Is it time to rethink your birth control?

Many of us settle into a routine — even in our sex lives. And while routines help us stay on track with healthy habits, they can sometimes use a refresh. So if you’ve been using the same birth control method for a while, it may be time to give it a second look.

Ask yourself (and your partner) these 5 questions to help assess whether your birth control method is still working for you, or whether it’s time to switch it up.

1. Do you want a hormonal method?

Birth control containing the hormones estrogen and progestin, or progestin only, prevent pregnancy by doing 1 or more things:

• Stopping or reducing ovulation (when your ovaries release an egg)
• Thickening the cervical mucus so that sperm can’t swim into the uterus
• Thinning the uterine lining so that it’s more difficult for a fertilized egg to attach

Hormonal methods are effective. The pill has a 91% efficacy rate with regular (aka real-world) use, according to Planned Parenthood. And that percentage increases when the method is taken as directed, at the same time each day, and without missing a dose.

Two other hormonal methods — the birth control implant and the IUD — have a 99% rate of efficacy, according to Planned Parenthood. (Go to question 5 to see efficacy rates for all the methods.)

Types of hormonal birth control
You can choose from several forms of hormonal birth control:

• The pill (taken daily)
• The patch (applied to the skin weekly)
• The ring (inserted into the vagina monthly)
• The hormonal IUD (inserted into your uterus for 3 to 7 years)
• The implant (inserted into your arm for up to 5 years)
• The shot (taken every 3 months)

Hormonal contraception has other benefits besides pregnancy prevention. It can:

• Reduce or stop your monthly period
• Ease symptoms of endometriosis and premenstrual syndrome (PMS)
• Clear up acne
• Protect against certain cancers

“The longer you use combined birth control pills, the better off you are in regards to some female cancers, especially ovarian cancer,” says Maureen Whelihan, MD. She’s an obstetrician-gynecologist in Greenacres, Florida. In fact, “what we can tell women is that it can reduce their risk of ovarian cancer as well as endometrial and colon cancers,” she notes.

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But hormonal birth control isn’t a good fit for everyone. It can cause side effects such as mood swings and spotting. It also could require regular doctor visits (for IUD checks, for example), and it may cost more than over-the-counter birth control options such as condoms. (See question No. 3 for more about managing side effects.)

Certain health conditions may also make it risky for a woman to be on hormonal birth control, says Tabitha Cranie, MD. She’s a gynecologist in St. Petersburg, Florida. These conditions include:

• High blood pressure
• Coronary artery disease
• Migraine (women over 35)
• Migraine with aura (any age)
• Being a smoker (women over 35)
• Having a history of blood clots, stroke or breast cancer

In some cases, women with these conditions may be candidates for progestin-only contraception, according to the American Academy of Family Physicians.

Also, hormonal methods don’t protect you from sexually transmitted diseases (STDs).

Types of non-hormonal birth control
If hormonal methods aren’t right for you, there are plenty of effective non-hormonal birth control options you can try. They include:

• Condom (male condom). It’s placed over the penis just before sex as a barrier to sperm. (Shop condoms at the Optum Store now.)
   
• Internal condom (female condom). It’s placed inside the vagina just before sex. It works as a barrier to sperm, and it helps protect against STDs.
   
• Diaphragm. This device is inserted into the vagina to cover your cervix up to 2 hours before sex. It works to prevent sperm from getting into the uterus. It’s recommended for use with a spermicide.
   
• Cervical cap. The cap is inserted into the vagina to cover the cervix. It’s designed to keep sperm from getting into the uterus and is recommended for use with a spermicide. It’s similar to a diaphragm but slightly smaller.
   
• Spermicides. These are inserted into the vagina (often in conjunction with a barrier method) before sex. They contain chemicals that stop the sperm from moving well enough to swim.
   
• Phexxi^® gel. This new gel changes the PH of the vagina so that sperm can’t move well. It’s designed to be less irritating to the vagina than spermicides and can be used on demand just before sex.
   
• Birth control sponge. The sponge is inserted deep into the vagina to cover the cervix. It works to prevent sperm from swimming into the uterus. It also contains spermicide.
   
• Non-hormonal IUD (Paragard^®). This is a copper device placed in the uterus that can last up to 12 years.

2. Do you want to take something every day?

Many women have a tough time remembering to take their birth control at the same time every day. If that’s not an issue, or you’d like to try a period-tracking app (many offer reminder features), a daily pill may be a good fit.

But if you’ve struggled with daily birth control pills or simply prefer not to think about it every day, you can choose from plenty of longer-term hormonal and non-hormonal birth control options.

Here are the other types of birth control, from shortest-lasting to longest-lasting:

• Patch. Apply a bandage-like patch to your skin and leave it for a week. At the end of 7 days, remove the patch and apply a new one. You’ll do this for 3 weeks and skip the fourth (your period week). If you don’t want your period, wear a patch in week 4.
   
• Vaginal ring. Insert a small, flexible piece of plastic into your vagina about once a month.
   
• Birth control shot. Visit a health center once every 3 months to get an injection from a doctor or nurse.
   
• Birth control implant. A doctor inserts a tiny thin rod (about the size of a matchstick) under the skin of your upper arm. The rod contains hormones to protect you from pregnancy for up to 5 years.
   
• Intrauterine device (IUD). A doctor inserts a tiny T-shaped device into your uterus to prevent pregnancy. There are hormonal options and a non-hormonal one. An IUD works between 3 and 12 years, depending on which brand and type you get. The non-hormonal copper IUD will last the longest.

“IUDs tend to be the most convenient because you just set it and then forget it for a few years,” Dr. Whelihan says. The downside: An IUD insertion can be painful.

Learn everything you need to know about how to get your hormonal birth control online.

