Healthy Contraception Guide: How to Choose the Best Birth Control with the Least Side Effects

There are a dizzying array of options when it comes to contraception, but more and more we’re realizing that many come with downsides for your health (especially hormonal options). At the same time, getting pregnant is something you definitely want to be ready for before it happens (if you want it to happen at all), and with the overturning of Roe v. Wade, contraception has become even more important  — and demand has gone way up. We made it our mission to help you find the best birth control with the least side effects, and put it all in this guide. Here you’ll learn important health info about all your different options, from the long-term side effects of birth control pills to some shocking stats on the effectiveness of certain contraceptives.

Listen to this guide on The WellBe Podcast. 

Our Criteria for Choosing the Best Birth Control with the Least Side Effects

There are a number of factors to consider when it comes to choosing the best birth control with the least side effects. As we analyzed all the different options, we looked at:

• How effective it is at preventing pregnancy
• How convenient it is
• The short-term side effects
• The long-term side effects
• The potential benefits

Of course, each birth control option has its own enthusiastic fans and detractors. After all, we all have different bodies, medical histories, sensitivities, and lifestyles. We also all have our own risk profiles for getting pregnant. We’ve ranked the contraceptive options below from most side effects to least, in our view, but remember that ultimately it’s all about finding what works best for you. Read on to find out the short- and long-term side effects of the most common birth control options out there. 

Hormonal vs. Non Hormonal Contraception

Before we get into your specific birth control options, it’s important to understand that all methods of birth control fall into one of two categories: hormonal and non-hormonal. Most contraceptive methods are hormonal, so many millions of American women are taking synthetic hormones in one form or another. Hormonal contraception can be very effective at preventing pregnancy, but taking these hormones does carry risks that we want to point out. 

We’ll get into the specific risks of each birth control option below, but for now we’ll just give a broad overview to help you better understand how hormonal contraceptives impact your health. In the short-term, there are a number of potential unpleasant side effects, such as headaches, nausea, sore breasts, vaginal yeast infections, spotting between periods, and reduced libido. 

Because synthetic hormones mess up your body’s natural balance of hormones — and because hormones are so essential to the overall functioning of your body — there are also some more serious risks, including:

• Thrombosis, also known as blood clots. This risk is higher in women over 40 and those who are overweight or smoke.
• Breast cancer, especially in younger women (those under 35).
• Reduced bone strength.
• Heart attack. This risk is higher in women over 35 and those who smoke. 
• Stroke. This risk is rare but it does exist, and is more pronounced in women who get migraines. 

What’s more, any sort of hormonal contraception should be completely avoided by women with certain conditions. Those conditions include blood clotting disorders, high blood pressure, diabetes, headaches with neurologic symptoms, heart disease, and history of stroke or breast cancer. 

Ultimately, we believe the best way to give your body what it needs is to be in tune with it. When you put synthetic hormones in your body and disrupt your natural cycle, you eliminate the possibility of being in tune with your body — and with it the ability to understand the important messages it may be sending you. 

The Short- and Long-Term Side Effects of the Sponge

Made famous by Seinfeld, the sponge is a soft foam disk that’s inserted into the vagina before sex and removed afterward. It also contains spermicide, so it blocks as well as kills sperm.

The sponge has a number of benefits that make it a super convenient form of contraception: it doesn’t require a prescription or fitting, it protects against pregnancy for a full 24 hours, and it doesn’t require a partner’s cooperation. 

However, there are a lot of side effects, which may outweigh the convenience factor. The sponge can cause vaginal irritation or dryness, increase your risk of contracting a UTI, and even put you at risk for toxic shock syndrome (a rare, life-threatening complication of some bacterial infections). Some people are sensitive to the spermicide in the sponge (because let’s face it, spermicide is meant to kill living organisms!), and the chemical used in spermicide, nonoxynol-9, can cause changes to the vaginal microbiome. Additionally, if the sponge causes irritation, it’s not only painful, but it can also increase your risk of HIV and other STDs.

Another big drawback of the sponge is that it’s hard to use correctly, and thus has a very high failure rate. Among women who have never had a baby, 12% will get pregnant within one year of using the sponge. Among women who have given birth before, that number rises to 24% — that’s almost a quarter! 

The Short- and Long-Term Side Effects of Birth Control Pills

The pill is the most common form of birth control, with 10.6 million American women choosing it as their form of contraception. Most of the side effects you hear about are short-term things, like headaches, breast tenderness, nausea, or fatigue. Some women also experience spotting between periods, bloating, weight gain, lightheadedness, acne, or mood changes. Many women need to try a few different pills before they find one that doesn’t have side effects, or at least one with side effects they can handle. Lots of women give up on the birth control pill altogether because the side effects are too intense. 

