Benefits and Risks of the Top 5 Most Common Prescriptive Birth Control Methods

As of 2019, approximately 65% of U.S. women aged 15–49 were using a contraceptive method. The most common contraceptive methods currently used among women are Oral Contraceptives and Long-Acting Reversible Contraceptives (LARCs).  

Whether you're thinking of trying a new birth control method or simply wanting to learn more about what's out there, here's what you need to know about the benefits and risks of the top 5 most common prescriptive birth control options.

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What is Birth Control?

Birth control is a method in which contraception is avoided. This can be through abstinence, barrier method, natural family planning, sterilization, or one of the varieties of prescription contraceptives. There are many forms of birth control to choose from when deciding which method is best for you. The top 5 most common prescriptive birth control options are oral contraception-combination pills, progestin-only pills (POP or minipills), copper IUDs, hormonal IUDs, and implants.

Oral Contraceptives Combination Pills

Combination pills come in various hormone dosages and different mixtures of active and inactive pills in the monthly packets. They work by preventing the ovaries from releasing an egg, slowing an egg down in its movement through your fallopian tube while also thickening cervical mucus and thinning the lining of the uterus. All of which prevent sperm from meeting an egg for fertilization.

Benefits

• 99% effective when taken perfectly.
• Relief of Premenstrual Symptoms (PMS).
• Reduces acne.
• Consistent periods.
• Lighter and shorter periods.
• Reduces symptoms of endometriosis and PCOS.
• Lowers risk of cancers-ovarian, endometrial, and colorectal.
  

Risk

• Irregular bleeding patterns within the first few months.
• Increased risk of stroke, heart attack, or clots.
• No protection against sexually transmitted infections.
• Possible increased blood pressure.
• Potential drug interactions that may reduce birth control efficacy.
• Liver and gallbladder conditions- Ex: higher incidence of adenocarcinoma, gallstones, intrahepatic cholestasis, dyslipidemia.
• Nutrient deficiencies- B2, B12, B6, Folate, Zinc, Magnesium, and Selenium.
  

Oral Contraceptives Minipill (progestin-only pills)

The minipill works the same as the combination pill, minus the consistent suppression of ovulation. Minipills, are the same amount of progestin throughout the month, and all pills are active.

Benefits

• Menstrual bleeding was reduced.
• A good alternative if you have a health condition that prevents you from using combination pills.
• Can be used immediately after giving birth (unless breastfeeding).
• Can be used within 3-6 months of starting breastfeeding.
• Easily reversed method if you plan to conceive.
• Reduced dysmenorrhea.

Risk

• Potential medication or supplement interactions (always consult your doctor on everything you are taking).
• Smoking while taking can increase your risk of heart attacks or stroke.
• Does not protect from sexually transmitted infections.
• The failure rate of the minipill is thought to be higher than that of other hormonal contraceptive methods.

Things to Look Out For

Both options of oral hormonal contraception have side effects that should be considered when deciding what is best for you.

Combination pills are not deemed suitable for those that have: breast cancer, high blood pressure, cardiovascular disease, heart disease, migraines with an aura, liver disease, are a smoker, have unexplained uterine bleeding, or have just given birth.

Minipills (Progestin-only birth control) should be avoided if you have: breast cancer, liver disease, unexplained uterine bleeding, or take anticonvulsant or anti-tuberculous medications.

Both options require that you take them daily and, at the same time, to be effective.

The mini-pill is more time sensitive- if you skip a pill or take a pill more than three hours late, it is advised to use a secondary form of contraception, like a condom, for the next two days if sexually active.

Potential Side-Effects

The side effects of the combination pill and progestin-only are similar. Both can result in irregular bleeding within the first few months of starting, breast tenderness, weight gain, headaches, and depression.

Combination pills have additional side effects of bloating and nausea, whereas POP can lead to increased acne, hirsutism, ovarian cysts, and decreased libido.

Copper Intrauterine Devices (IUDs)

Copper IUDs, also known as non-hormonal IUDs, is a long-acting reversible contraceptive option. The small T-shaped device is coiled in copper, the active ingredient preventing sperm from meeting an egg during a fertile window. The only Copper IUD that is FDA-approved is Paraguard®, which is effective for up to 10 years after placement.

