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.
The Birth Control Patch
What is it?
The patch is a small, beige band-aid-like patch that you put on your skin weekly. Commonly called Ortho Evra (its brand name), it sticks to your skin and releases both estrogen and progestin. A new one is put on once a week for three consecutive weeks, and then you go patch-free for a week during which you have your period.
As for the appearance of the patch, it’s a very small rectangle (20 by 20 cm) that looks just like a band-aid, and you can put it on your upper arm, abdomen, back, or butt. It’s important not to put it somewhere that will be rubbed against tight clothing, such as near the waistband of your pants, because it is possible for the patch to fall off. If the patch does fall off, it is like missing a pill—you may not be protected against pregnancy and must put a new patch on. You can find out what exactly you should do in this case here on the Ortho Evra website.
How much does it cost?
About $15-$80 per month, according to Planned Parenthood.
Is it for you?
According to the Ortho Evra website, “you will be exposed to about 60% more estrogen if you use Ortho Evra than if you use a typical birth control pill containing 35 micograms of estrogen. In general, increased estrogen may increase the risk of side effects,” such as blood clots. If you are afraid of or more susceptible to blood clots (for example, if you have a blood clotting disorder like Thrombophilia or are obese), have not reacted well to high-estrogen forms of birth control in the past, or would be bothered by the feeling or appearance of a patch on your skin, then the patch may not be right for you.
The Vaginal Hormonal Ring
What is it?
The ring is flexible and about two inches in diameter (about the size of a bracelet). Often referred to as the NuvaRing (its brand name), the ring contains both estrogen and progestin hormones so it functions in the same way as the Pill and has the same potential side effects and risks. What is different about the NuvaRing, however, is that it contains a lower dose of hormones, released continuously.
You insert the ring into your vagina much like a tampon, keep it in for three weeks, and then remove it for a week during which you have your period, and then after the fourth week you insert a new ring and the cycle starts over. The ring is very easy to insert—there is no “wrong” placement of it once it’s in, it can’t get stuck or lost inside of you, and you cannot feel it when it is inside of you. If you do experience discomfort, you can shift it or reinsert it.
You can have the ring in while having sex or wearing a tampon and it shouldn’t interfere, but if it does the ring can be removed for up to three hours without affecting you. It is also possible for the ring to accidentally come out during sex or with the removal of a tampon, which is okay as long as you reinsert it within three hours.
How much does it cost?
Roughly $15-$80 per month, according to Planned Parenthood.
Is it right for you?
If you’ve experienced trouble with birth control that contains a higher dose of hormones, you may find that your body reacts better to the lower-dose ring. Additionally, if you are opposed to the idea of taking a pill every day or changing a patch every week, the ring may be a better fit for you. That being said, you do still need to remember to take the ring out after three weeks and insert the new one a week later, so conscientiously marking your calendar is a must.
“I’ve been using the NuvaRing for 2 years now and it has been a great fit for me,” says Hyanna, a collegiette at Emmanuel College. “I hated having to remember to take my BC, setting alarms, and remembering to carry it around! The ring is a perfect alternative for girls who find those little things super annoying.”
For Kayla*, on the other hand, the ring was not a good match. She tried it after a bad experience on the Pill and says that although it was nice to have to take a pill every day, “putting the NuvaRing in and taking it out was kind of gross and difficult to do.” So, ladies, if you hate putting in tampons and getting a little up close and personal with yourself, you might not like the ring.
Kayla says that she also felt groggy while taking it and it made her gain weight, so she ultimately went off of it and is now taking a different brand of the Pill that she likes better, reinforcing the idea that finding the right birth control can require some trial-and-error because everything works differently for every girl.
The Contraceptive Injection
What is it?
The contraceptive injection is a shot given to you by a health care provider once every three months. Mainly referred to by its brand name, Depo-Provera, or “the birth control shot,” this method of birth control only contains progestin, delivered in a shot that protects you against pregnancy for twelve weeks following the injection. You must keep getting a shot every three months for as long as you want to be protected against pregnancy.
