You know what birth control is and does. But you might not know what options are out there to help you plan for your future — whether that involves kids or not.
Let’s start from the beginning. Here’s how you can get pregnant, in fifty words or less:
Sperm meets egg in one of the fallopian tubes. Sperm and egg unite to form the zygote (aka fertilized egg) which eventually finds a home in the lining of the uterus. If all goes well, boom, pregnancy. Birth control methods can block parts of that process.
About that process...
Because it’s probably been a minute since sex ed, here’s theSkimm of terms you’ll want to know:
Ovulation: When an egg is released from an ovary, about halfway through a menstrual cycle. If you’re trying to get pregnant, this is the date you want to watch.
Contraception: Another way to say “birth control.”
Estrogen and Progesterone: Reproductive hormones that the ovaries (and other body tissues) make. Estrogen and progesterone power your period and get the body ready for pregnancy.
Progestin: A synthetic progesterone-like hormone that can help suppress ovulation and prevent pregnancy. It’s in most hormonal birth control. More on that later.
Period: The body’s (approximately) monthly way of saying ‘You’re not pregnant’ by shedding the lining of the uterus. Normally, it’s triggered by a drop in your estrogen and progesterone levels after ovulation if an egg isn’t fertilized. Fun (ish) fact: On certain types of hormonal birth control, you’re actually having a fake period called ‘withdrawal bleeding.’ It looks and feels a lot like a period (and still confirms you aren’t expecting). But it’s usually lighter and shorter than a real period. Watch the video below for more on your menstrual cycle.
Sperm: Those tiny swimmers...aka male reproductive cells. Millions of them are released in every milliliter of semen.
Fallopian Tubes: What connects the ovaries to the uterus. Think of it like a pathway for your egg.
Cervix: The lower part of the uterus that connects to the vagina.
Thanks. Can we talk about specific types of birth control now?
Yup. And there are pros and cons for each. Here’s your friendly reminder to consult your doctor about which type of birth control is right for you given your age and stage, plus the side effects. Now let's get to what’s on the market:
The pill..the popular kid. It’s the most commonly prescribed contraceptive, and if used perfectly, it can be 99% effective. There are two main kinds: the combination pill (estrogen and progestin) and the “minipill” (only progestin). The hormones in the pill can prevent your ovaries from producing an egg, thicken the mucus in the cervix, and thin the uterine lining. All to stop sperm from swimming to an egg. The mini pill is best for people who can’t take estrogen for health reasons.
Pros: Some pills are known to regulate your menstrual cycle and can reduce acne. And all you have to do is stop taking it when you want to start trying to have a baby. You can start trying right away, though your cycle might not be totally regular at first. One more win: Women who have used the pill may be at lower risk for ovarian and endometrial cancer.
Cons: If you don’t take it at the same time every day, it’s less effective. So set those phone alarms. And as with other combined hormonal methods, it can increase your risk of blood clots. Note: Some pills can cause side effects such as depression, weight gain, headaches, acne (it can go both ways), and decreased libido. Rude.
Condoms… old faithful. Most of the time. Versions of the condom have existed for thousands of years. Today, around 10% of women in their 20s and 30s use them, according to the CDC. What both the male and female condom (which is significantly less popular) do: block sperm from getting through to the eggs. Other barrier options include the female sponge, cervical cap, and diaphragm (which was the most effective birth control method before the pill was approved by the FDA in 1960). Barrier methods are around 80% effective depending on the one you choose.
Pros: They’re cheap, available at most pharmacies and grocery stores, and can protect you from some STIs.
Cons: Condoms can rip or slip off. They can also cause irritation if you have a latex allergy. And in that case, you can look for non-latex versions.
IUD...stands for ‘intrauterine device’ because it hangs out in the uterus, where it releases progestin. What that does to the body: thickens mucus in the cervix (to stop sperm from coming in), thins the lining of the uterus (so eggs don’t stick around), and sometimes suppresses ovulation. There’s also a nonhormonal version of the IUD that is wrapped in copper. Yes, that copper. Because it’s toxic to sperm.
