When it comes to birth control, there tend to be very polarizing views.
Some people see it as a blessing of modern medicine, supporting reproductive autonomy. While others have experienced negative side effects or have felt it was given as a band-aid treatment for their menstrual concerns, with it worsening many, if not all, of their symptoms.
Birth control option discussions must be nuanced, because they are often prescribed for many purposes beyond contraception. When they are prescribed, most people are handed a prescription with little more than a quick explanation and a warning about side effects such as decreased libido, mood changes and nausea.
As a pharmacist at NutriChem, I’ve seen firsthand how complex and personal birth control choices can be. There is no “one-size-fits-all” approach, and the right method depends on your health history, lifestyle, goals, and how well your body tolerates hormonal changes.
Let’s explore the options – where birth control shines, where it doesn’t have the best evidence, and where it can potentially increase health risks. We will discuss common concerns and, importantly, how you can support your body while using them.
Understanding Your Birth Control Options
There are two main categories of birth control:
1. Hormonal Birth Control
This includes:
- Combination oral contraceptives (contain estrogen and progestin)
- Progestin-only pills
- Hormonal IUDs
- Other less common options: Injections (progestins), vaginal rings, patches.
These work by suppressing ovulation, thickening cervical mucus, or thinning the uterine lining.
2. Non-Hormonal Birth Control
This includes:
- Copper IUD
- Barrier methods (condoms, diaphragms)
- Fertility awareness methods
- Tubal litigation
Non-hormonal methods don’t alter your hormone levels, which is why many people turn to them when they experience side effects from hormonal contraceptives.
A Brief Overview of Hormonal Birth Control Options
1. Hormonal Intrauterine Device (IUD)
What Is It?
The IUD is a small, T-shaped device inserted into the uterus through the cervix. It releases a low dose of progestin locally each day. Examples of this form of birth control are known as the Mirena (lasts up to 7 years) or Kyleena IUD (lasts up to 5 years).
How Do Hormonal IUDs Work?
- Thickens cervical mucus, making it harder for sperm to reach the egg
- May thin the uterine lining, reducing the likelihood of implantation
- Can suppress ovulation in some users
Who Is It Best For?
- Those seeking highly effective, low-maintenance contraception: Over 98% effective and lasts for several years
- Those with heavy or painful periods: Many users experience lighter periods or no period at all after 3–6 months, which can be especially helpful for individuals with iron deficiency or period-related anemia. It may be helpful for those with fibroids, endometriosis or short menstrual cycles.
- Those experiencing cycle irregularity during perimenopause
What Are The Potential Adverse Effects?
- Post-insertion, some individuals may experience prolonged spotting or discomfort.
- Insertion and removal can be painful and anxiety-inducing for some individuals. There are some risks associated with insertion, especially if not done by an experienced clinician.
- Hormonal IUDs can slightly increase the risk of ovarian cysts, although most cysts are benign and resolve on their own.
2. Oral Contraception - Combination Pill
What Is It?
Combined oral contraceptives are birth control pills that contain a synthetic form of estrogen along with a progestin, which is why they are called “combination” pills. They must be taken daily to maintain effectiveness. Examples: Alesse, Yaz
How Does It Work?
Oral contraceptives work by increasing circulating estrogen levels, which suppress the hormonal signals that trigger ovulation. These hormone levels need to remain consistent: missing pills or taking them irregularly can allow ovulation to occur, increasing the risk of pregnancy. Important Note: The 7-day hormone-free interval typically causes a withdrawal bleed. This mimics a period, but it is not a true menstrual cycle.
Who Is It Best For?
- Those with painful periods: For individuals struggling with intense cramping or debilitating menstrual pain, shutting down the natural cycle can significantly reduce symptoms. However, this approach does not address the root cause. It’s important to investigate why your periods are painful—whether it’s due to endometriosis, inflammation, or another underlying issue—so that comprehensive treatment options can be explored.
- Those with acne: If you’re prone to cystic or hormonally driven acne, elevated androgens may be a contributing factor. Combined oral contraceptives can help by increasing levels of sex hormone binding globulin (SHBG), which reduces free androgen levels and may improve skin clarity. That said, using the pill without addressing the root causes—such as gut health, blood sugar imbalances, nutrient deficiencies, or stress—can be like putting a Band-Aid on a deeper issue. A holistic approach should come first, with oral contraception used as a supportive option.
