Coronavirus information and resources LEARN MORE

Drug Info

The best birth control pill for you: A guide to contraceptive options

Cropped SingleCare logo By | Updated on April 30, 2020
Medically reviewed by Kristi C. Torres, Pharm.D.

Since it was first legalized in the U.S. in the 1960s, the birth control pill has become one of the most popular forms of female contraception. Sixty percent of all women of childbearing years are estimated to use some type of birth control to avoid pregnancy. Many women opt to use birth control pills thanks to their ease of use, availability, safety, limited side effects, additional health benefits, and effectiveness. 

Types of birth control pills

Birth control pills contain synthetic versions of hormones, estrogen and progestin, that your body produces naturally. Which specific pill is best for you depends on your body’s needs, plus the recommendation of your healthcare provider. 

Here’s a brief explanation of the various types of pills on the market:

  • Combination pills: Taken orally at the same time each day, combination pills regulate your menstrual cycle with a blend of the hormones estrogen and progestin.
  • Extended cycle pills: A combination pill that contains both estrogen and progestin, these pills are designed to allow for longer menstrual cycles. For example, instead of having twelve periods per year, a female on an extended cycle pill will have her period every twelve weeks, so only four periods a year. 
  • Progestin-only pills: Also called the minipill, this birth control pill only contains the hormone progestin (a synthetic version of the natural hormone, progesterone). Like combination pills, it is taken orally daily.
  • Low-dose pills: Available as both combination or progestin-only, low-dose pills contain a lower dose of hormones. Just as effective as high-dose pills, low-dose pills are believed to cause fewer side effects.
  • Emergency contraception: Unlike other pills, these are used after sexual intercourse to prevent pregnancy, usually in the case of unprotected sex or a broken condom. There are various types, including combination, progestin-only and antiprogestin pills.

What is the best birth control pill?

It’s no secret, everyone’s body is different. That’s why, in order to determine the right birth control pill for you, you’ll need to have an open conversation with your doctor or gynecologist. There are many factors to consider when choosing a birth control pill, including your health history, how you respond to treatment, and your lifestyle and preferences. The journey to finding the best birth control pill for you can often take some trial and error and requires an open dialogue with your physician. 

Combination birth control pills

Combination pills are a blend of two hormones, estrogen and progestin, typically taken once a day at the same time each day. The combination birth control pill prevents pregnancy in three ways:

  1. Preventing sperm from reaching the egg and fertilizing it. Sperm is stopped thanks to a thickening of cervical mucus. 
  2. Suppressing ovulation. If eggs are not released, they are not there to be fertilized.
  3. Thinning the uterus’ endometrial lining so if an egg is fertilized, it cannot implant. 

There are four types of combination pills currently on the market in the U.S: conventional combination pills, extended cycle combination pills, monophasic combination pills, and  multiphasic combination pills. The conventional combination pill contains the two hormones estrogen and progestin, and follows a standard dosing schedule. This generally includes 21 days of the active pill along with seven pills that are inactive. This means that you’ll get your period each month when you take your inactive pills. When a combination pill contains the same amount of estrogen and progestin in each pill, it’s called monophasic. When the hormone levels vary in each combination pill to mimic a woman’s natural hormone changes through her cycle, it’s called multiphasic. 

Combination birth control pills are 99% effective at preventing pregnancy if used correctly. However, if not taken perfectly, the combination birth control pill is only 91% effective. For maximum pregnancy prevention, make sure to take your pills at the same time daily and start new pill packs on time. If you want to be extra careful, use a backup method of contraception, such as condoms. 

Advantages

Pros of the combination pill may include the following:

  • Shorter, lighter and more regular periods
  • Less severe menstrual cramps
  • Improved acne
  • Less severe PMS 
  • Preventing period-related anemia (due to less intense periods)
  • Reducing risk of ovarian cancer

Disadvantages

Cons of the combination pill may include the following: 

  • Breast tenderness 
  • Breakthrough bleeding or irregular menstruation
  • Bloating
  • Nausea and weight gain
  • Slight increased risk for heart attack, stroke and blood clots
  • Combination birth control pills can cost anywhere from $5 to $50 a pack, depending on your script and prescription coverage. Fortunately, SingleCare can help you save on your birth control prescription. Try searching for the lowest priced options available in your area.

Popular combination birth control pills

Consider these common combination birth control pill brands as options when comparing pills for pricing and side effects:

RELATED: Yaz vs. Yasmin

Extended cycle pills 

Extended cycle pills are a type of combination pill, however, they create longer cycles and are designed to be taken over longer periods of time. Unlike the standard combination birth control pill, extended cycle combination pills are typically prescribed for 12 to 13 weeks of continuous active pills followed by a full week of an inactive pill. This extended cycle pill still allows you to get your period, just less often. 

Depending on your body and dosing schedule, you may only get your period three or four times a year on this pill. If you are looking to skip your period altogether, continuous dosing may be prescribed at the discretion of your healthcare provider, although some women may still experience spotting. A continuous dosing schedule includes taking a combination pill every day without taking any breaks from the hormones.