There’s less conclusive research on the long-term side effects of birth control pills (after all, it’s only been around for a few decades), but there’s enough out there to make us concerned about being on the pill indefinitely, or at all. This is because the birth control pills alter the natural hormone levels of your body, which is a pretty big deal, since hormonal imbalance can cause a cascade of health issues. 

So what are the potential long-term side effects of the birth control pill? Let’s start off with hormones. Oral contraceptives essentially act like a testosterone sponge, so they lower your testosterone levels, which can have a negative impact on your libido (which sort of defeats the main purpose of birth control, no?). Essentially, the pill makes your body believe it’s pregnant when it’s not, thus preventing you from getting pregnant. It also creates a “fake” period, which means the very important process of having a monthly period is now being taken away. 

Taking the pill and getting a fake period also means that if something goes wrong in your body that causes your period to stop, you wouldn’t know. When your body stops menstruating normally at an age when it should be (roughly 12-51 years old), it’s a cry for help, a symptom of an underlying issue. Taking the birth control pill stifles those cries.

Long-term use of the birth control pill can also deplete your levels of certain vital nutrients, including vitamin C, B vitamins, folate, magnesium, selenium, and zinc. 

Crohn’s disease is another one of the surprising long-term side effects of the birth control pill, since the pill has an impact on your gut permeability. The pill can also increase your risk of inflammation as well as blood clots (according to this research only if you’re over 35, but we would suspect your risk would increase at any age).

Then there’s cancer. We can’t say there’s a definitive link between oral contraception and cancer, because all of the studies on the issue have been observational (vs a controlled study), meaning that there may be additional factors to account for the results (i.e., women who take birth control pills tend to have lifestyle/genetic/other factors that could increase cancer risk). However, there is a growing and consistent body of evidence showing that oral contraception increases risk of both breast cancer and cervical cancer.

One study of over 150,00 women showed that women who were currently using oral contraceptives had a 24% increase in risk of breast cancer, and women who had ever used oral contraceptives (but were not currently) had a 7% increased risk compared to those who had never taken them. After ten years without oral contraceptives, the increased risk disappeared. Another study found that the risk of cervical cancer continues to rise the longer you take the pill: 10% increased risk after five years, 60% after five to nine years, and 100% (aka double) the risk with 10 or more years. The American Cancer Society has also stated that women who take birth control pills are more likely to develop both breast cancer and cervical cancer than those who don’t. With both cancers, the risk increases the longer you take the pill. 

Confusingly, there’s also research suggesting that the pill can actually decrease your risk of other cancers, like ovarian, endometrial, and colorectal cancer. For colorectal cancer, oral contraception is associated with a 15-20% lower risk; with ovarian, risk is lowered by 30-50%; and with endometrial cancer, risk is reduced by 30%. These findings could definitely be considered a silver lining, but in our view they’re offset by the potential increased risk for other cancers. If you’re considering going on the birth control pill, look at your own family history of cancers and make an informed decision.  

The Short- and Long-Term Side Effects of the Hormonal Patch 

The patch is an adhesive contraceptive that sticks onto your skin and delivers the hormones progestin (the synthetic form of progesterone) and estrogen into your bloodstream. You can place the patch on your upper arm, lower abdomen, or butt. Because the hormones in the patch are the same hormones in oral contraceptives, the list of potential short-term side effects are largely similar: headache, weight gain, bloating, tender breasts, impacted libido. Again, these side effects don’t happen to everyone who uses the patch, and some women might only experience side effects temporarily, but the same issues we discussed with the hormonal pill apply to the hormonal patch.

Like the pill, the patch has a shorter list of more serious — but much more rare — potential side effects. These include things like increased risk for blood clots, heart attack, stroke, and liver tumors. 

The Short- and Long-Term Side Effects of a Hormonal IUD

An IUD (intrauterine device) is a t-shaped device that is inserted into the uterus. There are two FDA-approved types, one which is made of copper that doesn’t emit any hormones, and one synthetic device that emits a small level of the hormone progestin. 

For the hormonal IUD, there are many of the same side effects you see with other hormonal contraceptives, such as weight gain, hair loss, mood changes, and acne. But since the dose of progestin in the IUD is only 20% the dose of progestin in the birth control pill and patch, these side effects are less common and less intense.

In the plus column for hormonal IUDs, they’re super effective for not getting pregnant — 99% — they last for anywhere from three to 10 years, and they can apparently reduce your risk of endometrial cancer. Sadly, the risks we described associated with infection, inflammation in the area, and hormonal interference from taking synthetic hormones are linked to a variety of other cancers and diseases including breast cancer, cervical cancer, and endometrial cancer.

