The pill is one of the most common forms of birth control. Photo by towfiqu ahamed/iStock

Public Health

Birth Control Options—What You Need to Know

From IUDs to the patch, the pill, and others, it’s more important than ever to know the differences

With the Supreme Court overturning Roe v. Wade and almost half of the states across the country now banning or restricting abortion, sexual health—and pregnancy prevention—have been put in a glaring spotlight. Access to birth control has become more crucial than ever for Americans of childbearing age, especially after Supreme Court Justice Clarence Thomas said in his written opinion that the Court “should reconsider” its past rulings codifying rights to contraception access.

But as anyone who’s ever used birth control can tell you, it’s sort of like picking your poison. While birth control has obvious benefits (mainly, ahem, preventing users from getting pregnant), it can sometimes come with less-than-ideal side effects. Hormonal birth control, for example, can cause strong reactions in some users, and almost none in others. That’s why it’s important to find a method of birth control—hormonal or nonhormonal—that works for you, your body, and your lifestyle. Remember, what works for a 19-year-old undergraduate may not be best for a single 28-year-old, and what works for that 28-year-old might be wrong for a married 40-something. 

Of course, with so many options out there, it can be hard to narrow it down. BU Today is here to help—below, you’ll find a list of current common birth control options on the market (not including condoms), plus information about their efficacy rates and how they work. And, coming soon: read more about the forthcoming Opill, the country’s first over-the-counter birth control pill that’s set to hit shelves in 2024.

How do you actually get birth control? Easy: depending on your health insurance, students can access birth control prescriptions for little to no cost from Student Health Services and the Planned Parenthood in West Campus. If you’re not a student and don’t have an established primary care physician or gynecologist in Boston, there are companies that can mail birth control to you every month, like Nurx, Favor, and PRJKT RUBY.  

But remember, most forms of birth control do not protect users against STDs (sexually transmitted diseases) and STIs (sexually transmitted infections), so make sure you’re combining your sexual activities with appropriate protective measures, like wearing condoms (shout-out to BU’s Condom Fairy), and getting regular STD and STI screening. Doctors recommend getting tested two weeks after every sexual encounter with a new partner. 

Birth Control 101

The pill

What it is: Perhaps the most well-known form of hormonal birth control, the birth control pill is a daily pill containing progestin and/or estrogen that prevents pregnancy when taken orally. The pill typically comes in monthly pill packs, but is also available in options such as 3-month and 12-month packs. Usually, pill packs come with both regular birth control pills and placebo pills; the latter will result in a period when taken. Whether or not you take those placebo pills—and therefore get your period—is up to you and your body.

How it works: The hormones in the pill work in three main ways: they stop or reduce ovulation (the release of an egg from the uterus), they thicken cervical mucus to make it harder for sperm to get through and find an egg, and they thin the uterine lining so that it’s more difficult for a fertilized egg to attach. Combination estrogen and progestin pills, which are more common, can stop ovulation completely. Progestin-only pills, frequently called “minipills,” often don’t inhibit ovulation as effectively, but can result in fewer hormonal side effects.

Efficacy rate: The pill is up to 99 percent effective when taken consistently. (That number drops to around 93 percent when you account for common user errors.) The pill is most effective when taken at the same time each day. If you forget one day, make sure to double up the following day. 

Final notes: The pill is well-known for its side effects, thanks to the hormones it contains. These can be both good and bad. On the plus side, the pill can help treat acne, regulate or lighten periods, minimize excessive hair growth, and manage PCOS (polycystic ovary syndrome) and endometriosis symptoms, among other benefits. Downside? It can cause mood swings, nausea, depression, blood clots, and decreased libido. Some users report weight gain on the pill, too.

IUDs

What it is: IUDs, or intrauterine devices, are small, T-shaped plastic devices that a healthcare professional places into your uterus to prevent pregnancy. IUDs come in hormonal and nonhormonal options. IUDs are both long-lasting and reversible. 

How it works: Similar to the pill, hormonal IUDs—like Mirena and Skyla—contain progestin and work by reducing ovulation and thickening cervical mucus. Some hormonal IUDs can also stop your period altogether. The nonhormonal IUD Paragard is wrapped in copper, which is a natural sperm repellent. 

