Hormonal contraception can be a minefield. There are many different types of hormonal contraceptives available and picking the right one for you can be a daunting decision. But if you’re a human with a vagina who happens to be sexually active with people who could get you pregnant (such as the majority of cis men, some trans women or trans feminine people, and some nonbinary or genderfluid people), choosing the right hormonal contraception for you is an important decision to make.
While barrier methods of contraception (such as condoms) are good for protecting against both pregnancy and STIs, they’re not the only option. If you’re after a birth control device that can be more seamlessly integrated into both your daily routines and your sex life, you might want to consider the hormonal contraceptives available to you. Consider the below your introductory guide into the weird and wonderful (and, often, downright confusing) world of hormonal contraception. It’s by no means an exhaustive overview so we’d advise doing more research into the hormonal birth control methods that appeal to you before settling on your contraceptive of choice.
What is hormonal contraception?
Put simply, pregnancy happens when sperm fertilises one of your eggs. The goal of all forms of contraception is to prevent this from happening, either by preventing the sperm from reaching the egg, preventing the egg from being released from the fallopian tubes, preventing a fertilised egg from implanting into the womb, or a combination of the three. Barrier contraceptive devices are focused on the former – prevent the sperm from ever getting the chance to get into the uterus and fertilise an egg. Hormonal contraceptives work by injecting synthetic versions of the hormones progesterone and oestrogen into your body and inhibit it’s natural hormonal cycle.
What are the different kinds of hormonal contraceptive?
While there are many birth control products to choose from, there are two different types of hormonal contraceptive. The first is the combined hormonal contraceptive, which contains both oestrogen and progesterone, and the progestin only kind, which is a synthetic version of the hormone progesterone, which our bodies naturally produce, and does not contain any oestrogen. Hormonal contraceptives with both oestrogen and progestin in them have slightly different effects on the body that hormonal contraceptive devices containing only progestin. These are outlined in the options below. The type of hormonal contraception that’s right for you will depend on your unique needs and medical history, so it’s vital that you speak to a doctor and make an informed decision.
The different birth control products available are:
- The combined oral contraceptive pill
- The progestogen-only pill
- The hormonal IUD
- The implant
- The hormonal vaginal ring
- The contraceptive patch
- The hormonal injection
Combined Oral Contraceptive Pill (AKA COCP, the pill, the combined pill) Combined hormonal contraceptive
Who is she? The combined pill is the birth control option that people are usually referring to when they say ‘the pill’. Despite likely being the contraceptive you’re most familiar with, it’s not the most effective form of hormonal birth control. When used perfectly (which means, roughly speaking, taken at the same time every day, with things like other medications, alcohol use, and diarrhoea or vomiting not interfering with its effectiveness) it’s 99% effective. It is usually taken for 21 days followed by a seven day break, which can be seven days of taking nothing or taking a sugar pill (the only purpose of this is that it doesn’t mess with your routine or require you to track the days on your own).
In addition to being a common pregnancy prevention option, the pill is often prescribed to people to regulate periods, to help manage heavy or painful periods, and to combat acne.
How it works: The pill prevents the ovaries from releasing an egg. It also thickens the mucus in the womb which helps prevent sperm from getting up in there to penetrate an egg.
Side effects include: headaches, mood swings, nausea, breast tenderness, and (far less commonly) blood clots and cervical cancer.
Progestogen Only Pill (AKA POP, the mini pill) Progestogen Only
Who is she? The mini pill is a birth control pill which needs to be taken every day consistently. Unlike the COCP, you do not take breaks when taking the POP. Similarly to it’s oestrogen-containing counterpart above, it’s 99% effective when used correctly, but only about 92% effective with ‘typical use’ – meaning that of 100 average women who use it, 8 of them will wind up pregnant (yeah, I made that face too).
The main benefit of the progestogen-only birth control pill is that it can be used by people who cannot take birth control that contains synthetic forms of oestrogen. Being sick, having diarrhoea, taking it at irregular times, and certain medicines will affect the mini pill’s effectiveness.
