Q:  How do I choose the birth control method that is right for me?

By Kasey Patton, NP –

Kalispell OB/GYN / 406 Magazine



Excellent question! There are so many options available to choose from today that picking which method is best for you may seem a bit overwhelming. Let me help by breaking down the options based on how often each method requires your attention.


Oral Contraceptive Pills (OCP’s) or “The Pill” 

Combined Oral Contraceptive Pills (COCP) COCP’s contain a dosage of both progestin and estrogen to prevent ovulation and thus prevent pregnancy.  The hormones also work by thickening the cervical mucus and making it difficult for semen to get past the cervix and into the uterus. COCP’s generally have three weeks of an active pill and one week of placebo or “sugar” pills.  Some COCP have three months of active pills and one week of placebo pills which allows the user to have a period every three months. COCP’s come in many different formulations and dosages which mean that a woman can usually find a pill that works well with her body.  The most common side effects of COCP’s are slight nausea or headache in the first few weeks, mood changes, irregular bleeding for the first few months, and weight gain. If you are over 35 and smoke, have a history of cardiovascular disease or high blood pressure, this medication may not be available to you.  Effectiveness is anywhere from 93-99% depending on actual usage.

Progestin Only Pills (POP).  POP’s contain a single dose of progestin for each day of the pill package with no placebo days.  A woman may experience a light period during her normal, expected time, or she may have no period at all. The most common side effect with POP’s is irregular bleeding or “spotting”.  A woman with pre-existing depression may also find that POP’s may worsen this so it is important to discuss any concerns with your provider prior to starting this method.  Effectiveness is anywhere from 93-99% depending on actual usage.  This method is safe to use when breastfeeding.


Ortho Evra Patch.  This patch has the same type of ingredients as the COCP’s, but instead of daily usage, you apply a patch that is changed once per week to the skin on your hip for three weeks. The fourth week a patch is not used which allows the user to have a period at a predictable time during that week. There is only one available dosage with this product and its effectiveness is anywhere from 93-99% depending on actual usage. There has been some evidence that the patch may not be as effective in women weighing more than 198 pounds and so an alternative method may be needed in these cases.


Nuva Ring

The Nuva Ring is a small plastic ring-shaped device that is inserted into the vagina once per month.  It is removed after three weeks and thrown away.  The woman does not use anything for one week and it is during this week that she should have a predictable period.  The device works the same way as the COCP and patch, using progestin and estrogen to prevent ovulation and increase cervical mucus.  The Nuva Ring is able to use a lower dose of estrogen than either the patch or most COCP’s and so estrogen-based side effects such as nausea, breast tenderness and headache are reduced.  Effectiveness is anywhere from 93-99% depending on actual usage.

Every 3 months

Depo Provera Injection

Depo Provera is a single dosage of progestin given every 3 months through a shot in the muscle. It boasts 97-99% effectiveness with minimal effort on the part of the woman using it.  Some women experience irregular bleeding in the first 3 months, but the majority of women will go on to have an overall decrease or complete absence of periods.  This is considered healthy and is no cause for concern. A drawback of using Depo Provera is a loss in bone density that is noted in women who use this product for more than two years although this loss is reversible once the medication is stopped.  It may also take a user of Depo Provera up to 18 months to return to fertility after the last injection given so this choice may not be the best for those seeking a very short-term form of birth control. This method is considered safe for breastfeeding mothers.

Every 3 years

Nexplanon Implant

The Nexplanon is a single rod the size of a matchstick that is inserted into a woman’s upper arm.  The device releases progestin over a three year period preventing ovulation and pregnancy.  There is minimal risk with usage of this device and the pregnancy prevention rate is above 99%.  The most common side effect was irregular bleeding that can last the life of the device.  Return to fertility is within one to two weeks after removal of device


The Skyla is an intrauterine device (IUD) that was approved for women who have never been pregnant. It contains a very small dosage of progestin that helps to make periods lighter as well as providing excellent birth control that is more than 99% effective.  The device is inserted in the doctor’s office and most women experience some cramping after the procedure that is similar to menstrual cramps. Irregular bleeding is seen in the first few months with Skyla usage but it often regulates or disappears over time.  Return to fertility is immediate upon removal of the device and it is safe to use in breastfeeding mothers.

Every 5 years

Mirena IUD

The Mirena IUD (MIUD) is a device that is similar to the Skyla. The MIUD is slightly larger and recommended for women who have already been pregnant.  MIUD has over 99% effectiveness and can be used by most women who need birth control.  The most common side effect is irregular spotting, especially in the first few months after insertion.  The device only needs to be replaced every 5 years and offers the same immediate return to fertility, decrease in flow of period and safety during breastfeeding that the Skyla offers.

Every 10 years

Paragard IUD 

The Paragard IUD (PIUD) contains no hormones and works by interfering with sperm and egg motility which is thought to be a result of the copper that is wrapped around the outside of the device, as well as the presence of the device itself inside the uterus.  It is also over 99% effective and can also be used as a form of emergency contraception if inserted within three to five days of unprotected sex.  The PIUD does not change a women’s menstrual cycle, but she may notice an increase in flow and cramping during the first few months after insertion.  This effect may or may not continue for the duration that the device is in place.  The PIUD is replaced every 10 years and offers an immediate return to fertility after removal, as well as safety during breastfeeding.

There are a lot of choices out there, right? Please be sure to speak with your provider about all of your medical conditions and family history so that she can help you choose the very best birth control for your unique situation.

*Original article & graphic posted in 406 Woman.