Birth Control: Pros and Cons of Hormonal Methods

Topic Overview

The following tables list some pros and cons of using hormonal birth control methods.

Combination pills, skin patch, or vaginal ring (estrogen plus progestin)

Pros	Cons
No interruption of foreplay or intercourse Reduced bleeding and cramping with periods, which lowers the risk of anemia Fewer or no periods (with certain types of pill) Reduced pain during ovulation Reduced risk of pelvic inflammatory disease (PID) Reduced fibrocystic breast changes Reduced risk of ectopic pregnancy May reduce acne May reduce ovarian cysts May reduce symptoms of endometriosis May protect against ovarian and endometrial cancer Can be used after an abortion	Does not protect against sexually transmitted infections or HIV May not be as effective when taken with certain medicines May delay return of normal cycles If used in early breastfeeding, may reduce milk supply Pills must be taken every day. Patches may not fully protect you from pregnancy if they are exposed to direct sun or high heat. This can release a high dose of hormone from the patch, which leaves less for the patch to release later in the week. Patches deliver more estrogen than low-dose birth control pills do. Some research has found that women using the patch are more likely to get dangerous blood clots in the legs and lungs. The risk may be higher if you smoke or have certain health problems. The U.S. Food and Drug Administration (FDA) suggests that you talk to your doctor about your risks before using the patch.

Pros

Cons

No interruption of foreplay or intercourse
Reduced bleeding and cramping with periods, which lowers the risk of anemia
Fewer or no periods (with certain types of pill)
Reduced pain during ovulation
Reduced risk of pelvic inflammatory disease (PID)
Reduced fibrocystic breast changes
Reduced risk of ectopic pregnancy
May reduce acne
May reduce ovarian cysts
May reduce symptoms of endometriosis
May protect against ovarian and endometrial cancer
Can be used after an abortion

Does not protect against sexually transmitted infections or HIV
May not be as effective when taken with certain medicines
May delay return of normal cycles
If used in early breastfeeding, may reduce milk supply
Pills must be taken every day.
Patches may not fully protect you from pregnancy if they are exposed to direct sun or high heat. This can release a high dose of hormone from the patch, which leaves less for the patch to release later in the week.
Patches deliver more estrogen than low-dose birth control pills do. Some research has found that women using the patch are more likely to get dangerous blood clots in the legs and lungs. The risk may be higher if you smoke or have certain health problems. The U.S. Food and Drug Administration (FDA) suggests that you talk to your doctor about your risks before using the patch.

Progestin-only pills, implant, or shot

Pros	Cons
No interruption of foreplay or intercourse Fewer or no periods (especially with shot or implant) Reduced cramps and pain during ovulation Reduced bleeding and cramping with periods, which lowers the risk of anemia Reduced risk of pelvic inflammatory disease (PID) Does not contain estrogen, so can be used by women who cannot take estrogen May be used by women over 35 who are smokers May be used while breastfeeding Reduces risk of ectopic pregnancy Possible protection against endometrial and ovarian cancer Implant gives rapid return to fertility following removal. Shot and implant provide extremely effective birth control protection. Shot protects for about 3 months; implant lasts 3 years. Shot reduces symptoms of endometriosis. Shot reduces frequency of seizures in women who have a seizure disorder. Shot reduces number of sickle cell crises in women who have sickle cell disease.	Does not protect against sexually transmitted infections or HIV Causes more irregular periods or spotting between periods May not be as effective when taken with certain medicines Makes diabetes more likely if you have had gestational diabetes during pregnancy ^{footnote 1} Progestin-only pills are less effective than combination pills, but the shot and implant are extremely effective. Pills must be taken at the same time each day. Implant may cause menstrual periods to stop or be very light. Implant must be inserted and removed by a trained health professional. Implant may cause headaches. Shot may delay return of normal cycles for 6 to 8 months after the medicine is stopped, but there is no delay with pills or implant. Shot may increase the risk of chlamydia or gonorrhea infection among women who are sexually exposed to these bacteria. ^{footnote 2} Shot causes slight weight gain. Shot may decrease levels of HDL ("good") cholesterol. Shot causes bone mineral loss, so calcium supplementation is necessary. Using the shot for 2 or more years can cause bone loss, which may not be fully reversible after stopping the medicine. This concern may be greatest during the teen years, when young women should be building bone mass. ^{footnote 3}

Pros

Cons

No interruption of foreplay or intercourse
Fewer or no periods (especially with shot or implant)
Reduced cramps and pain during ovulation
Reduced bleeding and cramping with periods, which lowers the risk of anemia
Reduced risk of pelvic inflammatory disease (PID)
Does not contain estrogen, so can be used by women who cannot take estrogen
May be used by women over 35 who are smokers
May be used while breastfeeding
Reduces risk of ectopic pregnancy
Possible protection against endometrial and ovarian cancer
Implant gives rapid return to fertility following removal.
Shot and implant provide extremely effective birth control protection.
Shot protects for about 3 months; implant lasts 3 years.
Shot reduces symptoms of endometriosis.
Shot reduces frequency of seizures in women who have a seizure disorder.
Shot reduces number of sickle cell crises in women who have sickle cell disease.