As a combination pill, the effectiveness of extended cycle pills are considered 99% effective at preventing pregnancy if used correctly. However, effectiveness drops to 91% if not taken correctly. One way to help ensure maximum pregnancy protection is to set a daily alarm on your phone that reminds you to take your pill at the same time each day, and set an alert you when to need start your new pill pack. Some women use a backup method of contraception, like condoms, if they want additional protection against pregnancy. 

Advantages

Advantages of extended cycle pills are much the same as for conventional combination pills, with the addition of:

  • Fewer periods
  • Potentially lighter, shorter periods

Disadvantages

As a type of combination pill, cons of extended cycle pills are also similar to conventional combination pills, with the addition of:

  • Potential spotting between periods
  • Possibility of heavier periods

Popular extended cycle birth control pills

There are a few extended cycle birth control pills available, including:

Progestin-only birth control pills (minipills)

The minipill is a birth control pill that only contains the hormone progestin, which is a synthesized version of the naturally occurring hormone, progesterone. Unlike the combination birth control pill, the minipill does not contain estrogen.

Minipills prevent pregnancy in a similar way: it stops sperm from reaching a female egg by thickening cervical mucus. On the off chance sperm does reach and fertilize an egg, the minipill also thins the uterus’ endometrial lining so the fertilized egg cannot implant. Minipills, however, do not prevent eggs from being released as consistently as a combination pill. 

Progestin-only birth control pills are oral contraceptives that are taken every day, and must be taken at the same time each day to maximize effectiveness. 

The minipill is just as effective at preventing pregnancy as the combination pill (about 99%) if taken perfectly. However, because the minipill must be taken at the same time each day, it has a higher failure rate than the combination pill. If it is not taken at the same time, for example 9 a.m. Monday, then 11 a.m. on Tuesday, your risk of pregnancy is increased for about 48 hours. About 13 females in every 100 get pregnant when on the minipill, in comparison to nine in 100 women on the combination pill. 

If you miss taking your scheduled dose on any day, consider abstaining from sex or use additional protection, such as a condom, over the next 48 hours or more. This added precaution can help to prevent any unplanned pregnancies during the interruption of doses.

Why would the minipill be used? 

There are a few reasons why your doctor may recommend a progestin-only pill instead of the more-common combination pill. For starters, the minipill contains no estrogen, so this could be a perk if you are sensitive to this hormone. Your physician may prescribe a progestin-only pill for you if you notice that you are sensitive to the estrogen in a combination pill. You may also be prescribed the minipill if you have a family or personal history of blood clots. Lastly, your physician may prescribe the minipill if you are currently breastfeeding, as it is safe to use immediately after giving birth. As always, consult your doctor if you are breastfeeding and looking for the best birth control option for you.

Advantages

Pros of the progestin-only pill may include the following: 

  • Safer option if you are at risk of blood clots, high blood pressure, cardiovascular concerns, or if you suffer from migraines
  • Can be used if you are sensitive to estrogen
  • Can be used immediately after giving birth if you are breastfeeding
  • Shorter return to fertility

Disadvantages

Cons of the progestin-only pill may include the following: 

  • Must be taken at the same time daily in order to be effective
  • Slightly higher failure rate than the combination pill
  • Like the combination pill, minipills can cost up to $50 a month. Consider looking into how much you could save on your minipill with SingleCare

Popular progestin-only birth control pills

Consider these common minipill brands as birth control options when comparing pills for pricing and side effects: 

  • Ortho Micronor
  • Nor Q D
  • Ovrette

Low-dose pills

Low-dose birth control pills are a type of combination pill that have, as the name suggests, lower hormone levels. Specifically, low-dose pills have 35 micrograms or less of estrogen, while ultra-low-dose pills have 20 micrograms or less of estrogen. The decreased levels of estrogen prevent common side effects like headache, nausea, and tender breasts while maintaining effectiveness. 

They work the same way as regular combination pills by preventing ovulation, sperm reaching an egg, and the inability for a fertilized egg to implant due to thinning of the uterus’ endometrial lining. 

One of the reasons low-dose pills have become so popular over the last 20 years is because they are just as effective at preventing pregnancy and regulating menstrual cycles as their high-dose counterparts. With typical use, low-dose pills are 91% effective. When used perfectly, they can be more than 99% effective in preventing pregnancy. 

Why would the low-dose birth control be prescribed?

Due to their effectiveness and reduced side effects, the majority of birth control pills prescribed today are considered low dose. As the low-dose pill contains lower levels of estrogen, your doctor may prescribe it if you have an estrogen sensitivity. 

If you think you’ll struggle to take the pill at the exact same time each day, as required with the progestin-only minipill, a low-dose birth control pill may be recommended as an alternative, as there is a slightly larger window for when you take it daily.