Benefits

• It's hormone free.
• Your menstrual and ovulatory cycle is unaffected.
• No daily pill and it is effective for up to 10 years.
• It can be removed anytime.
• No risk of blood clots or related hormonal birth control side effects
• It can be used while breastfeeding.
• Approved for emergency contraceptive use if placed within five days of unprotected sex.
• Intrauterine Devices have an effective rate of almost 100%.

Risk

• Heavier periods and more extended periods at first.
• Initial spotting in between periods.
• If you do conceive, there is a high risk of ectopic pregnancy.
• Does not offer protection from sexually transmitted infections.
• Risk for pelvic inflammatory disease (PID).
• Risk for anemia.
  

Things to Look Out For

Common side effects of using a Copper IUD are cramping, back pain, vaginitis, and severe or heavy menstrual bleeding. If these symptoms do not resolve within a few months after the IUD is placed, it is best to consult with your doctor. There is also a small chance of expelling the IUD.

Like all forms of medication, this is not the correct choice for everyone. Paraguard is not appropriate if you have uterine fibroids, pelvic infections or PID, uterine or cervical cancer, unexplained vaginal bleeding, you are allergic to the device, or you have a disorder that causes copper to accumulate in your liver, such as Wilson's disease.

Hormonal Intrauterine Devices (IUDs)

Intrauterine devices can also be hormonal in the form of Progestin releasing. These T-shaped devices release progestin into the uterus, which blocks sperm from meeting an egg during ovulation by thickening cervical mucus while also stopping an egg from leaving the ovaries. Examples of hormonal IUDs include Mirena, Skyla, Kyleena, and Liletta. Although each brand releases the same hormone, Progestin, the dosing differs. Each brand has its own lifespan, ranging from 3-8 years.

Benefits

• Convenient.
• Fertility returns once IUD is removed.
• Decreases painful and heavy periods.
• It can reduce symptoms of endometriosis and PCOS.
• Mirena and Liletta can be used as emergency contraceptives if placed within five days of unprotected sex.
• Intrauterine Devices have an effective rate of almost 100%.

Risk

• Does not protect against sexually transmitted infections.
• IUD can dislodge from the uterus, although this is rare.
• If you do conceive, there is a high risk of ectopic pregnancy.
• Risk for ovarian cysts.
• Risk for pelvic inflammatory disease (PID).

Things to Look Out For

Common side effects of hormonal IUDs include spotting, initial cramping after device placement, and irregular periods. Some women will experience amenorrhea, which can be expected while the device is in place.

While using either form of IUD, you should not use a menstrual cup. It is also possible to get an infection during IUD placement or improper placement that requires surgical removal. You should always keep track of the IUD string that hangs from the end of the T-shaped device. If the string ever seems shorter or you can feel the bottom of the IUD, consult with your doctor. There should not be pain during sexual intercourse or pain in your lower abdomen. If either of these occurs, seek care.

Implant

This long-acting reversible contraceptive is a rod-shaped device, about the size of a matchstick, placed subdermally into your upper arm. You may sometimes hear these referred to as "arm bars." It releases small amounts of synthetic progestin in the form of etonogestrel. The only FDA-approved implant is Nexplanon, which lasts up to 3 years. Like an IUD, an implant prevents sperm from reaching an egg while also stopping an egg from being released from your ovary. A systemic review of etonogestrel subdermal implants revealed an almost 100% effective rate, with 0 to 1.4 unintended pregnancies per 100 users. Although very effective, this study also revealed that continuation rates decline after one year of use primarily due to abnormal menstruation.

Benefits

• One of the most effective birth control methods (>99% effective).
• Easy to use. One-time placement and can be removed.
• Effects are reversible once the implant is removed.
• Lighter periods.
• Reduction in painful periods.

Risk

• Vaginitis.
• Bruising or irritation at the implant site.
• Potential interaction with other medications.
• Mild insulin resistance.
• Increased risk of ovarian cysts.
• Does not protect against sexually transmitted infections.
• If you conceive with the implant in place, there is a higher chance of an ectopic pregnancy.

