By Leslie Rosenthal, MD
There are a lot of birth control methods out there, so choosing which one is right for you can seem intimidating. Fortunately, having so many options means that you can find a birth control method that fits your body and lifestyle. While you might love the first method you try, it could also take a few trials and errors to find the right fit for you. Just because your best friend loves one method doesn’t mean you will—your body is unique, and may react differently to different hormones.
As a fellow in Adolescent Medicine, I talk to patients about birth control every day. Here are some of the questions that I ask my patients who are interested in starting birth control or changing their method.
Remember: none of these methods protect you from sexually transmitted infections (STIs). Always use condoms. Not only will they protect you from STIs, but they’re a great back-up birth control method (and one of the only methods that can be used by people with penises!). I don’t recommend them as primary birth control because even though they’re 98% effective when used perfectly, external condoms are only 82% effective with typical use (yikes!). In order to be effective, condoms need to be used perfectly every single time. Even if you’re super careful, condoms can slip or break. It only takes one accident for you to get pregnant.
1. Are you forgetful?
Yes, very: Definitely go for a long-acting method like the implant, copper IUD, or hormonal IUD.
Kind of: Long-acting methods are probably still the best choice, but if you want to avoid a procedure, the shot (Depo-Provera), the ring, and the patch are other options that don’t require daily attention.
Not at all: Birth control pills may not be a bad option for you, but their effectiveness requires taking the pill at the same time every day. Even if you have a perfect memory, I recommend long-acting methods.
I ask this question to see if I’d recommend even considering the pill. Even if your memory is great, I usually still recommend long-acting methods like the implant, copper IUD, or hormonal IUD. This is because even disciplined people with a great memory make mistakes sometimes. Long-acting methods are mostly fool-proof. They’re highly effective and work for three to ten YEARS, taking the worry out of your day.
Other methods require less discipline than the pill, but still involve regular action. You only need to think about the patch each week when you change it. The ring only requires attention once a month, and you only need to get the shot (also called Depo-Provera) every three months.
The pill may be a good method for you for other reasons, but it requires daily action in order to be effective. Frequently taking the pill at different times can be a big problem. If your schedule changes a lot and you can’t think of a good time to take your pill, this option is probably not your best bet. If you’re generally anxious, or are already on the pill and find yourself freaking out every time you take it 15 minutes late, consider switching to an option that you don’t have to think about, like an IUD or implant. You’ll feel better knowing that your birth control is working even when you forget about it.
2. Do you want to get your period?
Getting your period can be a big pain, but it can also be a welcome sign that you are, in fact, not pregnant. If you want to stop or significantly reduce your periods, consider a hormonal IUD, the shot, or the implant. It’s also possible to skip a period when on the birth control pill, patch or ring. However, you should talk to your doctor in order to know how to do this safely. On the flip-side, copper IUDs (also called ParaGard) can make your periods heavier and more painful.
3. Are you worried about your parents finding out?
If you don’t want anyone to know you use birth control, long-acting methods such as an IUD or implant may work best. There’s no evidence of your birth control that they can stumble on. Depo-Provera is also a good bet, since you get the shot in a doctor’s office every 3 months. The ring, patch, and birth control pills all require storage, which someone could potentially find. In addition, there’s a chance someone may see you wearing the patch and ask about it (even though it’s normally covered by clothing).
4. How comfortable are you with your body?
The ring needs to be inserted and removed every month. While the process is painless and pretty simple, it does require you to become closely acquainted with your vagina. It can be a great opportunity to get to know your body a little better, but if thinking about dealing with that freaks you out, consider a different method. While you can largely forget about IUDs, it’s still a good idea to check for strings shortly after it’s inserted (and periodically from then on). This requires inserting your fingers into your vagina to feel for strings hanging just outside of your cervix. However, it’s still a lot less involved than with the ring.
5. How tolerant are you of procedures and needles?
If needles freak you out, you probably don’t want to get a shot every three months (and can cross Depo-Provera off your list). You also may not like getting an implant, which is inserted into your arm. IUDs are inserted in a doctor’s office, and some people say the procedure feels uncomfortable (though others aren’t bothered by it). The pill, patch, and ring, on the other hand, don’t require any needles or medical procedures.
6. Are you trying to get anything else out of your birth control?
Yes: Talk to your doctor, they’ll help you figure out what’s best for your body!
Some methods of birth control have additional health benefits. Birth control pills can help some people with acne. They can also ease period pain. The pill, patch, and ring are also used to treat polycystic ovary syndrome (PCOS), endometriosis, and other health issues. If you’re concerned about acne or the intensity of your periods, definitely talk to your doctor about it. They’ll help you figure out which method of birth control fits your needs best.
If you’re thinking of starting birth control or changing your method, it’s ALWAYS a good idea to talk to your doctor, who can address any questions or concerns you have. The Mount Sinai Adolescent Health Center provides completely free, confidential health services to people between the ages of 10 and 22. If you live near NYC, call for an appointment, or just stop by.
Note: There are some birth control methods that I didn’t include here because their effectiveness rate is typically much lower than other methods. These include: diaphragms, spermicide, the cervical cap, withdrawal, fertility awareness (also called the rhythm method) and the sponge. While diaphragms are more effective than some of the other methods I left out, they’re not very popular with young people. If you’re looking for a non-hormonal method besides the copper IUD, ask your doctor if they would recommend using a diaphragm with spermicide. I also didn’t discuss sterilization (or “getting your tubes tied”) because it’s a permanent procedure, and I wouldn’t recommend it to a teen.
Dr. Leslie Rosenthal is a board certified Pediatrician, and a Fellow in Adolescent Medicine at Mount Sinai Adolescent Health Center. She received her medical degree from the University of Iowa Carver College of Medicine, and completed a residency in Pediatrics at Children’s Hospital of Los Angeles in Southern California. Her interests include health disparities, reproductive health, childhood obesity and chronic disease.
The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.