It’s always been more than just birth control. It helped spark the sexual revolution. It’s a feminist icon and lets women live life on their own terms. For 50+ years, the pill has been changing lives for the better. And if you’re thinking about using it, here’s everything you need to know to find the right one.
While an IUD, implant, or shot may make more sense if you don’t want to get pregnant for at least a few years, the pill is a bit more flexible. It’s the most popular birth control method in America, with a price point that fits almost everyone. You can get a month’s packet of generic pills for as little as $10 with insurance. Some states even offer the pill for free, if you and your income qualify. At the other end of the spectrum, new formulas that offer fewer or lighter periods are constantly coming to market, and they cost more. Brand-name pills like Loestrin24, Yaz, Yasmin, Seasonale, and Seasonique can cost as much as $50-$90 per month.
Different kinds of pills and how they work
The pill is made of synthetic hormones like those that occur naturally in your body. These synthetic hormones cause your body to behave as it does during the times of the month when you cannot get pregnant.
There are basically two different kids of pills, the combination pill and the mini-pill.
Combination pills contain two types of hormones, estrogen and progestin. They prevent pregnancy in three ways: by suppressing ovulation (meaning your eggs stay put in your ovaries); by thickening cervical mucus (making it harder for sperm to move); and by thinning the lining of the uterus (making it harder for an egg to attach there). This type of pill is more widely used than the mini-pill.
Combination pill names: Alesse, Apri, Aranelle, Aviane, Enpresse, Estrostep, Lessina, Levlen, Levlite, Levora, Loestrin, Mircette, Natazia, Nordette, Lo/Orval, Ortho-Novum, Ortho Tri-Cyclen, Yasmin and Yaz. (Not quite as clever as nail polish names, but they get the birth control job done.) Lybrel, Seasonique and Seasonale (generic names: Jolessa or Qualsense) are combo pills that can minimize periods to just a few times a year or less.
Benefits: Aside from being very effective at preventing pregnancy (when taken correctly), combination pills are linked to less crampy, lighter, shorter periods. (That can also mean less chance of anemia.) These pills may also clear up acne. The combo pill may reduce the risk of ovarian and endometrial cancer.
Combination pills might not be right for you if: you are sensitive to estrogen. If that’s your case, you can try a lower-dose combination pill, which contain less estrogen. You may have fewer side effects than with the regular combo pill, but there might be more between-period bleeding.
Other concerns: You shouldn’t take the combination pill if your doctor has determined you are at risk of stroke, heart attacks or blood clots. Women who are overweight or smoke may fit this description. Many women with high blood pressure or who get migraines with aura shouldn’t use the combo pill. While the pill is perfectly safe for most women, you should always discuss your medical history and questions with your doctor before taking a new medicine. One more thing: Women who are breast-feeding should not take the combination pill.
Heads up! The combo pill can be less effective against pregnancy if you use it while taking any of the following: the herbal supplement St. John’s Wort; HIV and seizure medicines; topamax/topiramate, which can be used to treat seizures or migraines; or the antibiotic rifampin, which is used to treat tuberculosis. (Other antibiotics are fine to take with the pill.) These medicines limit your body’s ability to adequately absorb the pill’s pregnancy-preventing hormones. If you take these meds, consider a birth control method that doesn’t contain estrogen, such as the mini-pill, an IUD, the shot, or the implant.
Inactive pills: There are typically four to seven inactive or placebo pills in each monthly pack. These are the pills that have no or a low-dose of hormones. You take these to maintain your daily habit of taking your pill at about the same time each day. (Speaking of taking your pill everyday, did you know that Bedsider can text you sexy little birth control reminders? To sign up, text MyBC to 42-411 or visit the Reminders page.)
Mini-pills contain only progestin. They prevent pregnancy by thickening your cervical mucus and thinning the lining of the uterus. Some mini-pills suppress ovulation, but that’s not the main way they work. The mini-pill was developed for women who are sensitive to estrogen.
Mini-pill names: Camila, Errin, Jolivette, and Mircronor.
Benefits: Aside from being very effective at preventing pregnancy (when taken correctly), the mini-pill is safe for women who are at risk of heart disease or strokes, or are heavy smokers. It’s also safe for breast-feeding women.
The mini-pill might not be right for you if: You’ve had breast cancer.
