Choosing the Best Birth Control Pill: The Ultimate Guide
What’s the best birth control pill? With hundreds of different brands and formulations available, it makes sense that so many women feel overwhelmed. It’s okay to put down the struggle because finding the right birth control doesn’t have to be this hard. This guide will empower you with the information you need to make the most informed choice for yourself.
We’ll cover all of the birth control pill options to help you find what’s right for you based on your unique health, history, lifestyle, and needs. First, we’ll go over how oral contraceptives work. Then we’ll turn to the different types of birth control pills on the market and the key differences between them. Next, we’ll go into detail to help you understand side effects, pros (like effectiveness and ease of use), cons (like health risks and who shouldn’t take certain meds), and the most popular birth control pills in each class. By the end of this guide, you’ll have the basic info you need to choose the best birth control pill for you.
How do birth control pills work?
Birth control pills use hormones to prevent pregnancy. The tablets in your pack contain synthetic versions of two kinds of naturally-occurring hormones. Combination pills contain both an estrogen and a progestin, while progestin-only pills contain only a progestin.
These hormones work by preventing the sperm from fertilizing an egg after sex—no contact between sperm and egg = no pregnancy. They also make it harder for a fertilized egg to mature into a pregnancy.
The types of birth control pills
There are 2 main classes of oral contraceptives. These classes are based on whether the tablets contain a single hormone called progestin or a mix of estrogen and progestin.
Combination pills contain a mix of 2 hormones that work to stop pregnancy, an estrogen and a progestin.
Progestin-only pills(sometimes called “minipills”) contain only 1 hormone, progestin.
Combination pills are either conventional or extended-cycle. They’re also further divided into monophasic or multiphasic packs. Don’t worry— we’ll cover all the details later on.
Combination pills vs. progestin-only pills
While closely related, the apparent difference between the two types of pills is that a combination pill contains estrogen and a progestin-only pill doesn’t. But this small difference has a definitive impact when it comes to your body.
So how does the pill work inside your body? Again, both types of pills use hormones to prevent pregnancy. The combination pill causes 3 significant changes in your body to do this.
- prevent the ovaries from releasing an egg
- thicken cervical mucus
- thin the uterine lining
These changes make it harder for the sperm to reach the egg and for a fertilized egg to become attached to the uterine lining.
Most progestin-only pills, or minipills, cause only 2 of these changes in your body.
- thicken cervical mucus
- thin the uterine lining
Indeed, a small percentage of progestin-only pills can also prevent ovulation (the release of an egg from the ovaries). But for the most part, the minipill won’t cause you to stop ovulating.
Low-dose birth control
Low-dose options are available for combination pills. While closely related to the regular, higher-dose tablets, these meds contain a lower daily dose of hormones.
Low-hormone birth control is just as effective at pregnancy prevention. It’s believed that pills with lower hormonal doses can decrease some of the classic side effects caused by higher-dose pills. These include side effects like headaches, breast tenderness, nausea, and vomiting.
Some of the most common low-dose birth control pills in the combination class are
Combination birth control pills
This kind of pill is taken daily for pregnancy prevention. These may be the right choice for you if you experience severe PMS, painful cramping, and heavy bleeding during your periods. You may also consider this option if you’re trying to find the best birth control for acne.
While these meds are generally safe, they do come with some risks. Even though the risk is low for most women, the complications can be life-threatening. We’ll take you through the details in just a moment.
How combination pills work
Once again, this type of pill does 3 things to keep you from getting pregnant:
- First, it keeps your ovaries from releasing an egg (a process called ovulation).
- Second, it thickens the mucus at the opening of your cervix to keep sperm from reaching the area where an egg might be.
- Finally, it makes the lining of your uterus thinner to keep any fertilized eggs from attaching.
All medications come with the potential for side effects. When taking this type of pill, the most common side effects include
- Breast tenderness
- Spotting or bleeding between periods
- Weight gain
Combination pills are great for many reasons. Below are some of the benefits you can expect from this method.
- Extremely effective. If taken 100% correctly, this method is 99% effective at preventing pregnancy. Since we’re human beings and not capable of perfection, this med is about 91% effective in actual practice.
- Can lessen the severity of periods. This means less cramping, relief from PMS, and lighter, shorter periods.
- Can improve certain conditions. Many women choose this option because it can help with acne and reduce the symptoms of endometriosis.
- More flexibility around when you take your pill. It’s best to take your med at the same time every day. But with this type of pill, you’ll still be protected from pregnancy as long as you take it daily.
Combination pills also come with a higher risk of complications. Here’s what you need to know.