According to Planned Parenthood, the most common side effect of the shot is irregular bleeding, particularly during the first half to full year of use. Most women experience fewer and lighter periods, or no periods at all (Planned Parenthood cites that one half of women stop having their periods completely after one year of taking Depo Provera), while some experience longer, heavier periods or increased spotting.
How much does it cost?
$35-$100 per injection, according to Planned Parenthood, but there could be additional exam fees depending on your health care provider.
Is it for you?
There is a bit more to consider when deciding if the shot is for you compared to some of the other forms of birth control. If needles make you queasy, or you have trouble making and keeping appointments that are scheduled in advance, or if you won’t be able to get to a health center every three months, the shot is probably not for you. You must also consider whether or not you will like having much less frequent periods—sounds like a dream for most girls, but others, such as Bryant University collegiette Hillary, are turned off by this side effect.
Hillary started the Depo Provera shot after she began taking anti-seizure medicine, which interfered with the birth control pill she was on. She did not react well to the shot, however, and two weeks after her first one she got a severe migraine that lasted seventeen days. “Needless to say… my body did not like it,” she says. “The way it works is very difficult for your body to handle. It puts 3 doses of BC in you at once, you never get your period… I am not a fan of not getting my period (I like a sense of relief once a month, and it is your body’s natural routine).”
Ashley*, on the other hand, has had a great experience with the shot, which she switched to after being on the Pill because she found that she could never remember to take it every day.
“Once every three months, I would swing by student health and a nurse would give me a quick shot in my hip, she says. “It was the easiest shot I’ve ever had—it felt like a pinch, and there was no bruising or swelling in the aftermath. I would schedule my next appointment for three months out, but if something came up, there is a 2 week window during which you can still get your next shot without any consequences.”
Ashley adds, “The best part about Depo was that I never got my period,” which just goes to show that every girl has different preferences. “For the first few months I had some spotting, but eventually my period disappeared completely. I thought this was great—I never had to buy tampons or worry about staining my clothes. Some of my friends have told me it would scare them not to get their period, but since I know I was using a reliable birth control method, I was never worried.”
Yannaccone, however, points out that “there is still question with the shot as to how it affects some women’s bone density… it still has a black box warning that says you should get re-evaluated after two years of being on it.” She adds that “with Depo Provera, it can take a longer time when you get off until you can conceive,” compared to other methods. For these reasons, Yannaccone feels better about the following LARC methods.
The Birth Control Implant
What is it?
The implant (brand names are Implanon and Nexplanon) is a thin, plastic rod about the size of a matchstick that’s inserted into your arm by a health care provider. Your arm will be treated with an anesthetic before, so little pain will be felt during the insertion, which usually takes no more than five minutes. You won’t see the implant once it’s in (although there is a slight risk of developing a scar at the insertion point), and you can’t feel that it’s in your arm unless you press against the area.
Like the shot, the implant only contains progestin, and likewise tends to produce fewer or lighter periods—“after one year, 1 out of 3 women who use the birth control implant will stop having periods completely,” Planned Parenthood says. The difference between the shot and the implant is that the implant lasts for three years as opposed to just three months, requiring even less frequent trips to your health care provider.
How much does it cost?
According to Planned Parenthood, “The cost of the exam, the implant, and insertion ranges from $400–$800,” but remember that is a one-time cost every three years (for as long as you keep getting the implant). Removal costs between $100 and $300.
Is it for you?
If you’re looking for a LARC method but are scared by the shot or want something that lasts longer and would rather have a mechanism inserted in your arm (as opposed to your hoo-ha like the IUD), then definitely talk to your health care provider about the possibility of getting the implant.
The Intrauterine Device
What is it?
An intrauterine device, or IUD, is a small, T-shaped mechanism that is inserted into your uterus by a health care provider, a process that may cause you to feel some cramping or mild discomfort that could last a few days.
IUDs are available in two brands in the U.S—ParaGuard and Mirena. According to Planned Parenthood, Paraguard contains copper instead of hormones and it lasts up to 12 years, where as Minera releases progestin and is effective for 5 years. After the specified number of years, you get the IUD removed by your health care provider.