Things to Look Out For

The most common side effects of Nexplanon are irregular menses, weight gain, depression, and pain. You may also experience headaches, abdominal or back pain, decreased sex drive, nausea or upset stomach, dizziness, and acne. See the list of other uncommon side effects here.

Placing an implant is an outpatient procedure and only takes a few minutes. Typically a local anesthetic is used for the procedure. After placement, you will need to keep the area covered with a bandage for five days. You may experience some discomfort at the site, such as bruising, pain, or bleeding. It is best to contact your provider if you have any additional symptoms or concerns.

Functional Medicine Labs to Test When Considering or On Birth Control

If you are concerned about hormonal imbalances or possible reactions to birth control, here are some laboratory testing options to consider.

DUTCH Cycle Mapping + Complete

DUTCH Complete is the gold standard for testing when it comes to getting pulsatile readings of sex hormones and their metabolites. DUTCH Cycle Mapping gives us a pattern of progesterone and estrogen, which can also reveal information relevant to symptoms you may be experiencing, such as PMS. If you are considering starting some form of LARCs or oral contraceptives but have a hormone imbalance condition, these tests could aid in the decision-making of the best form of birth control for you.

Micronutrient

Micronutrient testing is a valuable tool, as combination hormonal birth control is known to deplete vitamins and minerals, particularly B2, B12, B6, Folate, Zinc, Magnesium, and Selenium. Micronutrient testing can help your provider individualize supplementation as needed.

CMP

Obtaining a Comprehensive Metabolic Panel (CMP) and a Lipid Panel can give insight into how well your liver is functioning and if there is any area of concern that would make you ineligible for one of these forms of birth control. A study published in the Journal of Sexual Medicine suggests that the long-term use of oral contraceptives may cause gene expression changes in Sex Hormone Binding Globulin from the liver. There is some evidence that women with NAFLD (non-alcoholic fatty liver disease) could have an increased chance of lobular liver inflammation. Another study out of Iran concluded that low-dose oral contraceptives could lead to dyslipidemia. Therefore, monitoring liver & lipid status while on long-term use of birth control may provide insight into changes.

CBC

Obtaining a CBC is always helpful to ensure no pre-existing anemia is present before starting birth control. It's also helpful in monitoring the potential side effect of anemia caused by using a Copper IUD.  

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Things to Focus on While On Birth Control

The following areas are helpful for those on Birth Control:

Nutrition

The Mediterranean Diet has shown promising results in supporting reproductive health and well-being. Consuming nutrient-dense foods that help replenish nutrient deficiencies that birth control can deplete is essential. When eating for hormone health, it is important to focus on:

• Fiber-rich fruits and vegetables, including berries, beans, oatmeal, sweet potatoes, and cruciferous vegetables like broccoli, cauliflower, and brussel sprouts.
• Fatty Acids- wild-caught fish, olive oil, nuts, avocado, flax, and chia seeds.
• Balanced whole food macronutrients- a variety of protein, fats, and carbohydrates.
  

Supplements

Multivitamin: Choosing a quality multivitamin and B-vitamin complex would be helpful if replenishing nutrients depleted by contraceptives. It is best to consult with your functional medicine practitioner for a recommendation.

Anti-Inflammatory Herbs: If you suffer from persistent side effects of birth control, such as painful periods or PMS, you may also benefit from anti-inflammatory botanicals such as Curcumin or hormone-supportive herbs like Vitex Agnus.

Lifestyle

Implementing a wellness routine can improve your overall health and may help mitigate potential side effects of birth control. Exercise, adequate sleep, and stress reduction practices are essential when hormone health is at play.

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Summary

When considering prescriptive birth control, knowing your risks, benefits, and options is vital in making an informed decision. Having a variety of choices, such as a combination oral contraceptive, progestin-only pill, copper IUD, hormonal IUD, or an implant, can empower you to make the best decision for your body. Combining your decision with proactive laboratory testing and supportive care can assist you in the best possible outcome for your reproductive health.