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Birth Control: Pros and Cons of Hormonal Methods

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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. Health Canada suggests that you talk to your doctor about your risks before using the patch.

Progestin-only pills or shot

Pros

Cons


  • No interruption of foreplay or intercourse
  • Fewer or no periods (especially with the shot)
  • 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
  • Shot provides extremely effective birth control protection.
  • Shot protects for about 3 months.
  • 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 is extremely effective.
  • Pills must be taken at the same time each day.
  • Shot may delay return of normal cycles for 6 to 8 months after the medicine is stopped, but there is no delay with pills.
  • 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 caesarean 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. (This cost may be covered by your provincial health plan or private health insurance. Some community clinics may offer insertion and removal at a reduced rate or free to low-income clients.) If the IUD is expelled, it costs just as much to get a new one. Having an IUD removed is also costly. But if an IUD is used for 5 years or longer, it is the most cost-effective form of birth control.
  • 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

References

Citations

  1. Raymond EG (2007). Progestin-only pills. In RA Hatcher et al., eds., Contraceptive Technology, 19th ed., pp. 181–191. New York: Ardent Media.
  2. Morrison CS, et al. (2004). Hormonal contraceptive use, cervical ectopy, and the acquisition of cervical infections. Sexually Transmitted Diseases, 31(9): 561–567.
  3. 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.
  4. Grimes DA (2007). Intrauterine devices (IUDs). In RA Hatcher et al., eds., Contraceptive Technology, 19th ed., pp. 117–143. New York: Ardent Media.

Credits

Current as ofSeptember 5, 2018

Author: Healthwise Staff
Medical Review: Sarah A. Marshall, MD - Family Medicine
Anne C. Poinier, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Femi Olatunbosun, MB, FRCSC, FACOG - Obstetrics and Gynecology, Reproductive Endocrinology
Rebecca Sue Uranga, MD - Obstetrics and Gynecology

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