The Short- and Long-Term Side Effects of the Copper IUD

The non-hormonal IUD uses copper wire to create an inflammatory reaction that is toxic to sperm and eggs. Because it doesn’t contain any hormones, it doesn’t have any of the side effects of the hormonal IUD, but is just as effective in preventing pregnancy. It has the added benefit of being effective as emergency contraception: it can actually prevent pregnancy if it’s inserted within five days after having unprotected sex. 

The copper IUD does, however, have a few side effects not related to hormones that concern us. It can be pretty painful upon insertion and cause cramps and backaches for a few days after. It can also lead to bleeding between periods, cramps, and severe menstrual pain, but these side effects can go away within 3-6 months of insertion. 

The same issue with hormonal IUDs exists with copper IUDs: namely, that you’re putting a foreign object inside your body, which your body is of course going to fight like hell to get OUT of your body — that’s your body’s job! This often leads to localized inflammation, which can then lead to chronic inflammation, since the object your body is trying to remove isn’t going anywhere. Chronic inflammation can cause a whole host of diseases including heart disease, diabetes, and cancer. 

For both types of IUDs, there’s a very slight chance of serious complications. About 1% of women get pelvic inflammatory disease after getting an IUD, which is a bacterial infection that requires antibiotics (which we try to avoid at all costs!) and can leave scar tissue that blocks the fallopian tubes and causes future infertility. 

In rare cases, the IUD can actually move out of place, pushing through the wall of the uterus (ow!) and causing perforations (holes) inside your body. According to research, in about one out of 1,000 insertions, the IUD punctures the uterine wall and makes its way into the abdominal cavity, where it can perforate organs like the intestine or enter the urinary tract. So scary!! The risk of your IUD moving around is higher if you’re under 20, breastfeeding, have a tilted uterus, or get strong cramps during your period. 

The Short- and Long-Term Side Effects of Nontoxic Condoms

It might seem obvious that condoms are the best birth control with least side effects — after all, they’re just a physical barrier, and they don’t stay inside you long-term, so how could they have any impact on your health? 

Unfortunately, certain kinds can. In fact, many condoms on the market contain the known carcinogen nitrosamine, which is pretty terrifying when you consider the sensitive and permeable place they’re going. Conventional condoms can also cause skin irritation due to latex sensitivity, or allergic reactions caused by spermicides, fragrance, lubricant, or other chemicals used in the condoms. 

The good news is that there’s now an increasing number of nontoxic condoms out there. These organic, vegan options don’t contain any harmful chemicals or potential skin irritants. However, they do have the one side effect that all condoms have: higher failure rate. While condoms are 98% effective when used perfectly, human error means that they’re actually only 85% effective in real life. 

Again, our recommendation is to understand what is important to you and whether you can use this birth control effectively. Non-toxic condoms are one of the best forms of birth control methods for your health, but of course they have to be used every time you have sex and put on properly for them to be an effective way of preventing pregnancy! Sustain Naturals are Lola are two non-toxic brands. 

Remember that your health is more important than how it might feel or how convenient it might be for your partner. Take a firm stance and explain the importance of using this birth control method for your short- and long-term health, and you may be surprised how well your partner responds and complies.

The Short- and Long-Term Side Effects of the Natural Family Planning App 

Ovulation trackers have been around for a while, but it wasn’t until recently that a natural family planning app was actually approved by the FDA for use as a form of contraception. This is a pretty big deal since the FDA requires drugs and medical devices to go through lots of hoops to get approval. The fact that an app could be approved is pretty new and remarkable.

The app, called Natural Cycles, pairs with a thermometer to track a woman’s temperature every day, and uses that data to predict when she’ll ovulate. Based on that prediction, the app will tell women whether or not it’s okay to have unprotected sex. 

The potential benefits of this app are pretty obvious: it doesn’t require you to put anything on or in your body, it uses no synthetic hormones or chemicals, and it won’t cause you any sort of pain or require a medical procedure. 

However, if a side-effect-free natural family planning app seems too good to be true, that’s because it might be. While the app claims that it’s 93% effective with standard use and 98% effective with perfect use, there’s been a major backlash of women who ended up with unwanted pregnancies after trusting the app’s predictions. It’s also important to note that the app does not protect against STDs so it’s best to only use it when in a committed, long-term relationship and after your partner has been tested for STDs.

The natural family planning app option is still super new, and it might improve with advancements in technology. Our recommendation here is again to know yourself: will you be able to use something like this perfectly? And how much do you not want to be pregnant? How important is it to you to use a side-effect free and natural birth control method? Once you answer these questions, you’ll know if this is a good option for you.