- Higher risk of developing a blood clot. Estrogen can increase your risk of clotting. This is especially true if you have a history of high blood pressure or hypertension or if you’ve ever had a blood clot, sometimes called a deep vein thrombosis (DVT) or pulmonary embolism (PE). The risk increases with age and other factors like smoking. However, clotting can occur in otherwise healthy women, though the risk is low.
- Can't be taken with certain meds. Don’t take these if you take a supplement called St. John’s wort or certain drugs like anticonvulsants, mood stabilizers, or anti-tuberculosis meds.
- Shouldn’t be used by women with a history of certain health conditions. You should avoid this med if you’ve ever had breast cancer, stroke, or heart disease, or if you have liver disease or abnormal uterine bleeding. You shouldn’t use this medication if you have complications from diabetes, like nerve damage, eye damage, or kidney damage. Finally, this med can make migraines worse and increase cholesterol.
- Can’t be taken by women who are breastfeeding.
- Not good post-surgery. You should also avoid this kind of med if you aren’t able to move for an extended period due to major surgery or for other reasons, as this increases your risk of clotting.
Conventional vs. extended-cycle birth control
Your pack of combination pills contains a mixture of hormonal and non-hormonal tablets. The number of inactive tablets in your pack determines how often you’ll have a period and how long it will last. Your pack has “active pills” (the ones with hormones) and “inactive pills” (those without hormones.) On days when you take inactive tablets, you’ll experience bleeding, much like a period.
Conventional birth control packs contain 21 active pills + 7 inactive pills or 24 active pills + 4 inactive pills.
Extended-cycle pills, also called continuous birth control, contain fewer inactive tablets in a pack. Many continuous-cycle birth control packs contain 84 active pills + 7 inactive pills for a 3-month cycle. The result is that you’ll only get a period 4 times a year. Other continuous packs contain no inactive tablets, which means you won’t have a period at all. Even though you won’t have a full period, you may still experience some light bleeding or spotting. Bleeding is one of the most common side effects of extended-cycle pills. Unfortunately, no pill is perfect.
Some of the most common extended-cycle birth control brands are
Monophasic vs. triphasic birth control
Combination pills are also divided into categories based on whether the active pills’ hormones stay the same or vary during your menstrual cycle. If all of your tablets have the same amount of hormones, they’re called monophasic pills. If the ratio of hormones in the active pills varies, they’re called multiphasic pills.
In other words, monophasic pills have the same amount of estrogen and progestin in each tablet. For multiphasic pills, the ratio of hormones in the active tablets varies throughout the cycle. Multiphasic pills can have 2 phases, called biphasic pills, or 3 phases, called triphasic pills.
You can usually tell the difference based on the color of the tablets. Monophasic tablets are generally all the same color, while the multiphasic pills differ in color based on their weekly hormone ratios.
Popular combination birth control pill brands
Some of the most common birth control pills are
Progestin-only pills (aka “minipills”)
Minipills are also taken daily to prevent pregnancy. They use a single hormone to keep you from getting pregnant, progestin. It’s a synthetic version of the hormone progesterone, which occurs naturally in your body.
Since they don’t contain any estrogen, progestin-only pills are a better option for you if you’re over 35, smoke cigarettes, or are at risk of developing blood clots. If any of these conditions apply to you, the minipill may be your safest option.
How progestin-only pills work
For the most part, they work the same way as combination pills. They thicken the cervical mucus to make it harder for sperm to pass through and thin the uterine lining to make it difficult for an egg to attach. As we explained earlier, there’s one way the minipill differs from a combination pill: most minipills don’t prevent your ovaries from releasing an egg.
When taken as prescribed for pregnancy prevention, both types of pills have a high effectiveness rate. But progestin-only methods give you much less room for error. Since your body needs a steady amount of the hormone to stop pregnancy from occurring, women considering the minipill must take their meds at the same time each day. If you don’t think you’ll be able to stick to the routine, consider an oral option that contains estrogen or a different method of contraception altogether.
Remember how many different types of combination options there are? Well, the minipill landscape is much simpler. There’s only one hormonal dosage, and every pill is an active pill.
All meds come with a risk of side effects. For progestin-only options, these include
- Spotting or bleeding between periods
- No periods
- Breast tendernesss
- Ovarian cysts
- Decreased libido
These are some of the benefits of progestin-only pills.
- Safer than oral contraceptives with estrogen. Since minipills don’t contain any estrogen, they’re not associated with blood clots. They’re usually a much safer option for smokers, women with high blood pressure, or those at risk of clotting for other reasons.