Pros: It’s more than 99% effective and it’s a LARC (long-acting reversible contraceptive). That means it’ll do its thing without much maintenance for three to five years for the hormonal IUD, and ten years for the copper IUD. A doc implants it and can remove it (for example, if you want to start trying to have a baby). About 14% of women in their 20s and 13% of women in their 30s have one.
Cons: IUDs can cause cramping, ovarian cysts, and changes to your period — in some cases stopping them completely. And in rare cases the IUD can move and cause complications.
The implant… a tiny rod that goes in your upper arm. It releases progestin to block pregnancy (sound familiar?), halting ovulation, thickening cervical mucus, and thinning the lining of your uterus. The implant stays in place for up to three years, and can be removed when you’re ready to get pregnant.
Cons: Can cause headaches, dizziness, and breast pain. And it’s not recommended for women with a history of blood clots.
The patch or vaginal ring…the ones you stick in or on regularly. These guys release your favorite hormones, progestin and estrogen, to prevent pregnancy. The patch looks like a square bandage and stays on your arm for a week, before you replace it with a new one. The flexible ring goes into your vagina, typically for three weeks at a time, and then it’s out for a one-week break. (If it’s Nuvaring, it goes in the trash. Annovera rings are washed and put back in.) According to the CDC, the patch and ring are each about 91% effective, if used correctly.
Pros: Easy (once you get used to it) to apply and remove yourself. Compared to the pill, you don’t have to think about it daily and it’s less likely to cause irregular bleeding.
Cons: They’re not recommended for smokers and women older than 35, and could cause headaches, irritation, and breast tenderness.
Withdrawal...you know it as the pull out method.
Pros: Requires neither equipment nor chemicals, is free, and doesn’t have any side effects.
Cons: According to the CDC, it’s only about 80% effective. And it requires that you (and your partner) time it right. Meaning you might want a backup.
Fertility awareness-based methods…strategically opening and closing the sex window. That’s when you can track your cycle by either using a calendar or app, charting body temperature, or monitoring changes in the consistency of your discharge. With that info, you determine when you’re least fertile and only Get. It. On. Then.
Pros: It doesn’t involve any medications and keeps you in touch with your body.
Cons: It’s one of the least reliable methods of avoiding pregnancy (as many as 24% of women get pregnant in the first year they try this contraception DIY). Also keep in mind: It works best on a cycle that functions like clockwork…and requires some major willpower on the days around ovulation.
Getting your (fallopian) tubes tied…What docs call tubal ligation or female sterilization. According to a CDC survey, nearly 40% of women in their 40s choose this option. What it means: A surgeon removes or closes pieces of the fallopian tubes. That keeps eggs and sperm from meeting.
Pros: It’s more than 99% effective, making it one of the most foolproof options.
Cons: Worth mentioning that once you snip, you can’t really go back.
Emergency contraceptive pill…aka the “morning-after pill.” But it actually does more than the nickname implies: It can prevent pregnancy up to a few days after sex. However, the sooner it’s taken, the better. What it does: Releases progestin that prevents or temporarily delays ovulation.
Pros: It’s usually available over the counter if Plan A for birth control falls through (How do you think Plan B got its name?).
Cons: You could experience nausea, fatigue, headaches, a temporary change in your period, and cramps. Though it can be used without impacting your future fertility, it shouldn’t be your primary method. Also it’s less effective than other types of birth control. And heads up: You might see some spotting.
New kids on the block…The FDA just approved a contraceptive gel. And we are still waiting for something to happen with that remote-controlled contraceptive computer chip that was backed by Bill Gates, and the nonhormonal vaginal ring by the same company.
How do I pay for birth control?
If you’re insured, good news: Most plans in the gov’s Health Insurance Marketplace cover contraception. But we said ‘most.’ The Supreme Court last summer upheld a ruling that “employers with religious and conscientious objections” didn’t need to provide free contraception to employees. But stay tuned: President Biden has emphasized that he wants to expand access to contraception. If you’re not insured, you’ll likely have to pay out of pocket for a birth control prescription or procedure. Another option is to visit a health clinic or nonprofit like Planned Parenthood for discounted contraception (Power to Decide has a list of centers here).
The only way to be 100% sure you don’t get pregnant is to never have sex. Full stop. But if you want to make love without making babies, birth control can help with that.
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