Birth control available online

Combination birth control pills

Combination pills contain synthetic forms of the hormones estrogen and progesterone (called progestin in its synthetic form). Estrogen controls the menstrual cycle.

Combination pills come in a 28-pack. Most pills in each cycle are active, which means they contain hormones. The remaining pills are inactive, which means they don’t contain hormones. There are several types of combination pills:

• Monophasic pills: These are used in 1-month cycles. Each active pill gives you the same dose of hormone. During the last week of the cycle, you can take (or skip) the inactive pills, and you still have your period.

• Multiphasic pills: These are used in 1-month cycles and provide different levels of hormones during the cycle. During the last week of the cycle, you can take or skip the inactive pills, and you still have your period.

• Extended-cycle pills: These are typically used in 13-week cycles. You take active pills for 12 weeks, and during the last week of the cycle, you can take or skip the inactive pills and have your period. As a result, you have your period only three to four times per year.

Examples of brand-name combination pills include:

• Yaz

• Apri

• Alesse

Progestin-only birth control pills

Progestin-only pills contain progestin (synthetic progesterone) without estrogen. This type of pill is also called the minipill.

Progestin-only pills can help decrease bleeding in people with heavy periods. You should also avoid estrogen if you’re over 35 and smoke, as this combination can increase your risk of developing a blood clot.

With progestin-only pills, all pills in the cycle are active. There are no inactive pills, so you may or may not have a period while taking progestin-only pills.

Examples of brand-name progestin-only pills include:

• Camila

• Errin

• Heather

How birth control pills work

Combination pills work in two ways: 

• First, they prevent your body from ovulating. This means your ovaries won’t release an egg each month.

• Second, these pills cause your body to thicken your cervical mucus, the fluid around your cervix that helps sperm travel to your uterus so it can fertilize an egg. The thickened mucus helps prevent sperm from reaching the uterus.

Progestin-only pills also work in a few different ways. Mainly, they work by thickening your cervical mucus and by thinning your endometrium. Progestin-only pills may also prevent ovulation.

When taken correctly, the pill is over 99% effective at preventing pregnancy. This means that fewer than 1 in 100 who use the combined pill as contraception will get pregnant in 1 year.

Side effects of birth control pills

While birth control pills are safe for most people, they do come with some side effects and risks. Side effects can include:

• Decreased sex drive

• Nausea

• Headaches

• Spotting or bleeding between periods

• Breast tenderness

• Abdominal cramping

• Increase in vaginal discharge
  

If you have these side effects, they will likely improve after a few months of using the pill. If they don’t improve, you should talk with your doctor. They may suggest you switch to a different type of birth control pill.

Birth control pill risks

A serious risk of using birth control pills, especially combination pills, is an increased risk of blood clots. This can lead to:

• Deep vein thrombosis

• Heart attack

• Stroke

• Pulmonary embolism

Overall, the risk of a blood clot from using any kind of birth control pill is low. However, the risk of a blood clot from the pill is higher for certain groups. This includes those who:

• Have high blood pressure

• Are on bed rest for long periods

If any of these factors apply to you, talk with your doctor about the risks of using a birth control pill.

Hormonal IUDs

Hormonal IUDs contain the hormone progestin, which is similar to progesterone, a naturally occurring hormone in your body. Each brand contains a different amount of the hormone, which affects how long they last. Examples of hormonal IUD brands include:

• Mirena

• Kyleena

• Skyla

• Liletta

Non-hormonal IUDs

The only non-hormonal IUD available in the U.S. is ParaGard, the copper IUD.

How IUDs work

Each type of IUD works a bit differently, but has the same function: making it difficult for sperm to reach an egg.

ParaGard is wrapped in copper coil. The copper ions released into your uterus create an environment that’s inhospitable to sperm. The copper essentially leaves sperm powerless, so it can’t fertilize an egg and get you pregnant.

The hormonal IUD works to prevent pregnancy in a few ways. It thickens cervical mucus to block sperm from entering the uterus and inhibits sperm movement to make it harder to reach and fertilize an egg. It also thins the uterine lining, so an egg is less likely to attach to the uterus.