3. Have you had side effects from past birth control?

As with any medication, hormonal prescription birth control can cause side effects. Common ones include sore breasts, spotting or bleeding between periods, nausea, headaches and mood changes. And birth control with estrogen can increase blood pressure.

“About 10% of my patients don’t do well on birth control pills because they become moody,” Dr. Whelihan says.

The reason has to do with how birth control pills affect your hormones: “When you take the pill, you suppress your natural estrogen levels to prevent ovulation, which is why the pill works,” Dr. Whelihan says. “But it also binds testosterone, which makes it inactive, and there’s a subgroup of women who are very sensitive to that reduction in estrogen and testosterone.”

Sometimes, you can bring mood swings and PMS under control. But if mood swings are an issue, your doctor may recommend non-hormonal options.

Weight gain is another side effect many women worry about with hormonal birth control. But the data doesn’t support this. “Every company does their own study, but on average, it’s a 3-pound weight change in a year across all demographics, and some of these companies study obese women along with normal body mass women,” Dr. Whelihan says.

Hormonal birth control may cause you to hold on to more fluid, making you feel a little bloated. But the fat gain is pretty minimal, and it’s more likely from excess calorie consumption, Dr. Whelihan adds.

The only birth control method that’s been shown to cause noticeable weight gain in women is the birth control shot (Depo-Provera^®). “Depo-Provera increases appetite, and so there is notable weight gain with this product,” Dr. Whelihan says.

If you’re bothered by any side effects, talk with your doctor about other methods you can try. (Explore the birth control options from Optum Store.)

4. Do you want to stop your period?

One advantage of hormonal birth control is its ability to stop or reduce your monthly period. Depending on which option you go with, your period could be limited to a day of spotting, or you may get no bleeding at all. “It’s especially great for athletes because they don’t want to lose any blood — they need to keep their red blood cell count up,” Dr. Whelihan says.

Stopping your period can also help if you have endometriosis, PMS symptoms or heavy, painful periods.

Several birth control options that can delay or prevent your period include:

• Estrogen-progestin birth control pills
• Vaginal ring
• Hormonal IUD
• Birth control shot

Talk to your doctor if you’re interested in stopping your period.

One other common method to prevent pregnancy is sterilization. This is often a permanent method of birth control. For women, the procedure is known as tubal ligation, or “getting your tubes tied.” It blocks or seals off the fallopian tubes so that the egg can’t reach the uterus and sperm cannot reach the egg, says Dr. Cranie. Discuss it with your doctor if you’re certain you never want to become pregnant. This procedure may reversed depending upon the type you receive.

For men, sterilization is done with a vasectomy. The procedure blocks the vas deferens, the tubes leading to the testes, where sperm is produced. A vasectomy generally carries fewer risks and complications than a tubal ligation. It can be reversed, but reversal is more complicated than the vasectomy.

5. Are you sexually active?

Specific birth control methods may be more effective at preventing unintended pregnancy than others. So if you’re having sex — even infrequently — it’s always a good idea to give your birth control the once-over, especially if you’re with a new partner.

Male condoms, for example, are 98% effective at preventing pregnancy when used correctly every single time you have sex. But because nobody’s perfect, these types of condoms are 85% effective on average.

Here are the effectiveness rates for popular forms of contraception. All statistics are for regular use.

Hormonal forms of birth control:

• Pill (91%)
• Patch (91%)
• Ring (91%)
• Hormonal IUD (99%)
• Shot (94%)
• Implant (99%)

Non-hormonal forms of birth control:

• Male condom (85%)
• Female condom (79%)
• Phexxi (86%)
• Diaphragm (88%)
• Spermicide (72%)
• Cervical cap (71% to 86%)
• Birth control sponge (76% to 88%)
• Non-hormonal IUD (Paragard^®, 99%)

You can also consider using emergency contraceptive pills if you think your current contraception has failed, has been used the wrong way, or you’ve had unprotected sex, says Dr. Cranie. Also known as the morning-after pill, it uses a medication called levonorgestrel or ulipristal acetate to stop ovulation, prevent fertilization or stop a fertilized egg from attaching to the uterine lining. (It does not induce an abortion.)

You can buy emergency contraception over the counter at drugstores. (Product names include Plan B One-Step^®, Take Action^® and My Choice^®.) You can also ask your doctor to prescribe Ella^® (ulipristal acetate), the only brand available by prescription. The morning-after pill is best if taken within 3 days after intercourse, but it can be effective up to 5 days, according to Planned Parenthood.

How can you decide?

Your choices may change over time, too, depending on your life stage. Perhaps you need a long-lasting method to use between kid No. 1 and kid No. 2. Or you want a more in-the-moment option to match the peaks and valleys of your sex life. Your best move may be to combine 2 forms of birth control.

A great pairing: male condoms with a hormonal method such as the pill, IUD or the patch. This way, you can protect against pregnancy and sexually transmitted diseases (STDs). You could also add a spermicide or Phexxi for extra birth control protection.

Whatever the case, the best choice is the most informed one. After reviewing your options and speaking with your partner, consult a health care provider to help find the method that’s right for you.

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Additional sources
Birth control effectiveness: The American College of Obstetricians and Gynecologists (2021). "Effectiveness of Birth Control Methods"
Contraceptive use data: The Guttmacher Institute (2021). "Contraceptive Use in the United States by Method"
Birth control and high blood pressure: Harvard Medical School (2020). "Birth Control and High Blood Pressure: Which Methods are Safe for You?"
Birth control basics: Planned Parenthood (n.d.). Birth Control
Vasectomy: University of Utah Health (2020). "Vasectomy or Tubal Ligation? Which Is the Best Option for You and Your Partner?"