Does not protect against sexually transmitted infections or HIV
Causes more irregular periods or spotting between periods
May not be as effective when taken with certain medicines
Makes diabetes more likely if you have had gestational diabetes during pregnancy ^{footnote 1}
Progestin-only pills are less effective than combination pills, but the shot and implant are extremely effective.
Pills must be taken at the same time each day.
Implant may cause menstrual periods to stop or be very light.
Implant must be inserted and removed by a trained health professional.
Implant may cause headaches.
Shot may delay return of normal cycles for 6 to 8 months after the medicine is stopped, but there is no delay with pills or implant.
Shot may increase the risk of chlamydia or gonorrhea infection among women who are sexually exposed to these bacteria. ^{footnote 2}
Shot causes slight weight gain.
Shot may decrease levels of HDL ("good") cholesterol.
Shot causes bone mineral loss, so calcium supplementation is necessary.
Using the shot for 2 or more years can cause bone loss, which may not be fully reversible after stopping the medicine. This concern may be greatest during the teen years, when young women should be building bone mass. ^{footnote 3}

Intrauterine devices (IUDs)

These advantages and disadvantages apply to both hormonal and non-hormonal IUDs.

Pros	Cons
Does not require interruption of foreplay or intercourse Does not require cooperation of sex partner More than 99% effective in preventing pregnancy ^{footnote 4} Easy to use Most cost-effective method of birth control over time Safe to use while breastfeeding Can be removed whenever you have problems or want to stop using it. Fertility returns with the first ovulation cycle following IUD removal. Can be inserted after a normal vaginal delivery, a cesarean section, or a first-trimester abortion Hormonal IUD can relieve heavy menstrual bleeding and cramping in most women.	Does not provide protection against sexually transmitted infections (STIs) or HIV Costs several hundred dollars for insertion. But this cost is often covered by your health insurance. And when an IUD is used long-term, it costs less than other methods over time. Only a health professional can remove the IUD. Never attempt to remove the IUD yourself or allow a partner to try to remove it. When inserted, an IUD can spread a genital infection into the uterus, leading to pelvic inflammatory disease (PID) in the first months after insertion. This is why you are screened for STIs before getting an IUD.

Pros

Cons

Does not require interruption of foreplay or intercourse
Does not require cooperation of sex partner
More than 99% effective in preventing pregnancy ^{footnote 4}
Easy to use
Most cost-effective method of birth control over time
Safe to use while breastfeeding
Can be removed whenever you have problems or want to stop using it. Fertility returns with the first ovulation cycle following IUD removal.
Can be inserted after a normal vaginal delivery, a cesarean section, or a first-trimester abortion
Hormonal IUD can relieve heavy menstrual bleeding and cramping in most women.

Does not provide protection against sexually transmitted infections (STIs) or HIV
Costs several hundred dollars for insertion. But this cost is often covered by your health insurance. And when an IUD is used long-term, it costs less than other methods over time.
Only a health professional can remove the IUD. Never attempt to remove the IUD yourself or allow a partner to try to remove it.
When inserted, an IUD can spread a genital infection into the uterus, leading to pelvic inflammatory disease (PID) in the first months after insertion. This is why you are screened for STIs before getting an IUD.

Related Information

Birth Control

References

Citations

Raymond EG (2007). Progestin-only pills. In RA Hatcher et al., eds., Contraceptive Technology, 19th ed., pp. 181-191. New York: Ardent Media.

Morrison CS, et al. (2004). Hormonal contraceptive use, cervical ectopy, and the acquisition of cervical infections. Sexually Transmitted Diseases, 31(9): 561-567.

U.S. Food and Drug Administration (2004). Depo-Provera contraceptive injection (medroxyprogesterone acetate injectable suspension). Safety Alerts for Human Medical Products. Available online: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm154784.htm.

Grimes DA (2007). Intrauterine devices (IUDs). In RA Hatcher et al., eds., Contraceptive Technology, 19th ed., pp. 117-143. New York: Ardent Media.

Credits

ByHealthwise Staff
Primary Medical Reviewer Sarah A. Marshall, MD - Family Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Rebecca Sue Uranga, MD - Obstetrics and Gynecology

Current as ofNovember 21, 2017