Advantages

If your doctor does recommend you try a low-dose pill, here are some pros:

  • Reduced estrogen-related side effects
  • Less side effects than higher-dose pills
  • Less severe menstrual cramping and PMS
  • Reduction of acne
  • Reduced risk of ovarian cancer
  • Period regulation

Disadvantages

As with most medications, there are some potential side effects and cons to using a low-dose birth control pill:

  • Slight risk of increased blood pressure
  • Rare potential for blood clots and deep vein thrombosis
  • Spotting between periods
  • Headache
  • Nausea

Popular low-dose pills

Many of the pills available today are low-dose. Here are some of the most common and popular brand names, with many generic versions also available:

Emergency Contraception Pill

Emergency contraception pills, otherwise known as the morning after pill, are used by women after having unprotected sex, or if a condom breaks. In the U.S. the most common morning after pills, available to purchase over-the-counter at pharmacies without I.D., are levonorgestrel pills. Levonorgestrel is a type of progestin hormone. Although many brands are available, they work in the same way: they prevent the release of an egg from the ovary or preventing fertilization of the egg by sperm. Morning after pills should not be used on a regular basis to prevent pregnancy, but instead as an emergency contraceptive or backup in case regular birth control fails or is used incorrectly.

When should emergency contraception be used?

Emergency contraception should be used after unprotected sex, or when another birth control method, like condoms, failed or were used incorrectly. It’s generally advised to take a morning after pill as soon as you can after sex. You can take a levonorgestrel (Plan B, My Way, AfterPill, Take Action) up to five days after unprotected sex, however the longer you wait, the less effective it becomes. 

Although levonorgestrel morning after pills are the most common in America, if you’re over 155 pounds, you may be advised to try another option like ella (30 mg of ulipristal acetate). This is a prescription only option however, and may make your hormonal birth control ineffective. In some cases, your doctor may recommend a copper IUD, which can then also be used going forward (up to ten years) as an effective birth control method.

Effectiveness of emergency contraception?

The effectiveness of the morning after pill varies depending on how quickly you take it after having unprotected sex. For example, if you take Plan B One-Step within 24 hours, it is about 95% effective, however if taken within three days of unprotected sex, the morning after pill can reduce the chance of pregnancy by 75-89% 

Advantages of emergency contraception

  • Available over the counter
  • No I.D. required
  • Can be purchased by persons of any gender
  • Inexpensive
  • Highly effective
  • Little to no side effects
  • Single dose

Disadvantages of emergency contraception

  • No serious side effects have been reported
  • Lightheaded
  • Dizziness
  • Nausea
  • Vomiting within two hours of taking the pill will render it ineffective
  • May not be suitable for women taking medication for liver problems, epilepsy, or severe asthma 

Popular emergency contraception

There are a number of emergency contraception options available, including:

Frequently asked questions about birth control pills

What is the safest contraception pill?

Generally, low-dose birth control pills, be it combination or progestin-only minipill, are considered safest as they are associated with the lowest risk of causing blood clots. 

What is the difference between 21- and 28-day birth control?

The only difference between the 21- and 28-day birth control pill is that the 28-day includes either seven inactive “sugar” pills or seven iron pills.

Which birth control pill does not cause weight gain?

Although some women report weight gain from various types of hormonal contraception, studies, including this one, indicate no sign of weight can when using a low-dose birth control pill.

What is the best birth control pill for acne?

Only three types of contraceptive pill have been approved by the FDA to treat acne.These are all combination pills: Ortho Tri-Cyclen, Yaz, and Estrostep

When should I take birth control pills?

For birth control pills to be most effective, you should take one pill at the same time each day.

Who shouldn’t take birth control?

If the following risk factors resonate with you, it is not recommended that you take any birth control that contains estrogen as it can increase the risk of clots, strokes, and heart attack. 

  • You are over 35 years of age and smoke.
  • You are scheduled to have surgery that will reduce your mobility for extended periods.
  • You have a history of heart disease, deep vein thrombosis, or pulmonary embolism.

Which birth control method is most effective?

The most effective birth control method is abstinence; however, this may not be the preferred method for many. Alternatively, the most effective birth control options are the implant (Nexplanon) and IUDs (intrauterine device), especially when paired with a condom. 

The implant is a small device that is inserted into your arm and slowly releases the hormone progestin into your body. It lasts for up to four years. 

Non-hormonal and hormonal IUDs are available as small devices. The IUD is placed into your uterus, lasting up to 12 years.

Implants and IUDs are considered more effective than the pill as there is no human error in remembering to take your medication. If taken perfectly, the contraceptive pill (combination birth control pill or the minipill), shot (Depo-Provera injection), vaginal ring (NuvaRing), and patch (Xulane patch) can all be highly effective. Speak to your doctor about which method will work with your medical history and lifestyle. 

Remember that birth control pills only protect from pregnancy. They do not protect against sexually transmitted infections or diseases. That’s why it’s always recommended to use them in conjunction with condoms.