How it works: The progestogen-only pill prevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg. Most forms of the POP (with the exception of the desogestrel pill) do not prevent ovulation from occurring.
Side effects include: lighter, irregular, or more frequent periods, acne, breast tenderness, changes to your libido, nausea, vomiting, (usually harmless) ovarian cysts, and mood swings. Many of these symptoms will disappear after a few months.
Intrauterine System (AKA the IUS, the coil, the hormonal version of the IUD) Progestogen-only hormonal contraceptive
Who is she? Not to be confused with the IUD, or copper coil, which does not release hormones, the IUS is a hormonal form of birth control sometimes referred to as simply ‘the coil’. It is a T-shaped device which is inserted into the uterus by a doctor or nurse. The IUS can be used by people who are unable to use combined hormonal contraceptives. It’s 99% effective when inserted correctly.
How it works: the coil releases progestogen into the uterus and lasts for 3-5 years but can be removed at any time should you wish to have it taken out. Some people experience discomfort during the insertion procedure, but once the IUS has been fitted, you don’t need to think about it or do anything to ensure its effectiveness. The coil works by thickening the cervical mucus to prevent sperm from barging their way in looking for an egg to fertilise, and also thins the lining of the womb so a fertilised egg is less likely to be able to implant. In some people it will also prevent the release of an egg from the fallopian tubes, but many people will ovulate as normal.
Side effects include: mood swings, breast tenderness, lighter or shorter periods, or it can stop your periods altogether. It can sometimes lead to infection after it’s been fitted. On rare occasions people might find that their bodies reject the IUS – either expelling it entirely or dislodging it (you’ll be shown how to check it’s in place).
The Implant Progestogen-only
Who is she? Sometimes known as Nexplanon, the implant is birth control in the form of a plastic rod that goes into your arm. It can be used by people who are unable to take combined hormonal contraceptives (those which contain oestrogen).
How does it work? It is inserted into your upper arm by a doctor or nurse and lasts for up to three years but can be removed at any time. The implant prevents pregnancy by releasing the hormone progesterone into your blood, preventing the release of an egg into the womb and thickening the cervical mucus to make it more difficult for sperm to get through to the uterus. It also thins the lining of the womb to prevent a fertilised egg from implanting. Once inserted, you do not need to do anything to ensure its effectiveness. It can be removed at any time.
Side effects include: bruising or tenderness around the spot where it is implanted, periods stopping, and (less commonly) infection around the area where it has been implanted.
The Vaginal Ring Combined hormonal contraceptive.
Who is she? You might also know the vaginal contraceptive ring as the NuvaRing. It’s worn for a month consistently – and, yes, you can wear it while having sex. When used perfectly, it’s 99.7% effective. With typical use, however, it has about a 91% no-baby rate, which is pretty freakin’ low if you ask me. If it comes out on its own, you can wash it and pop it straight back in and it works even if you experience vomiting or diarrhea. It doesn’t need to cover the entrance to the cervix (unlike barrier contraceptives).
How it works: this is a contraceptive device that you can insert yourself, into your vagina. The birth control ring releases both oestrogen and progestogen into your blood, preventing the release of an egg each month. It also thickens the cervical mucus and thins the lining of the womb which help to prevent an egg being fertilised and implanted, respectively.
Side effects include: you may experience more vaginal discharge, breast tenderness and headaches, but these are usually temporary. Periods often get lighter or less painful. It has been known to cause blood clots
The Contraceptive Patch Combined hormonal contraceptive
Who is she? You might know the patch by the brand name Evra, which sounds like a character from Lord of the Rings if you ask me. It’s a small sticky patch a bit like the nicotine ones your dad used to wear/grumble about. When used correctly (there’s that caveat again) it’s 99% effective. It’s waterproof and functions regardless of whether you get sick or have diarrhea, but is thought to be less effective in people who are overweight.