- Those with menstrual-related migraines: Combination pills can suppress ovulation and are often prescribed for those with menstrual-related migraines to be taken continuously (without stopping the pill and inducing a withdrawal bleed). This results in fewer hormonal fluctuations, which can help to reduce the frequency and severity of migraines in some women. However, for older women who experience migraine with aura, this may increase the risk of stroke.
- Those who prefer short-term birth control: For those seeking temporary contraception or who prefer not to use an IUD, the pill offers flexibility and can be discontinued at any time.
Using birth control to help with acne, painful periods, or PCOS? Read Dr. Sophie’s blog about how to support your cycle by clicking here.
Who Might Want to Avoid Oral Contraception:
- Do not use oral contraception if you smoke, especially if you’re over 35, as this significantly increases your risk of cardiovascular events.
- Avoid oral contraception if you have uncontrolled high blood pressure, as it can further elevate your cardiovascular risk.
- Oral estrogens are processed through the liver and can increase the risk of blood clots or stroke. Combination contraceptives are contraindicated in those with a history of stroke or ischemic heart disease. While the absolute risk of stroke is low for younger users, it rises with contributing factors like smoking, frequent air travel, or hypertension. If any of these apply to you, a non-estrogen birth control method may be a safer option
3. Oral Contraception (Progestin Only Pill)
What is it?
Progestin‑only contraceptives are birth control methods that contain only one type of hormone (progestin) and do not contain estrogen. Progestin is a synthetic form of progesterone, a hormone naturally produced by your body during the menstrual cycle.
How does it work?
- Thickening cervical mucus: Makes it harder for sperm to reach the egg
- Thinning the uterine lining: Reduces the chance of implantation
- Sometimes suppressing ovulation: Preventing the release of an egg (varies by method and user)
Who is it best for?
- Those who react to, or cannot take, combination pills: Progestin‑only pills (POPs) are a safe and effective choice for people who cannot take combination contraceptives (see above), or for those who experience significant side effects from combination birth control pills.
- Those who experience heavy, painful, or irregular periods: POPs are effective at reducing menstrual-related pain and heavy bleeding. They can be a great option for women in perimenopause who are experiencing irregular menstrual cycles and heavy bleeding but do not wish to use the combination oral contraceptives due to the negative impact on libido and potential adverse effects related to mood changes.
4. Non-Hormonal Birth Control (Copper IUD)
What is it?
A copper IUD is a small, T‑shaped device placed inside the uterus by a healthcare professional. Instead of hormones, it’s wrapped in copper wire, which is toxic to sperm and makes it nearly impossible for them to fertilize an egg. Brand example: ParaGard (effective for up to 10–12 years)
Who is it best for?
A copper IUD can be a great option if you:
- Want long‑term, hormone‑free contraception
- Have had side effects from hormonal birth control
- Need immediate, reliable birth control. The Copper IUD works immediately upon insertion.
A copper IUD may not be the best choice if you:
- Have very heavy or painful periods: Copper IUDs can make bleeding heavier and cramps worse, especially in the first 3–6 months
- Have an allergy to copper
- Have a bleeding disorder or anemia
As a reminder, none of the above contraceptives will protect from sexually transmitted infections (STIs), and it is important to consider barrier methods such as condoms in combination to help prevent infection. Always talk to your pharmacist or prescriber to evaluate your personal risk factors and lifestyle.
Your Birth Control, Your Choice
Birth control is not just a medical decision, it’s a deeply personal one that deserves time, understanding, and respect. There is no “perfect” option that works for everyone, and that’s exactly why informed choice matters. Whether you’re considering hormonal or non‑hormonal methods, the best decision will balance your health history, lifestyle, goals, and how your body responds.
Unfortunately, too many people are handed a prescription with little more than a brief explanation, leaving them to navigate side effects and uncertainty on their own. You deserve better. You deserve a thoughtful conversation about your needs, the full range of options available, and how to support your body if you choose to use birth control.
At NutriChem, we believe that knowledge is power, and when it comes to reproductive health, empowered choices lead to healthier, happier outcomes. Take the time to ask questions, explore your options, and work with a trusted healthcare provider who respects your voice in the process. Birth control should never be about simply “managing” your body, it should be about supporting it, protecting it, and giving you the freedom to live life on your terms.
