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Comparing Birth Control Pill Types

'The pill' isn't just one pill. It comes in many forms. Here are the options.
By Sonya Collins
WebMD Feature

Are you taking, or considering taking, a birth control pill? Nearly 12 million U.S. women do. And though you may simply call it "the pill," there are many different types of birth control pills.

Each type of pill has pros and cons. But first, make sure that this form of contraception is right for you.

Here's what to consider.

2 Questions to Ask Yourself First

  1. Will you still use a condom to protect against STDs? Male condoms offer the best protection against STDs. With all other methods of contraception, you should also use a condom.
  2. How likely are you to forget pills now and then? The answer matters, because it affects how well the pill works. "You should swallow a pill at the same time every day, whether or not you have sex," the FDA's web site states.

When taken correctly, the pill is highly effective at preventing pregnancy. But that phrase "when taken correctly" is key.

About 8% of women who take the pill become pregnant unintentionally each year. In most of those cases, the women forgot to take pills. Yet when used perfectly -- every day at the same time of day -- only 1 in 100 women have an unintended pregnancy during the first year of using the pill.

So yes, the pill works. But it's not ideal for women wanting a contraception method that they don't need to think about.

"It's a very effective method for women who remember to take their pill each and every day at around the same," says Elizabeth Micks, MD, an instructor and fellow in family planning at Oregon Health and Science University.

Birth control methods that don't require daily action on the woman's part, such as intrauterine devices (IUD) and contraceptive implants, have significantly lower failure rates.

If you've answered those questions and decided that you want birth control pills as your form of contraception, here are the options.

Types of Pills

There are two main types of birth control pills: combination pills and progestin-only pills. Most pills are available in both a 21-day or a 28-day pack. They are often classified on the amount of estrogen and/or the amount and type of progestin.

Combination pills. These contain the hormones estrogen and progestin. Most birth control pills are combination pills. They're equally effective at preventing pregnancy -- again, when taken correctly. They may also have other benefits, including:

  • Shorter, lighter, more regular, and less painful periods
  • May reduce the severity or frequency of menstrual migraines
  • Can improve bleeding and pain associated with endometriosis and fibroids
  • May improve acne
  • Can lower risk of ovarian and uterine cancer
  • Can lower risk of pelvic inflammatory disease
  • May improve bone density in the years just before menopause

All combination pills slightly raise the risk of heart attacks, stroke, and blood clots that start in a leg vein but could travel to other parts of the body -- including the lungs, which could be fatal. That risk rises if you're a smoker older than 35.

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