Once the IUD is in, a one to two inch string will hang down into the vagina so you can always ensure it is still in. It is possible for an IUD to slip out of place, especially in the first few months or during your period, so it is important to check for the string end (by inserting a finger into your vagina until you feel the string coming through) every few days and go to your health care provider if you cannot feel it or it has moved. Regardless of whether or not you feel the string, you should have a check-up after your first period and then regular check-ups every few months after that to make sure it’s all okay in there.
There are rare problems that can arise with the IUD. Aside from it potentially slipping out, there is also the chance of developing an infection if bacteria enter the uterus during insertion. It is also possible for the IUD to push through the wall of the uterus when it’s inserted, which can usually be fixed immediately but could require surgery.
How much does it cost?
$500-$1,000, according to Planned Parenthood—but since it can last up to either 5 or 12 years, it is the least expensive method over the long term.
Is it for you?
Like all the other methods, IUDs are not for everyone. Anyone who has or may have an STI or other pelvic infection, cervical cancer, unexplained vaginal bleeding, severe liver disease, or an allergy to copper (if opting for ParaGuard) should not use an IUD. And as with the shot and implant, if you want a regular, monthly period you should opt for a different method.
Chelsea Niewald from the University of Montana has now had the Minera IUD for a year and plans to use it until the five years is up, despite an initially painful experience. “The initial insertion of the IUD was slightly painful, but the month of cramping afterward was the worst part for me… I had cramping for a good 5 weeks, some cramping made me stop in my tracks due to the pain,” she says.
But don’t be totally scared away—“Now, I don’t even know I have it in,” she says. She no longer gets her period but explains, “I’ll get the occasional cramping for one or two days like I would have normally when I had my period. She adds, “Overall, I have enjoyed the Mirena IUD experience… the only fear I have is having scar tissue form around the IUD, making it more difficult to remove. That’s why it’s important to go see your doctor every few months so they can monitor it.”
While IUDs do have potential side effects and require check-ups, they are the most hassle-free, cheapest option for girls looking to be on birth control for an extended period of time—a definite pro. “If you have an IUD put in, it’s good for five years… you don’t even have to think about birth control for five years, which is absolutely wonderful,” Yannaccone says, which also means that it’s more effective because girls don’t need to remember to stay on a certain schedule to activate their birth control. Additionally, girls who are wary of altering their levels of hormones may find the copper IUD to be their best bet, as this is the only hormone-free method besides barrier methods.
Now that you’ve been completely inundated with the deets on the many different birth control methods out there, all that’s left for you to do is have a good, long talk with your doctor or gynecologist so you can really zero in on the right form and brand for you. Don’t stay in an unhappy relationship with your BC—find one that treats you right.
|Pill||Daily||$15-$50 per month||Estrogen & Progestin or Progestin-only||Many different options (different brands, dose of hormones, effect on frequency of period) to choose from based on your preferences||Must remember and be diligent about taking it every day around the same time – more room for user error|
|Patch||Weekly||$15-$80 per month||Estrogen & Progestin||Requires less frequent action than the Pill, easy and painless to put on and take off||Visible on your skin, can fall off, must remember to change it weekly, exposes you to 60% more estrogen|
|Ring||Monthly||$15-$80 per month||Estrogen & Progestin||Requires less frequent action than the Pill or patch, lower dose of hormones||Must remember to take it out/put new one back in on the right day, may not like feeling of putting it in/taking it out, can slip out during sex/tampon removal|
|Shot||Every 3 months||$35-$100 per shot||Progestin||Lasts 3 months, fewer or no periods||Must go to health care provider every 3 months, effect on bone density still in question, may take longer to get pregnant after stopping it|
|Implant||Every 3 years||$400-$800 per implant||Progestin||Lasts 3 years, not visible in your arm, fewer periods||Can feel it when you press on the area, might get tiny scar|
|IUD||Every 5-10 years||$500-$1,000 per IUD||Progestin (Mirena) or none (ParaGuard)||Longest lasting option, considered most effective, least expensive in th elong run, non-hormonal option||May initially cause cramping, could slip out/cause infection/ require surgery if provider inserts it improperly|