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There are many safe and effective birth control options available for women. Birth control pills are widely available and can be inexpensive, making them an attractive option; however, depending on your needs, health, and pre-existing medical conditions, certain choices may be better for you, so it’s important to discuss your birth control needs with your healthcare provider.  There are two main kinds of birth control pills. Combination pills use the hormones estrogen and progestin. Another type, the minipill, uses only progestin.  Combination pills also come in two types. Monophasic birth control pills all contain the same amount of estrogen and progestin. Multiphasic pills vary the amount of hormones in certain phases. Combination pills also come as “low-dose” pills. These pills contain less than 20 micrograms of ethinyl estradiol (normal birth control pills contain 50 micrograms or less). Women who are sensitive to hormones, especially estrogen, may benefit from the low-dose pill; however, the low-dose pill may also cause more bleeding between periods. Combination pills are commonly prescribed, but they are not always appropriate. Your doctor and you will make the final decision. If any of the following apply to you, your doctor may recommend that you do not use combination pills:  You are breastfeeding You are older than age 35 and a smoker You have high blood pressure You have a history of pulmonary embolism or deep vein thrombosis or you have an inherited condition that increases your risk of clots You have a history of breast cancer You have a history or heart disease or stroke You have medical complications related to diabetes You have liver or kidney disease You have unexplained uterine or vaginal bleeding You have a history of blood clots You have lupus You have migraine with aura You will be having major surgery that immobilizes you for a prolonged period of time You take St. John’s wort, anticonvulsants, or anti-tuberculous medications Your doctor may recommend that you do not use the minipill if you have breast cancer, unexplained uterine or vaginal bleeding, or take anticonvulsant or anti-tuberculous medications. Combination pills offer a variety of benefits that make them an attractive choice for many women; however, they also carry some risks. When considering which type of pill is right for you, you may want to take both of these into account. Benefits of the combination pill include:  Highly effective prevention of pregnancy when used correctly (99%) About eight in 100 women will become pregnant during the first year of using this pill due to incorrect usage  Reduces menstrual cramping May protect against pelvic inflammatory disease Decreases your risk of ovarian and endometrial cancers Can reduce the frequency and heaviness of menstrual cycles Improves acne May help improve bone mineral density Reduces androgen production caused by polycystic ovary syndrome (PCOS) Protects against ectopic pregnancy Reduces the risk of iron deficiency anemia due to heavy menstrual flow Protects against breast and ovarian cysts While combination pills offer many benefits, there are also risks that you should discuss with your doctor. Most of these risks are rare, but can be serious. Many of these risks increase if you have certain medical conditions or if you smoke. Risks of using combination birth control pills include:  No protection against sexually transmitted infections or HIV (you must use condoms to protect against these) Increased risk of heart attack and stroke Increased risk of blood clots Increased risk of developing high blood pressure Increased risk of developing liver tumors, gallstones, or jaundice Increased breast tenderness Nausea or vomiting Weight gain Headache Depression Irregular bleeding Minipills, or progestin-only pills, have fewer benefits than combination pills; however, they also tend to have fewer risks. You should talk to your doctor to determine whether the minipill is a good choice for you. Benefits of the minipill include:  May be able to be taken even if you have certain health problems, such as blood clots, high blood pressure, migraines, or risk of heart disease Can be used during breastfeeding Reduces menstrual cramping May make periods lighter May help protect against pelvic inflammatory disease While the risks of the minipill are fewer than for combination pills, it is still possible to experience rare but severe side effects from using it. Speak with your doctor to consider whether the benefits outweigh the risks for you. Risks of using the minipill include:  No protection against sexually transmitted infections or HIV (you must use condoms to protect against these) Potentially less effective than combination pills Backup birth control is required if you forget to take the pill within three hours of the same time every day Bleeding between periods (more common with the minipill than with combination pills) Increased breast tenderness Nausea and vomiting Increased risk of ovarian cysts Slightly increased risk of ectopic pregnancy vs. combination pills Possible increase in acne Weight gain Depression Unusual hair growth Headache If you are healthy enough for birth control pills, you have a few options. If you choose combination birth control pills — which many women do — you can choose to reduce the frequency of your menstrual cycles if you wish.  Continuous-dose pills, also called extended-cycle pills, reduce the number of menstrual cycles you have each year. Women may have as few as four periods a year. Some women may stop having a period altogether.  Conventional pills do not reduce the number of menstrual cycles. You’ll still have a period every month. Your doctor can help you determine whether you are taking any medications or supplements that will interfere with your birth control’s effectiveness. Medications that are known to interfere with the effectiveness of hormonal birth control include:  Several antibiotics, including penicillin and tetracycline Certain seizure medications Certain drugs used to treat HIV Anti-tuberculosis drugs St. John’s wort Before you decide on a birth control pill, tell your doctor about any medications and supplements that you’re currently taking. Some medications interfere with the effectiveness of birth control pills, and many others may cause negative interactions and side effects. Make sure to mention if you take any of the following:  Thyroid hormone drugs Benzodiazepines (such as diazepam) Prednisone drugs Tricyclic antidepressants Beta-blockers Anti-coagulants (“blood thinners” like warfarin) Insulin

Summary:
Talk with your healthcare provider about your options. Consider your health. Consider the benefits of combination pills. Consider the risks of combination pills. Consider the benefits of the minipill. Consider the risks of the minipill. Think about your menstruation preferences. Know that some medications can interfere with the pill. Tell your doctor about any medications that you take.