How it works: It’s a sticky patch that you put on your upper arm like you’d put on a plaster. It releases hormones blah. It releases oestrogen and progestogen into your blood to prevent the release of an egg, thickens the cervical mucus and thins the lining of the womb which help to prevent an egg being fertilised and implanted, respectively. Each birth control patch only lasts one week and it’s similar to the combined pill in that you wear three patches in a row (so, three weeks) then take one week off.
Side effects include: the contraceptive patch can cause raised blood pressure and (usually temporarily) headaches. It has been known to cause blood clots but it’s thought that using the patch can help prevent some gynaecological cancers. Avoid putting the patch on irritated or infected areas of skin.
The Contraceptive Injection progestogen-only
Who is she? 99% effective, the hormonal contraceptive injection is, well, an injection that can be used by people who are unable to take combined hormonal birth control such as the combined oral contraceptive pill. It lasts between 8 and 13 weeks depending on the type you have and is unaffected by other medicines, diarrhea, and vomiting.
How it works: this form of contraception is delivered as an injection with a needle of the hormone progestogen, which goes into the bloodstream to prevent the release of an egg, block sperm from making its way into the uterus, and thinning the womb lining to stop a fertilised egg from being implanted. Two forms of the hormonal injection (Depo-Provera and Noristerat) can be injected into your bum or arm, while Sayana Press is administered into the belly area – you can do this one yourself.
Side effects include: breast tenderness, weight gain, decreased sex drive, mood swings, hair loss, headaches, and irregular bleeding (your periods can get heavier or lighter and longer or shorter). It can take up to a year for your fertility to return to normal.
Phew. That’s a lot of options.
It sure is. It’s also important to note that not a single one of the above options prevents against STIs, so if you’re planning to have sex with a lot of people or people whose sexual health status you don’t know, it’s always safest to use a barrier contraception method such as condoms (don’t worry babe, we’ll go over these options soon too).
The pros and cons of different forms of hormonal contraception
An advantage of every single one of the birth control options we’ve outlined above is that they don’t interrupt penetrative sex (or, well, any form of sex). You can be fooling around, having oral sex, washing the dishes (you do you boo) and just start going at it without first locating the condoms, pulling out your fertility tracking app, or having a debate over the merits of the pullout method (obligatory reminder to please be mindful that you can still get pregnant from precum).
While some options may sound more invasive than others – such as getting the IUS or implant fitted, they gain brownie points for their seamless integration into your life. The pill (combined or mini) needs to be taken at the same time every day, and the less rigorous you are with your use of it, the less effective it will be.
Similarly, while you do have to remember to replace the contraceptive patch and vaginal ring and to schedule regular appointments for the injection, these methods require less daily attention and maintenance than the pill or some barrier forms of contraception.
But we’re not entirely hating on the pill, never fear. It is pretty much the most common form of hormonal contraception, and for good reason. It can be acquired in bulk, taken abroad, and is very easy to self-administer. It’s discreet, if that’s a factor you need to be concerned with, and it’s far quicker to stop taking the pill than it is to make an appointment to get the coil or implant removed (you should still consult with your doctor if you’re experiencing side effects and not yo-yo on and off the pill whenever you feel like it).
The side effects of hormonal birth control methods
The side effects listed above are by no means exhaustive. It’s important to note that research into female sexual health is limited, to put it kindly. Much of the anecdotal evidence – such as links between some forms of hormonal contraception and weight gain, loss of sex drive, or depression – are unsupported by research, but that doesn’t make those people’s experiences any less valid.
Of all the ways to prevent pregnancy listed above, it’s worth noting that they will almost all take some time to get used to. If you experience non-dangerous side effects in the first few weeks or even months, it’s likely that your doctor will recommend that you stick it out and see if your symptoms dies down once your body has adjusted to the new hormones. It’s important to be careful when thinking about which hormonal contraception is right for you, your body, and your lifestyle.
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Image credit @vivanhoorn