March 14, 2019

Finding the birth control that's right for you

A person smiling, holding birth control pills in one hand and a wrapped condom in the other

There are more safe and effective birth control options on the market than ever before. From a tiny daily pill to an injection every few months, to an invisible implant that can last for years, your doctor has these — and a wealth of other options — at her disposal to find a contraceptive solution that's perfectly suited to your specific lifestyle and individual needs.

But with so many choices, how do you find the birth control method that's right for you?

Of course your own doctor will be your best resource when it comes to assessing your needs and medical history, but just knowing what questions to ask and having a general idea of your options can help you start that conversation. With that in mind, Dr. Eliza Bennett, an ob-gyn and expert in family planning at the UW Department of Ob-Gyn, provides an overview of some of the contraceptive methods available and what factors to consider when making your choice.

When a patient asks her about starting a birth control regimen, Dr. Bennett says the process always begins with an honest discussion.

"I think it's really important to have a conversation about goals and things people feel uncomfortable with or more comfortable with and tailor that contraceptive choice based on those goals and preferences that a particular patient has," she said. "One of the really great things about contraception now is that we have a huge range of choices. So there's almost always a right choice for every woman."

What should you think about when choosing a birth control method

So what are the issues you should you consider? In order narrow down the options, you can expect your doctor to ask you about the following:

Your reasons for seeking birth control

The most common motive is the desire to have sex without getting pregnant. But Dr. Bennett said women ask for contraceptives for a wide variety of other reasons too.

"I see people who just don't want to have a period — they're involved in sports or involved with a job where that's inconvenient for them or it would really diminish their ability to participate in those activities," she said. Some hormonal contraceptives can be used to manage menopause symptoms as well.

For younger patients, Dr. Bennett's conversation will also frequently include a reminder that pregnancy isn't the only thing to protect against.

"Obviously, in young women we have a little bit higher risk of STDs — they tend to engage in more risky sexual behaviors. So there's always an emphasis on using a barrier method, such as condoms, concurrently with highly effective forms of contraception," Dr. Bennett said.

Your health

Blood clots have been associated with estrogen-containing birth control methods, and genetics, smoking and obesity can compound those risks.

And while some medications are fine to take in conjunction with contraceptives, others — even over-the-counter or herbal supplements — can impact the efficacy of some hormonal contraceptives, so it's critical that your provider is aware of your full medical picture and everything you're taking.

Your history

Have you used any type of birth control before? Have you had a previous pregnancy?

"For some women, they have health issues where certain things are just not appropriate choices for them — they carry too much risk or they won't be as effective. And so being honest and forthright with all of your past medical history is really important so that your provider can shine a light on what are better or worse choices for your particular health situation," Dr. Bennett said.

Your feelings about menstruation

For some women, having a regular period is very important. But others experiencing irregular bleeding, painful or very heavy periods might prefer a contraception that can treat or even eliminate those problems.

Your future fertility plans

If and when you'd like to become pregnant can play an important role in choosing the right method for you.

"Some women need contraception but they're planning a pregnancy in months, versus other women who need contraception and don't want a pregnancy for the next number of years — or maybe even ever. Those women have very different goals and very different needs," Dr. Bennett said.

Your schedule

Ask yourself how well — realistically — you would be able to keep up with a medication that needs to be taken at the exact same time every day.

"One of the big struggles people have with any medication regimen is remembering to use it," Dr. Bennett said. "Having self-awareness about one's own ability to adhere to a medication regimen and how that's going to work in their life … that's a really important thing to think about."

Your other concerns

An aversion to needles probably means you aren't a good candidate for an injectable contraception.

"Other women feel very uncomfortable having something implanted or embedded into the body," Dr. Bennett said, and that could rule out several options as well.

But regardless of the type of contraceptive a woman chooses, Dr. Bennett stressed that any method prescribed by a doctor would be safe to use, and effective as long as it's used properly.

"There's a lot of misconceptions out there. A lot of people perceive contraception to be more dangerous than it is, and have more negative side effects or risks than it does," she said. "In general contraception is very, very safe. And pregnancy is almost always higher-risk — it carries a higher risk of complications — than any form of contraception that we have."

But while safety is crucial, it's the contraceptive's side effects that are typically a patient's most common concern.

"Side effects are probably the biggest reason for discontinuing contraceptive methods," Dr. Bennett said, and irregular bleeding is the most-cited complaint. "Many women have different problems with different contraceptives. Oftentimes there is little ability to predict what effects a specific form of contraception will have until we perform a sort of trial and error to see what works best.

"But knowing that everything has side effects and prioritizing what's important for you — and what will have a negative or positive impact on your particular life — is really important in choosing the right method for oneself."

But no matter what method of birth control you choose now, just remember that you can always change your mind at a later point.

"It's not like someone is married to their particular contraceptive choice for the rest of their life," Dr. Bennett said. "They can make changes as their life changes."