Inactive pills: Unlike the combo pill formulas, every mini-pill in your pack is active. Take one every single day, at about the same time each day. (Again, Bedsider can text or email you handy birth control reminders. To sign up, text MyBC to 42-411 or use the Reminders page.)
Popular pill-related questions
Can I use the pill to have my period less often, or to skip a month once in a while?
Yes. The pill’s hormones cause your body to mimic a natural cycle, but if you have heavy, painful periods, or conditions that your menstrual cycle suck like migraines, endometriosis, or epilepsy, then skipping periods could be awesome.
There are two ways to do this. By tinkering temporarily with the way you take your regular combination pills. Or by taking one of the pill formulas approved to cut down the number of periods you have.
Say you want to be period-free for a one-time event like running a 10K or going on vacation. Most combination pills contain 21 active pills and seven placebos, or 24 active pills and four placebos. You usually get your period when you’re taking the placebo-pills. To skip that month’s period, don’t take the placebos. Go straight on to the first active pill in the next month’s pack. From there, take one pill each day, just like normal. Heads up: This only works for combo pills, not mini-pills!
Newer combination pill formulations have been developed that give you four or fewer periods a year. Instead of a 28-day pill pack, they typically come in packets of 84. With Seasonale (generic names: Jolessa, Qualsense), the last seven pills in the packet are inactive placebos. With Seasonique, they’re low-dose estrogen pills. In either case, you get your period when you take the placebos. With Lybrel, there are no placebos, and your period is postponed indefinitely as long as you keep taking it. Get more info on methods that let you skip your period.
What other birth control methods contain estrogen?
Like the combination pill, the patch and the ring both contain estrogen and progestin. Progestin-only methods include the mini-pill, the shot, the implant, the Mirena IUD, and emergency contraception (EC).
Isn’t estrogen for women going through menopause?
Yes. Our body’s estrogen surges during puberty and declines during menopause, which typically occurs anywhere between ages 40 and 55.
Some women use estrogen pills, patches, or creams to relieve the hot flashes, vaginal dryness or other not-so-fun symptoms of menopause. Progestin is also used in some hormone-replacement therapies. Estrogen also helps your body process calcium. Women who lack estrogen because they are menopausal, or don’t have periods because of intense athleticism or eating disorders can be at risk of osteoporosis.
Is there a connection between the pill and cancer?
While some early research suggested the combination pill could lead to a higher risk of breast cancer, more recent studies show no difference for pill takers or non-pill takers. Other studies indicate the combo pill can reduce the risk of ovarian and endometrial cancer, and maybe colon cancer too.
Everything in life comes with possible risks and benefits, including pregnancy which researchers say poses many more health risks to women than does the use of hormonal birth control. Because so much depends on your body, the safest route is always to discuss your family history and any other concerns with your doctor or health care provider.
And when it comes to birth control information, always keep in mind that some organizations and individuals exaggerate or twist the possible links between hormonal birth control and disease because they want to scare women away from having sex outside of marriage.
The truth is, medical researchers have found that the pill can decrease your risk of some cancers and possibly increase the risk for others. Again, you’ll have to weigh the benefits and risks to find out if the pill is right for you.
What about the pill and migraines?
Some women who experience migraines say the pill makes them better, others say just the opposite, and some say the pill makes no difference at all. Wish we had a definitive answer here, but your mileage may vary.
Women under 35 who have migraines without aura generally do fine on either type of pill or hormone-based birth control. Women who have migraines with aura, and any migraine sufferer (with or without aura) over age 35 should talk to their doctors (including general practitioner, gynecologist, and if you have one, a neurologist) about a possible increased risk of stroke while on estrogen-based methods.
If the combination pill or some mini-pills keep my eggs from being released, does this mean that I’ll remain fertile longer than I would off the pill? Say I take the pill from age 18 to 40; will all those eggs still need to come out one by one in the form of continued periods after I stop taking the pill?
Nope. Your eggs don’t “store up” in this fashion. They age and tend to dissolve and break down over the years. There’s no real difference between pill takers and women who never used hormonal birth control when it comes to how old you’ll be when menopause begins.
My friend loves her pill. Should I just go on that one too?
Maybe, but you still have to discuss it with your doctor to find out for sure. Just because it works for your best friend doesn’t mean it’s the perfect pill for you, and vice versa. Every body is different, and you really have to try it to know if it’s right. Fortunately, most women who use the pill do just fine.