From the first day of menstruation to the last, most people assigned female at birth (AFAB) consider birth control (contraception) at some point. Which contraception method you use is not a decision to be taken lightly.
"Most people spend nearly two-thirds of their lives preventing pregnancy," says Aparna Sridhar, MD, MPH, a comprehensive women's reproductive health provider at UCLA Health. "Contraception, including how it affects your body and whether it works for you, is a very personal experience that depends on your health, lifestyle and age. It's essential to work with your health care provider to tailor your birth control."
Regardless of whether your contraception choice contains hormones or not, every birth control method comes with risks and benefits. Ultimately, you need to consider how those risks and benefits fit into your lifestyle and health.
Dr. Sridhar shares what you need to know when considering non-hormonal and hormonal birth control:
Non-hormonal birth control
There are many types of contraception that do not contain hormones, such as:
- Barrier methods, including male and female condoms, diaphragms and contraception gel
- Intrauterine devices (IUD), specifically the copper IUD
- Natural cycle tracking, which helps determine when you are ovulating
Non-hormonal birth control methods have fewer associated risks than contraception containing hormones. These methods are a good option for people who should not use hormones or who prefer less risk. However, these non-hormonal methods also have fewer benefits and may take more effort to be consistent.
"The lack of hormones result in lesser long-term consequences for most people," Dr. Sridhar says. "However, these methods often require taking action during a spontaneous act of intercourse, and that may not be the best choice for everyone."
Dr. Sridhar notes that the copper IUD does have risks for certain people because it can cause heavier menstrual cycles. This may not be the best choice for people who:
- Already experience heavy menstrual periods
- Have baseline anemia (low iron)
- Take anticoagulant medication (blood thinners)
Talk to your health care provider about non-hormonal contraception methods to see if they are a good option for you.
Hormonal birth control
Hormonal birth control may contain progesterone or a combination of estrogen and progesterone. It comes in many forms, including:
- Hormonal implant
- Hormonal IUD
- Injection
- Oral medication
- Skin patch
- Vaginal ring
Because this type of contraception affects your hormones, there can be a bit more to consider when weighing the risks and rewards.
"For people with no concerning medical issues, hormonal birth control has more contraceptive and non-contraceptive benefits than associated risks," Dr. Sridhar says. "But your overall health, medical conditions, family history and age play a role."
Benefits of hormonal birth control
Using hormonal contraception may provide benefits, such as:
- Decreases menstrual pain (dysmenorrhea), which is especially helpful for adolescents and people with endometriosis
- Lessens acne severity and occurrence, especially in people with polycystic ovary syndrome (PCOS)
- Improves severe mood symptoms in people with premenstrual symptoms and premenstrual dysphoric disorder (PMDD)
- Lowers the risk of certain cancers, such as endometrial and ovarian cancer
- Reduces excess facial hair for people with PCOS
- Reduces menstrual migraines, which can be caused by the withdrawal of hormones before each menstrual cycle
- Regulates menstrual bleeding, which is good for iron levels and people with fibroids, adenomyosis, endometriosis and PCOS
- Eases perimenopausal symptoms, including hot flashes
- Helps with bone health in people at high risk for osteopenia or osteoporosis
"It's not uncommon to take hormonal birth control for the non-contraceptive benefits," Dr. Sridhar says. "For people in perimenopause who have irregular periods and severe symptoms, this type of hormone regulation can help."
Risks associated with hormonal birth control
Most hormonal contraception, except hormonal IUDs, is delivered systemically — the hormones circulate throughout your body. Circulating hormones can affect your body in many ways.
The most significant risk associated with hormonal birth control is venous thromboembolism — blood clot formation in the legs and lungs. Blood clots are more likely with combined hormonal birth control, but are still considered extremely rare. Your risk may be higher if you have:
- History of blood clots
- Obesity (body mass index greater than 30)
- Smoking
- Other conditions, such as active lupus disease or cancer
Some experts have also suggested that hormonal birth control may be associated with an increased risk of breast cancer. However, Dr. Sridhar warns there is conflicting data, and individualized counseling is critical.
"Hormonal birth control does not cause breast cancer, but there could potentially be an association," Dr. Sridhar says. "Talk to your provider to understand your baseline risk of breast cancer before using hormonal contraception."
Tips for making birth control choices
The effectiveness of any birth control depends on your lifestyle and whether you use it correctly and consistently. Dr. Sridhar's recommendations for choosing birth control include:
- Work closely with your health care provider: Your provider can screen you for birth control use, taking your medical history, family history, risk factors and medications into account.
- Don't discount non-hormonal methods: Many people use non-hormonal contraception and have no issues. These methods may be a good choice if you have complex medical conditions.
- Be prepared for trial-and-error with hormonal birth control: Everyone reacts to hormonal contraception differently. However, you can immediately reverse unpleasant side effects by stopping most types. The exception is injected hormonal contraception, which may take longer to exit your system. Let your provider know if you are experiencing side effects so you can change course.
- Beware of social media influences: Your health care provider uses scientific data and best practices to individualize and recommend birth control.
"Menstrual patterns, metabolic health and health risks evolve over time," Dr. Sridhar says. "Contraceptive choices should reflect these shifts and fit well with your lifestyle.”
