A Guide To Navigating Birth Control

Enlarge this image Becky Harlan/NPR Becky Harlan/NPR

Birth control is so personal.

I'm a family physician, and I talk to my patients about birth control all the time. And the more I do it, the more I've come to realize that no two patients are alike. Choosing a method of contraception is a really intimate decision.

It's also a decision that's about way more than just birth control: It's about sex and relationships and all the baggage that comes along with those topics.

Here are five tips to help you think through your options and make a choice that's right for you.

If you want to compare different methods of birth control side by side, there's a handy chart at the end of this article!

1. Know the facts about (the many different kinds of) hormonal birth control.

Many people have concerns about hormonal birth control. They worry that it can cause weight gain or depression or decrease their sex drive. But most of these fears aren't grounded in science and come from much older versions of birth control pills with higher doses of hormones.

Today, there are lots of different options, but they aren't all created equal. And they definitely aren't one size fits all.

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"There are millions of different combinations of ways that a body could metabolize hormones," says Dr. Madeline Deutsch, an associate professor of family and community medicine at the University of California, San Francisco, and the director of UCSF Transgender Care. "Because of this, everybody's response to hormones is going to be a little bit different."

Most hormonal contraception options contain either progesterone alone or progesterone combined with estrogen. When used in birth control, they help prevent pregnancy and regulate periods. (Technically, birth control contains synthetic versions of estrogen and a class of hormones called progestins. There are lots of different types, each with a different name you might see listed on your medicine. We'll use the terms estrogen and progesterone to keep things simple.)

A wide variety of pills are on the market, each with a slightly different combination of estrogen and progesterone and with slightly different amounts of each hormone.

There are also several long-acting methods, such as the hormonal intrauterine device (IUD) and implant, that use much lower doses of progesterone than the pill. Both of these are devices that go inside your body — the IUD in your uterus, the implant under the skin in your arm — and prevent pregnancy. They're some of the most effective options out there.

If you don't have a good experience using one method, don't write off hormones entirely — there may be an option that works well for your body. There are also lots of non-hormonal methods. Keeping a diary of your symptoms can help you pinpoint what may be causing them, and then you can troubleshoot with your doctor.

"If you don't feel good when taking this, you should let me know immediately and we can try something else," Deutsch tells her patients.

Enlarge this image toggle caption Becky Harlan/NPR Becky Harlan/NPR

Here's more on the risks of (and the research behind) hormonal birth control.

If the risks of hormonal birth control have you feeling worried, there's a lot of research on it out there, and most of it shows that it's safe for most people.

There's no data that shows it causes depression — in fact, doctors will use birth control pills to treat a form of depression known as premenstrual dysphoric disorder. Birth control pills can also help protect against uterine and ovarian cancer. There's also no consistent link between use of hormonal birth control and decreased libido.

"People often overestimate the risk associated with contraception," says Dr. Melissa Gilliam, a professor of obstetrics and gynecology at the University of Chicago, a leading researcher on teens and birth control and founder and director of the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health.

Hormonal contraception can also have some meaningful benefits.

The pill and the hormonal IUD can also help regulate your period. This can really help people who have fibroids or endometriosis, which can cause heavy periods, anemia and pain. It's also an added bonus for people who don't like getting a period. Birth control pills can also help clear up acne.

"There is no medical reason for anyone to ever have a period when using any form of hormonal contraception," Deutsch says.

The most important thing is to talk to your health care provider about your full medical history before you start any hormonal birth control. The hormones in birth control can be risky for people with particular medical conditions.

For instance, methods that contain estrogen can be dangerous for people who smoke, have heart disease or have had a blood clot in the past. They also can be dangerous for people who have certain types of cancer, like breast cancer.

Ultimately, you know your body best. You never have to use a medication you're not comfortable with.

2. Do what's right for your body, not what someone else tells you to do.

Birth control has a controversial history in the United States. It has been used as a tool for eugenics. Even within the last 50 years, people with disabilities and people of color have been sterilized without their consent.

It's no surprise that many people are skeptical of what their doctors tell them about birth control.

"That does impact how people engage with medical institutions," says Mariotta Gary-Smith, a cultural sexologist and a founder of the Women of Color Sexual Health Network. "Folks do not trust the medical institution's ability to allow them to make their own decision."

Today, many people are pressured by their partners, friends or doctors into using types of birth control they don't want. This is called reproductive coercion, and unfortunately, it's really common. There are also lots of people who have a hard time accessing the type of contraception they do want to use.

Gary-Smith dedicates her sex education work to a philosophy called reproductive justice, which is "being able to control and determine for one's body the right to parent or not, the right to bear children or not, the right to engage in sexual behavior or not."