- Highly effective. This med has a high rate of effectiveness when taken at the same time each day. You must take the minipill at the same time daily to successfully prevent a pregnancy. When taken 100% correctly, it’s 99% effective in pregnancy prevention. But since we’re all humans here, the practical efficacy of the minipill is closer to 91%.
- Less interference for women who are breastfeeding.
Progestin-only methods may be safer than combination pill options, but there are also some downsides.
- Must be taken at the same time every day. If you’re 3 or more hours late on your pill, you’ll need to use backup contraception methods, like condoms. Minipills must be taken at the same time daily to keep hormone levels high enough to prevent a pregnancy. This means there’s much less room for error with the minipill.
- Can't be taken with certain meds. You shouldn’t take this medication if you use a supplement called St. John’s wort or are taking certain meds like anticonvulsants, mood stabilizers, or anti-tuberculosis drugs. If you’re not sure about interactions, get advice from your doctor.
Popular minipill brands
Here are some of the most popular progestin-only birth control brands in the US.
What is the best birth control pill?
Since birth control isn’t a one-size-fits-all medication, the right type for one woman may not work for another. That’s why we encourage you to ask this question instead: which birth control is best for me? When looking at your choices, there are some essential factors to take into consideration. These include your health and medical history, age, lifestyle, and your unique needs.
We want to empower you with as much information as possible as you explore your options, but we also encourage you to work with a licensed doctor or nurse practitioner (NP) when choosing a pill. The Lemonaid medical team is always happy to help you understand the birth control landscape. We’ll make sure you find an option that works well for you and is as safe as possible.
Okay, what is the best form of birth control for me?
To discover the right type of birth control pill for you, you may want to start by considering what makes you unique. For instance, are there any past health conditions that put you at a higher risk of complications? What about current health issues and their impact on oral contraceptives? Are you taking any medications or supplements? Consider your lifestyle and preferences, as well, since these are part of your individual makeup.
Considering what’s unique about you is one decisive way to ensure you start with the right question: which birth control pill is best for me?
Once you’ve looked at individual needs, turn to your highest priority birth control benefits. You may be interested in the pill for reasons beyond safe sex. Most women want to use a form of birth control that doesn't cause weight gain. Perhaps you care most about finding a pill that will help clear up acne. Or maybe you’ve always struggled with severe PMS and heavy bleeding, and you're looking for relief.
If your priority is finding the best birth control to avoid weight gain, you may look at a pill that contains estrogen. (Still, recent studies have shown that the likelihood of weight gain with progestin-only options is pretty low.)
If you want a pill that will help with heavy periods or acne, you may want to find a pill that contains estrogen. Maybe you want to minimize the side effects of higher-dose meds. If so, we encourage you to check out low-hormone birth control pills. Again, if you’re over 35, a smoker, or at high risk of blood clots, the safest option would likely be a pill with no estrogen.
How can choosing a birth control be less stressful?
It’s easy to get overwhelmed by the options, but choosing a contraceptive pill doesn’t have to cause you stress. Working with a doctor or nurse practitioner makes it easy to get the info you need. Yes, a doctor or nurse practitioner can write you a prescription for the pill. But they can also offer important health advice.
A medical professional can help you narrow down choices to find the best possible fit for you. They’ll make sure the med you want to take is safe and doesn’t interact with your other medications or increase your risk of complications. Consulting with a trained medical professional is essential for your safety and wellbeing.
How Lemonaid makes your life easier
Let’s face it: the world is complicated enough. Finding the right birth control pill should be easy. Lemonaid helps simplify the whole process, from research to medical consultation to online prescriptions. Talk with a doctor or nurse practitioner from your living room and get your new medicine delivered to your door with fast, free shipping.
We’ll send you 3 conventional packs or 1 extended cycle pack at a time, so you’re on-time every time. And we can send auto-refills, which means you never have to worry about running out. Plus, we charge just $15/pack for conventional birth control and $45 for 3 months of extended-cycle pills.
The Lemonaid mobile app is the easiest way to order birth control pills online. Here’s how a birth control visit works:
- Download and open the Lemonaid mobile app for iPhone or Android.
- Select the birth control service. (Interested in a particular pill? You can let us know your preference or ask us for help choosing the pill that’s right for you. We can also prescribe the patch and the ring.)
- Answer some health questions, including a recent blood pressure reading.
- A Lemonaid doctor or nurse practitioner will contact you for a mobile visit to review your medical history, confirm your pill of choice, and, if safe and appropriate, write you a prescription.
- That’s it! We’ll get your new meds to you within a couple of days. We’ll ship your meds free and in discreet packaging.