Efficacy rate: IUDs are more than 99 percent effective. They’re considered among the most effective birth control options. Note that they do have different efficacy windows: hormonal IUDs are effective for anywhere from three to eight years, depending on the brand. The Paragard IUD is effective for up to 12 years.

Final notes: Side effects of hormonal IUDs are similar to the birth control pill. The Paragard IUD can make periods heavier and lead to worse cramping, but won’t come with the less-desirable side effects of hormonal birth control. Like most forms of birth control, an IUD can cause irregular periods or spotting for a few months while your body gets used to it.

Also, getting an IUD placed requires dilating your cervix a small amount. Depending on your pain tolerance, the feeling can range from discomfort and cramps to severe pain, so be prepared. Most providers will tell you to take ibuprofen or Advil beforehand, but it can be worth asking for something stronger while the device is being placed and for afterward. (Discomfort and pain generally last a day following an IUD insertion.) A professional will also need to remove your IUD when it’s time—do not try to remove it yourself. 

Nexplanon

What it is: Nexplanon, or the arm implant, is a small, matchstick-sized rod a healthcare professional inserts under the skin on the inside of your upper arm to prevent pregnancy. Nexplanon is a hormonal form of birth control. Like an IUD, Nexplanon is both long-lasting and reversible. (Note: there’s also an older version of Nexplanon, called Implanon.)

How it works: The Nexplanon implant works by releasing a steady dose of progestin into your body to thicken your cervical mucus and prevent ovulation. 

Efficacy rate: Nexplanon is 99 percent effective for up to three years.

Final notes: Healthcare professionals recommend getting Nexplanon inserted during the first five days of your period so that it takes effect immediately. If you get it inserted at any other time, use another form of birth control for a week until the device starts to work. It’s painless, we promise: a healthcare professional will numb the area with a numbing agent when inserting and removing the implant. You should not use Nexplanon if you’ve had breast cancer. Because it contains progestin, the side effects of Nexplanon can be similar to those of the pill. 

The patch

What it is: The birth control patch is a BandAid-like patch that you stick to the skin on your abdominal area, arm, lower back, or butt to prevent pregnancy. There are two brands of patches: Xulane and Twirla. The patch is a form of hormonal birth control.

How it works: The patch, like many birth control pills, combines progestin and estrogen. The hormones release into your system to thicken your cervical mucus and stop ovulation. Switch out a patch once a week for three weeks; for the fourth week, leave the patch off. That’s when you’ll get your period. If you like, you can wear patches continuously and skip your period altogether.  

Efficacy rate: The patch system is 99 percent effective when patches are worn correctly and consistently (otherwise that number is closer to 93 percent). If you forget to switch a patch on time, know that you do have up to 48 hours of wiggle room during which the old patch is still effective.

Final notes: Yes, you can shower, swim, and sweat while wearing a patch. The adhesive is strong enough to stay on. (But if you’re using Twirla, avoid being in water for more than 30 minutes at a time.) When using the patch, make sure to reapply on the same day every week. Folks with eczema or sensitive skin might want to skip this one to avoid any skin irritation. Because it contains progestin and estrogen, the side effects of the patch can be similar to those of the pill. 

The ring

What it is: Birth control rings are roughly hairband-sized plastic circles that you insert into your vagina to prevent pregnancy. There are two types of rings: NuvaRing and Annovera. Rings are hormonal forms of birth control.

How it works: Rings contain progestin and estrogen that absorb through your vaginal lining to stop ovulation and thicken your cervical mucus. To use a vaginal ring, you insert it into your vagina for three weeks, then take it out for the fourth week, during which you’ll get your period. You can choose to wear a NuvaRing continuously and skip your period (but not with Annovera). You should get a new NuvaRing every month, and a new Annovera every year. 

Efficacy rate: The efficacy rate for rings ranges from 93 percent to 99 percent, just because the ring is a little bit harder to use perfectly. 

