Understanding Different Options For Birth Control

In the decades since the first hormonal birth control pill was first introduced, patients have been presented with more diverse options. Now the first ever over-the-counter birth control pill is available at select pharmacies in the U.S.

Before starting any new medication, including an over-the-counter birth control pill, Northeast Medical Group OBGYN Omar Sobh, MD, who practices in Shelton and Fairfield, recommends patients speak with their clinician.

“Part of my practice is complex contraception counseling, and that includes taking care of patients who have lots of medical issues or have had lots of side effects with prior birth control methods so that we can review the many different types of methods to find what works best for them,” said Dr. Sobh.

Types of birth control

The most effective long-term birth control option for female patients would be a tubal ligation, which is a surgical procedure that closes the fallopian tubes. For male patients, a vasectomy is a permanent form of birth control that requires a procedure but is a much easier recovery than a tubal ligation.

There are also long-term options with similar efficacy that do not require surgery and are reversible. There are two types of IUDs: A hormonal IUD, and a copper IUD. An IUD is a small contraceptive device inserted into the uterus that is 99% effective and can last for around a decade. Another long-acting method is an arm implant that releases hormones into the body to prevent pregnancy.

Other hormonal options can include different types of birth control pills, patch, or ring, which are slightly less effective than the long-term options. A hormonal birth control can be a good option for patients with endometriosis or painful periods, as it can decrease the severity of cramps and heavy bleeding. Finding the right option for each patient will depend on factors including potential side effects or contraindications.

“Every medication has risks,” said Dr. Sobh. “For example, a common one would be migraines with aura. In that case, we would avoid estrogen, so it’s important for patients to review their full medical history and we always keep an eye on patients with elevated blood pressure as well since that can be affected. Some birth control options have non-contraceptive benefits too. For example, hormonal IUD's are a great medication for helping with heavy menstrual bleeding.”

The over-the-counter pill, which was approved by the FDA in July of 2023, is a progestin-only pill. When a dose is taken at the same time every day, it can prevent pregnancy by making the fluid around the cervix thicker. Another way the progestin-only pill works is by preventing the release of an egg during some of the menstrual cycles.

While this birth control method is generally considered a safe option, there are still certain contraindications.

“Speak with a clinician or pharmacist before starting this medication,” said Yale New Haven Health Clinical Pharmacist Catherine Tom-Revzon. “Even though the new over-the-counter birth control pill does not have any estrogen, there are still certain health conditions that could prevent you from using this medication. This is true especially if this is your first time using the pill or if you are already on a different form of birth control with a hormone and want to switch.”

Misconceptions about birth control

It can take up to three months for the body to adjust to a new birth control method and just like with any other medication, they can come with some side effects. However, inevitable weight gain is a common misconception.

Some patients may also believe that it’s hard to come off a birth control because they could be at risk of severe side effects, but that’s also uncommon. If one option isn’t working, patients should tell their clinician so they can adjust their medication or find another method that’s a better fit.

“What I always tell patients is if they are concerned about it, we are as well and they should come in and talk to us about it,” said Dr. Sobh. “If a patient is not happy with a certain type of method, there is likely an alternative that works better for them.”

YNHHS uses the terms "female" and "male" to reflect biological status typically assigned at birth, and "women" and "men" when referring to gender. According to the Human Rights Campaign, a doctor or midwife assigns a child's sex, male, female or intersex at birth based on their external anatomy. Gender identity is one's innermost identification of self as male, female, a blend of both or neither. Gender identification may differ from birth sex.