, the local effect of the hormones makes the cramping better,” she says.
The major downside is initially getting an IUD. Not only do you have to cough up a huge chunk of cash, but you also have to get the IUD inserted by a doctor, which is a more invasive procedure than other methods. “It wasn’t the most pleasant experience, “Jessica admits. “It didn’t really hurt because I got a numbing shot. You feel pressue, but the procedure takes about 10 minutes, so it’s really not bad. Having a great gynecologist really, really helps.” And, while more serious side effects are rare, there is a bit more of a risk with an invasive procedure compared to a method like the Pill. Before you get the IUD inserted, your doctor will warn you about the possibility of the IUD migrating through the uterine wall, and there’s also a larger chance of developing an infection. “I would caution folks to be very careful about making sure that their partner uses a candom,” Jackson-Moore says. But in most cases, especially with proper check-ups and monitoring of the device, that won’t be an issue.
Pros: Effective, very long-lasting, cost-effective over time, often leads to lighter and shorter periods.
Cons: Large up-front cost ($500 to $1000), has to be inserted by a doctor, rare but more serious possible side effects such as infection
The birth control implant is a matchstick-sized rod that’s inserted into the upper arm, using the hormone progestin to prevent pregnancy. Like the IUD, a birth control implant is extremely effective. It has to be inserted by a doctor, but the procedure is less invasive than the IUD and only takes a few minutes. “I’m really bad about remembering to take pills, and they’re only as effective as they’re marketed if you take them at the exact same time every single day,” says Katy, a freshman at Asheville-Buncombe Technical Community College who has had the implant for about five months.
While the implant does need to be inserted by a doctor, the procedure is simpler than the IUD. “The nice thing about it is it’s very easy to place, and it’s impregnated with hormone that’s slowly released, so it’s good for three years,” Jackson-Moore says. Katy says the procedure wasn’t bad. “You can’t feel it going in at all; the only thing that hurts is the whole numbing process,” she says. Having a tiny stick permanently inserted into your arm may sound like a strange idea, but “Your arm doesn’t look weird,” Katy says. “There’s a tiny itty bitty scar, but you can’t see it; you don’t notice it; it doesn’t bother anything.”
The major drawback to the implant is its tendency to mess with your cycle. “The only thing I don’t like about it is how it’s affected my periods,” Katy says. “I had consistent, regular periods up until I got the Implanon, but now my periods are wacky and all over the place.” Jackson-Moore says that this is more common with the implant than with other hormonal birth control. “The con with that is it really can be associated with some erratic bleeding,” Jackson-Moore says. “We always counsel patients that if that would be the deal-breaker, then you don’t want to have it placed.”
Pros: Lasts up to three years, super effective, less invasive than the IUD
Cons: Large up-front cost ($400 to $800), has to be inserted by a doctor, greater chance of erratic bleeding
The shot (Depo-Provera)
Another method of hormonal birth control is getting a simple shot every 12 weeks. This is also one of the most effective methods, and if you react strongly to estrogen, the shot only contains progestin. Amelia, a senior at UNC-Chapel Hill, switched to Depo-Provera in high school after the estrogen in the Pill caused problems for her. She’s now been on it for more than five years and has had a great experience. “I don’t really have any cons, for me,” Amelia says. “I’ve enjoyed it.” If decreasing or getting rid of your period is a huge attraction for you, the shot might be worth considering. “The longer folks stay on the Depo-Provera, they tend to have very light periods, and some women may not have a period,” Jackson-Moore says.
But that doesn’t mean that the shot is without its possible downsides. “If you are worried about getting pregnant, it might not be so great because you never get your period, so that might be a con for some people,” Amelia notes. So if you rely on that monthly reminder to reassure yourself that everything is working as it should, a method like the shot could cause more stress than it’s worth. The need for a doctor’s visit every few months could also pose some problems if you’re the jet-setting type. “It was hard going abroad because I had to take it with me,” Amelia says. But while you do have to make a visit to the doctor’s office every three months, one benefit to this method is that it’s very private. If you’re worried about your parents discovering your pack of pills or catching a glimpse of your patch, this method could be a discreet solution.
Pros: Very effective, long-lasting, does not contain estrogen, very private method of birth control, reduces periods.
Cons: Requires a doctor’s visit every three months, can be expensive ($35 to $75 per shot, plus exam fees), possibility of bone density loss over time because of higher levels of hormones
The bottom line
Some methods might be easy for you to rule out. If you have a phobia of needles for instance, then the birth control shot may not be right for you, or if you’re like my roommate who detests stickers, then the patch probably isn’t your best choice. But aside from that, Jackson-Moore offers one bit of advice that applies to everyone: “The best method is whatever she’s going to use correctly.” If one of these methods sounds like it could be best for you, do some research (Planned Parenthood and your school’s health center are both good options for more information). And of course, make sure you consult with a real doctor to help you decide what’s right for you. Luckily, with so many options out there, you’re bound to find a method that works for you.
Lisa Jackson-Moore, M.D., an OBGYN working in North Carolina
College women across the country