Final notes: There are a few things to remember when it comes to proper ring use. Just like tampons, rings should be inserted far enough inside of your vagina that you don’t feel them. While it’s okay to remove your ring for sex (but know that you can leave it in!) or other physical activities, there are time frames to keep in mind. If you have a NuvaRing, it should be outside of you for no more than two days total during the weeks you’re supposed to be using it. For Annovera, that number is just two hours total. Also, if you’re using Annovera, you should wash your ring with mild soap and water every time you put it in. Because they contain progestin and estrogen, the side effects of rings can be similar to those of the pill. 

Depo-Provera shot

What it is: The Depo-Provera shot, most commonly known as the Depo shot, is a hormonal injection you get once every three months to prevent pregnancy.  

How it works: The Depo shot is another form of birth control that contains progestin, which prevents ovulation and thickens your cervical mucus. You get the shot once every 3 months, or every 12 to 13 weeks. You can either make a new appointment to get a shot every three months or if you’re comfortable doing it, you can ask your health provider to provide you with the supplies to inject yourself at home.

Efficacy rate: The Depo shot is 96 percent to 99 percent effective, just because users can sometimes forget to get a new injection on time. Know that you can get a new injection anywhere from 10 to 15 weeks after your last shot to have continuous protection.

Final notes: If you’re afraid of needles, this probably isn’t the option for you. Otherwise, the most difficult thing about the Depo shot is simply remembering to get a new one (mark your calendar!). Timing-wise, if you get your first injection within seven days of day one of your period, it starts working right away. If you don’t, it’ll take a week to kick in, during which you should use backup birth control. Because it contains progestin, the side effects of the Depo shot can be similar to those of the pill. 

Finally, know that certain medications can interfere with the efficacy of birth control. Always consult with a trusted healthcare professional before starting any new birth control regimen. And remember, give yourself time (doctors generally recommend three to six months) to adjust to any new birth control before deciding to switch. Ultimately, listen to your body to decide what’s right for you.

Accidents will happen: emergency contraception

The morning-after pill

What it is: The morning-after pill is a pill you can take to stop the fertilization of an egg after having unprotected sex. There are two types of morning-after pills on the market: Ella and pills like Plan B One Step.

How it works: Ella contains ulipristal acetate. You can take Ella up to five days after having unprotected sex. Plan B and similar pills contain levonorgestrel, a synthetic form of progestin. They can be taken up to 72 hours after unprotected sex. Both pills work by delaying or preventing ovulation. Both types of pill work best when taken as soon as possible, ideally within 24 hours.  

Efficacy rate: Plan B is up to 95 percent effective when taken within 24 hours and 89 percent effective within 72 hours. Ella is up to 85 percent effective when taken within five days. Plan B works best if you weigh under 165 pounds, and Ella works best if you weigh under 195 pounds.

Final notes: The morning-after pill does not end a pregnancy if an egg has already been fertilized and implanted. Rather, the morning-after pill prevents fertilization from occurring at all by stopping or delaying the release of an egg if taken within the appropriate window. Side effects of the morning-after pill can include irregular periods, dizziness, breast tenderness, and sometimes nausea. If you vomit within two hours of taking a morning-after pill, you will need to take another one.  

The morning-after pill can also be expensive—a safe estimate for Plan B is $35 to $50, while Ella can run anywhere from around $50 to over $100. Plan B and similar pills can be purchased over the counter. Ella requires a prescription, but there are workarounds: try calling your pharmacist to see if they’ll write you a prescription directly. Student Health Services and Planned Parenthood can also help get you a prescription. (Find more info about emergency contraception, including the Plan B vending machine in the GSU, here.)

IUDs

How it works: Some IUDs can be implanted as emergency contraception, and are actually the most effective form of emergency contraception. Liletta, Mirena, and Paragard IUDs can all be implanted within five days of unprotected sex to prevent the fertilization of an egg.

Efficacy rate: Up to 99.9 percent effective when inserted within five days of unprotected sex.

Final notes: IUDs don’t come with weight restrictions like the morning-after pill. Other than that, everything you need to know is the same as getting an IUD normally—see above for info about what an IUD entails.