Which Birth Control is Best for Me?

The name sounds pretty simple — the pill — and yet with so many options it can be overwhelming to choose the right birth control for you.

We break it all down so you don’t have to get lost in the bowels of WebMD, searching for what should be an easy solution. Let’s help you set it and forget it.

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What is it?

Combined estrogen-progestin oral contraceptives (COCs) are also known as birth control pills or “the pill.” COCs contain an estrogen and a progestin component, both of which are hormones produced mainly by the ovaries. All COCs are equally effective when taken correctly, which is at the same time daily. Low-dose COCs are a safe and reliable contraceptive option for the vast majority of women.

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What are the benefits of taking COCs?

COCs have many advantages including rapid reversibility (you can stop the pill if you want to get pregnant), regulation of menstrual bleeding (more regular and hopefully decreased flow), less cramping (yes, please!), and potentially lower risk of certain cancers such as uterine and ovarian cancer. But mainly, COCs are used to prevent undesired pregnancies.

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Brand name vs. generic?

We prefer generic COCs because they’re more affordable. Brand name COCs are more expensive out-of-pocket and there is no evidence that generic COCs are less effective than the brand name ones.

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Monophasic? Multiphasic?

Monophasic pills, which means each active pill has the same hormone dosing. These tend to be easier to use and offer a consistent hormone dose.

Multiphasic COCs were first introduced as an attempt to reduce hormone-related side effects and unscheduled bleeding. But there’s no data that they have any important advantages over monophasic pills. There are a couple of shortcomings of multiphasic COCs. Firstly, you need to be more careful about the order in which you take the pills. Secondly, you can’t take pill packages back-to-back in order to skip a period. Also, the changing hormone levels in multiphasic COCs can make low mood symptoms worse in some women.

Some women use a multiphasic pill and like it. Felix doctors are happy to prescribe multiphasic pills to women who prefer them based on experience, but in general they prefer to prescribe monophasic pills given the consistent level of hormones and ability to skip periods.

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What are the side effects of COCs?

Patients may experience breast tenderness, headaches, nausea, and bloating when starting a COC. These symptoms typically resolve quickly. Sometimes in the first three months, you might have unscheduled bleeding (spotting, or periods at unexpected times), which usually clears up. Some people report low mood or decreased libido when taking COCs. And although there’s a lot of patient concern over this, there’s no evidence that COCs cause weight gain.

Good to note: be patient when taking COCs for the first time as it may take a few weeks to adjust to the new medication.

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Who can’t use COCs?

Women aged 35+ and who smoke more than 15 cigarettes a day can’t use estrogen due to increased risk of blood clots. Our doctors also don’t recommend estrogen containing birth control if you have a history of blood clots, migraines with aura, high blood pressure, heart disease, breast or liver cancer, liver disease, or a long history of diabetes. For people who fall into these categories, the progestin-only pill (POP) or the progestin-containing intrauterine device (IUD) are great birth control options.

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What’s POP all about?

The progestin-only pill doesn’t contain estrogen. It’s slightly less effective than a COC, and it must be taken at the same time every day to be effective. You may not get a period while taking a POP, which is expected and completely normal. If you can’t take estrogen, you can also consider using copper or progestin-based IUDs or condoms for birth control. These pills may not be as effective as COCs in preventing pregnancy, especially if not taken at the same time every day. Some women use condoms as a backup when using POPs.

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Can I skip my periods with the pill?

Continuous or extended-cycle COC regimens allow you to choose if and when to have a period. Skipping periods on the pill is safe. If you’re taking a regular 28-day package, you can just skip the last 7 inactive pills and move straight into your next package of active pills to skip a period. Some pill packs have fewer pill-free days, so be sure to read the pack instructions first.

Extended-cycle preparations are actually packaged so you take 84 active pills in a row and automatically have no periods.

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When should I start my pill?

We recommend the “quick start method” which means you begin taking COCs the day that you get the prescription. You can safely start your birth control on any day of your cycle. Be sure to use back up (like condoms) for two weeks after you start the pill to prevent pregnancy.

What do I do if I miss a pill?

Sexandu.ca does an incredible job guiding women through this, providing advice and planning based on their individual scenario. This site was created by the Society of Obstetricians and Gynaecologists of Canada so it’s a very trusted source. In general, if you miss a pill, take it as soon as you remember and use a back up contraception like condoms for a week.

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How long can I take the pill for?

Hormonal contraception can be continued until menopause (average age 50) in healthy, non-smoking, normal weight women. There is no need to take time off from the pill, or change which pill you take. Women can use COCs for years and stop only for pregnancy or menopause.

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More questions?

We’re big fans of sexandu.ca for info and resources around birth control and more!

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