What does this all mean for you? Putting reproductive justice into action, Gary-Smith says, is all about being prepared.

She recommends you do your own research about your birth control options using trusted websites like Bedsider.org or Advocates for Youth. She also suggests that when going to doctor's appointments, you bring along a friend or family member who can help you ask questions and act as an advocate.

"Take ownership of your body," Gary-Smith says. "Share with the medical professional, the doctor: 'These are the things I'm concerned about.'"

There are so many different types of contraceptives — thinking about how birth control will fit into your daily routine can help you decide which option is right for you.

3. Think about how different types of contraception might fit into your life.

So many birth control options are out there — how do you even begin to choose the right one?

Ask yourself some questions about your daily life, your relationships and your personality.

"You will always do best with the method that you'll use," says Gilliam, the University of Chicago gynecologist.

Certain methods of birth control require daily use or keeping track of them on a calendar. Gilliam calls this phenomenon "use behavior" — that's what you have to do every day when you're using a particular method.

Condoms are a great example. They're the best method for preventing sexually transmitted infections, but of course, you have to actually use them for condoms to work.

About 13% of people using condoms that go on a penis become pregnant within a year. For comparison, fewer than 1% of people using the hormonal IUD or the implant become pregnant while using these methods. Researchers speculate that condoms' high failure rate is because the "use behavior" can be difficult for people.

Another example is fertility awareness, where you track your cycles and abstain from sex when you're most likely to get pregnant. The failure rate for this method ranges from 2% to 23%. (That wide variability is because it can be difficult to study, since it's challenging to put patients in a controlled trial comparing fertility awareness with other methods, since the chance of unintended pregnancy is so high.)

If you love routines or have no problem remembering to take a pill, one of these short-acting methods may be perfect for you. An important benefit is that you can stop them whenever you want if you don't like the method or if you're thinking about pregnancy.

But if you have a hard time using them consistently, short-acting methods become less effective at preventing pregnancy. In that case, a long-acting method might be a more effective choice.

Enlarge this image toggle caption Becky Harlan/NPR Becky Harlan/NPR

4. Considering pregnancy? Factor that into your decision.

If you're using contraception to prevent pregnancy, thinking about if and when you might want to become a parent can help you think through your choices.

For example, if you know you want to conceive in the next year or so, you or your partner may want to consider a short-acting method, so you can stop using it exactly when you're ready.

But if you know it'll be at least a few years before you want to become pregnant, Gilliam says a long-acting method such as the IUD or implant may be a better fit.

"The IUD is one of the most effective methods of birth control," Gilliam says. "It takes out all of that remembering. You can just forget about it, and you can forget about it for years."

If you know that you don't want to have kids at all or that your family is complete, the IUD and implant are still good options. You may also want to consider permanent sterilization: For people with a uterus, that's a tubal ligation, and for people with a penis, that's a vasectomy. Both are surgeries that should be considered permanent, although there have been cases of successful reversals.

There are plenty of people, however, who use short-acting methods for years. If it works for you, it works! It's also totally OK to use an IUD or an implant for only a few months.

Enlarge this image Becky Harlan/NPR Becky Harlan/NPR

5. Stay in touch with your health care provider.

Just as you have the right to start whatever kind of contraception is right for you, you also have the right to stop it.

"People have the right to make their decisions as they see fit," says Gary-Smith. "The patient is the one that gets to make that choice."

For the short-acting methods, that's usually as simple as just stopping. When you stop birth control pills, the vaginal ring or the patch, you can usually get pregnant within a few months. Depo-Provera shots — they're a type of progesterone injection — can take a few months to leave your system.

Stopping a long-acting method may take a little advance planning, since you'll need a doctor or nurse to remove an IUD or implant. It's usually a quick procedure done in an office, but very rarely it does require an ultrasound or a referral.

If you're using a long-acting method and you're worried you'll lose your insurance, you can always go to a community health center or Planned Parenthood to get it removed for a low fee or for free.

Gary-Smith does recommend you make a plan for your next steps after discontinuing birth control. If you're trying to conceive, talk to your doctor about staying healthy in pregnancy.

And if you still want to prevent pregnancy, make an appointment to discuss your other options. Plenty are out there.

"Keep asking questions," Gary-Smith says. "There is no dumb question. There never will be a dumb question."

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The contraceptive models pictured in this article were created by Hello Greenlight, a sexual health initiative from the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), a research center at the University of Chicago. Ci3 develops innovative community and clinic-based interventions to advance the health and assets of young people.

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The audio portion of this podcast was produced by Audrey Nguyen.