One good hybrid option that is best for your health but also boosts the effectiveness of the app for preventing pregnancy is using a non-toxic condom during sex around any of the times the app indicates are medium fertility vs. only abstaining or using a condom during times the app indicates are high fertility. Another way to further improve the effectiveness of the app is to use the pull-out method (more below) at times of low fertility and non-toxic condoms at times of medium or high fertility.

The Short- and Long-Term Side Effects of the Pull-out Method

Believe it or not, the pull-out method when done correctly is 96% effective at preventing pregnancy — but so few do it correctly, so in actuality it’s only 78% effective. It’s worth it to perfect your technique, however, because similar to the Natural Cycles app, it has no negative side effects for yourself. The pull-out method doesn’t require you to put anything on or in your body, it uses no synthetic hormones or chemicals, and it won’t cause you any sort of pain or require a medical procedure.

However, similar to the Natural Cycles app, IUDs and hormonal birth control, the pull-out method does not protect against STDs so it’s best to only use it when in a committed, long-term relationship and after your partner has been tested for STDs. 

As we mentioned above, you can improve the pull-out method’s effectiveness by pairing it with the Natural Cycles app and either abstaining or using non-toxic condoms during times of medium or high fertility.

The WellBe Takeaway on the Best Birth Control  

Finding an effective and safe birth control method can be challenging. There are a ton of different options out there, and it can be overwhelming to understand all their differences and make a choice. The info above is a lot to remember, so here’s a handy little cheat sheet with everything you need to know about finding the best birth control with the least side effects:

• Most methods of birth control use synthetic (meaning not natural) hormones. Specifically, they use the hormones estrogen and progestin to prevent ovulation. These hormones can cause minor side effects like weight gain, breast tenderness, nausea, and bloating, as well as more serious side effects like an increased risk of blood clots and heart disease. Examples of hormonal birth control include the pill, the hormonal IUD, and the patch. There are enough long- and short-term health impacts of hormonal contraception that it is not considered the best method for your health, even if hormonal birth control is an effective and convenient birth control method.
• The sponge is a device that can be inserted into the vagina, and it also has a lot of drawbacks. It can cause vaginal irritation and dryness, and increase your risk of getting a UTI or toxic shock syndrome. Some people are sensitive to the spermicide in the sponge, and if irritation occurs, it can increase your risk of contracting an STD. In addition, the sponge isn’t all that effective at preventing pregnancy.
• Birth control pills are the most commonly used type of contraception. They’re noninvasive and very effective, but the long-term side effects of birth control bills are significant. They use synthetic hormones to alter your cycle and prevent pregnancy, and long-term use has been associated with an increased risk of breast and cervical cancer. 
• The patch is a hormonal method of contraception in which a patch delivers synthetic hormones through your skin. Like the pill, it is noninvasive and effective, but it carries all the risks of hormonal contraception. 
• There are two types of IUDs: hormonal and non-hormonal (copper). The hormonal IUD is associated with many of the same side risks and side effects as other hormonal birth control methods. The copper IUD is an effective, no-hormone option for contraception. The drawbacks include pain upon insertion; the potential to have heavier, more painful periods; and an increase in inflammation in your uterus, which can lead to chronic inflammation and raise your risk of getting an infection requiring antibiotics. Both types of IUDs also carry the rare risk of moving out of place and causing punctures to organs within your body. 
• Condoms come with lower rates of effectiveness, as they’re easy to misuse, and conventional versions contain chemicals, spermicides, and fragrance that can cause irritation and raise the risk of serious health issues, like HIV or cancer. However, non-toxic condoms get rid of these risks, and are one of the three best birth control methods out there for your long- and short-term health, but remember they have to be used properly or you risk a potentially high failure rate.
• A new FDA-approved natural family planning app, called Natural Cycles, is an option with zero side effects — but there are issues with effectiveness at the moment. Some women have ended up with unwanted pregnancies while using the app as their sole form of contraception. Still, given that there are zero side effects or health risks, if you believe you can use this method properly, we consider it one of the three best birth control options for your short- and long-term health.
• The pull-out method (ideally in conjunction with the Natural Cycles app and/or non-toxic condoms) is a less effective birth control method but one that is one of the three best birth control options for your short- and long-term health.
• Ultimately, choosing a method of birth control is extremely personal. When deciding, consider not just the effectiveness and ease of a certain kind of birth control, but also the impact on your body and your short- and long-term health. Often things that seem too easy or too good to be true, are just that.

Have you used any of the contraceptive methods listed above? What was your experience? Tell us in the comments below!

Listen to this guide on The WellBe Podcast. 

Citations:

1. Zimmerman, Y. Human Reproduction Update 2014; 20(1): 76-105

2. Felix, A. Int J Cancer. 2015 Mar 1; 136(5): E410–E422.

3. Ortiz, ME. Obstet Gynecol Surv. 1996 Dec;51(12 Suppl):S42-51