IUDs are over 99% effective in preventing pregnancy. This means that less than 1 out of every 100 people using an IUD will become pregnant in a year.

How to use an IUD

IUDs must be inserted by a medical professional. Once inserted, there is not much needed from the patient, other than routine checkups to ensure it's correctly placed. To insert the IUD, the nurse or doctor will put a speculum into your vagina and then use a special inserter to put the IUD in through the opening of your cervix and into your uterus. The process usually takes less than five minutes.

IUD side effects 

Cramping and backaches are common within the first few hours to a few days after IUD insertion. You may get some relief from both by taking OTC pain relievers, using a heating pad, or taking a hot bath. Spotting can also be common and should stop within 3 to 6 months.

IUD risks

IUDs are safe for most, but having certain conditions can increase the chances of side effects and complications.

IUDs aren’t recommended for people who:

• Have an STI

• Have a recent history of pelvic inflammatory disease (PID)

• May be pregnant

• Have cervical or uterine cancers

• Had an infection following an abortion or childbirth in the past 3 months

Also, ParaGard isn’t recommended if you:

• Are allergic to copper

• Have a bleeding disorder that prevents your blood from clotting properly

• Have Wilson’s disease

Hormonal IUDs shouldn’t be used by people who’ve had breast cancer.

Other possible risks include:

• Infection: There’s a small risk of infection after insertion. The risk is highest (though still very low) in the first 20 days, and then it drops significantly.

• Expulsion: There’s a slight chance that your IUD could shift out of place. Using a menstrual cup, being under the age of 20, and never having been pregnant can increase the risk of expulsion.

• Perforation: There’s a very low risk of perforation during insertion.

How the vaginal ring works

The vaginal ring prevents pregnancy by continuously releasing synthetic estrogen and progestin. These hormones prevent your ovaries from releasing eggs to be fertilized. The hormones also thicken your cervical mucus, which helps prevent sperm from reaching the egg.

Types of vaginal rings

There are 2 kinds of birth control rings: NuvaRing and Annovera. 

Each NuvaRing lasts for up to 5 weeks. You take your old NuvaRing out of your vagina and put in a new one about once a month, depending on the ring schedule you choose.

One Annovera ring lasts for 1 year (13 cycles). You put the Annovera ring in your vagina for 21 days (3 weeks), then take it out for 7 days — Annovera comes with a case to safely store it during your ring-free week.

How to use the vaginal ring

Using the NuvaRing:

• Insert 1 NuvaRing in the vagina and keep it in place for 3 weeks (21 days). Regularly check that NuvaRing is in your vagina (for example, before and after intercourse) to ensure that you are protected from pregnancy.

• Remove the NuvaRing for a 1-week break (7 days).

Using Annovera:

• Annovera is inserted for 21 continuous days and removed for 7 days for one year (13 cycles). Using thumb and index finger, squeeze the Annovera ring into a narrow oval shape. The Annovera ring can be inserted while lying down, squatting, or standing with 1 leg up.

If you use it properly, the vaginal ring can be very effective. According to the Centers for Disease Control and Prevention (CDC), typically only 7% of those who use the ring will get pregnant.

Vaginal ring side effects 

Because a vaginal ring is a hormonal contraceptive, the potential side effects are similar to those of taking combination birth control pills.

They may include:

• Reduced sex drive

• Headaches

• Nausea

• Breast pain or tenderness

• Cramping

• Vaginal discharge

• Spotting or bleeding in between your period

Vaginal ring risks

The vaginal ring slightly increases your risk of a deep vein thrombosis (blood clot), heart attack, or stroke. It may also lead to a tiny increase in your risk of breast cancer. The risk of developing breast cancer due to vaginal ring or pill use in people aged under 35 years is 1 in 50,000.

Certain medications and supplements can also reduce the effectiveness of the vaginal ring. These include:

• St. John’s wort

• The antibiotic, rifampin

• Some HIV medications

• Some antiseizure medications

If you take any of these, it’s a good idea to use a backup form of birth control.