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A Guide to Hormonal Birth Control: The Birth Control Pill, IUD, Implants, and More

September 11 2020 | Written by Miranda Van Haarlem (She/Her), Graphics by Sissi Chen (She/Her)

In last week’s blog we focused on the history of the birth control pill and how far society has come with respect to the development and accessibility of the pill. Recent years have seen more hormonal and non hormonal birth control options come onto the market, allowing individuals to pick and choose what is right for them. Please note that while this blog is going to focus on the different types of hormonal contraceptives, there are other options that are non hormonal such as barrier methods (condoms, the sponge, the diaphragm etc.), natural methods (withdrawal, Fertility Awareness method - FAM, Lactational Amenorrhea method - LAM, etc.) and emergency methods. It is always a good idea to discuss with your practitioner on the best method for you.
Individuals who menstruate typically release one egg from their ovaries monthly, which has the ability to become fertilized by sperm. When hormonal contraceptives are taken, this process becomes nearly impossible. Hormonal contraceptives work by altering three main components; 
  1. Hormonal birth control contains man-made estrogen and progestin which act to stop the body from ovulating.
  2. Hormonal birth control thickens the cervical mucus, making it more difficult for sperm to enter the uterus.
  3. Hormonal birth control thins the lining of the uterus, making it unlikely that a fertilized egg will be able to implant itself.

Types of Hormonal Birth Control

1. The Intrauterine Device (IUD) 
When perfect used: Over 99% Effective 
With real life use: Over 99% Effective 

The IUD is a small, T-shaped device that is implanted into the uterus in order to prevent pregnancy. IUDs can last anywhere from 3 to 10 years, depending on which type you prefer. There is an IUD available that is non-hormonal, known as the copper IUD, which works by altering the biochemical environment of the uterus, thereby hampering a sperm's ability to move. On the other hand, hormonal IUDs work by releasing a low dose of progestin that helps to thicken the cervical mucus and thinning the lining of the uterus. You do need a prescription in order to have an IUD inserted and they can cost up to $700 but are usually covered by insurance plans. For a comprehensive look at IUDs, check out our other blog post.
Advantages of the IUD 
  • Effective and convenient
  • Lighter periods (or no period at all)

  • Lasts up to 6 years

Disadvantages of the IUD
  • Insertion can be painful
  • Expensive without an insurance plan
2. The Birth Control Pill 
When perfect used: 99% Effective 
With real life use: 91% Effective 

As one of the first kinds of hormonal birth control invented, the birth control pill has become extremely popular over the years. With tons of different brands and types available, finding the right one for you can take some patience. The majority of birth control pills are combination pills, which means they contain both progestin and estrogen. They basically do the same thing as other hormonal birth control options in that they stop ovulation, thicken cervical mucus and thins the uterine lining. Birth control pills do require a prescription and cost upwards of $100 a month if you do not have insurance. 

 

Advantages of the Birth Control Pill

  • Can have positive side effects due to hormones including clearer skin, lighter periods, and reduced cramps

  • Easily paired with other forms of birth control such as condoms

Disadvantages of the Birth Control Pill

  • You have to remember to take it everyday for it to be 99%  effective

  • Can have negative side effects due to the hormones including weight gain, mood fluctuations, and headaches 

3. The Ring 

When perfect used: 99% Effective
With real life use: 91% Effective

The vaginal ring is a thin, flexible ring that you wear inside your vagina. It prevents pregnancy by releasing both estrogen and progestin into the body which, again, stops ovulation, thickens the cervical music and thins the uterine lining. You leave the ring inside you for three weeks and then take it out for one week in order to have your period, and then you switch to another ring. You can choose whether or not to leave the ring inserted during sex, but if you decide to take it out, remember to put it back in immediately after. A prescription is required to get a vaginal ring and they usually cost up to $80 for one ring but again, it is often covered by insurance. 

 

Advantages of the Ring

  • Can have positive side effects due to hormones including clearer skin, lighter periods, and reduced cramps

  • Easily paired with other forms of birth control such as condoms

  • Only have to think about it once a month

Disadvantages of the Ring

  • Can have negative side effects due to the hormones including weight gain, mood fluctuations, and headaches 

  • Effectiveness can be reduced if one forgets to change it or put it back in 

4. The Shot 

When perfect used: 99% Effective 

With real life use: 94% Effective

The birth control shot is administered at a doctors office or health centre once every three months. It works in the same way as other hormonal contraceptives by releasing the hormone progestin which ceases ovulation and thickens the cervical mucus, making it more difficult for sperm to swing up through the cervix. The shot is only effective if administered one time every 3 months, making it extremely important to be in close proximity with your local health centre. You have to have a prescription in order to receive the birth control shot and it can cost up to $130 each month, unless covered by insurance.

 

Advantages of the Shot

  • Can have positive side effects due to hormones including clearer skin, lighter periods, and reduced cramps

  • Easily paired with other forms of birth control such as condoms

  • Progestin only (safe for those who are sensitive to estrogen)

  • Only have to think about it once every 3 months

Disadvantages of the Shot

  • Can have negative side effects due to the hormones including weight gain, mood fluctuations, and headaches 

  • It is a shot, therefore there may be soreness for a few days 

  • You must be in close proximity with your local health centre and schedule ahead of time

  • If you want to conceive, it may take up to 18 months after you stop getting the shot as your body has to readjust

  • The shot has been known to cause temporary bone loss in some patients

5. The Patch 

When perfect used: 99% Effective 

With real life use: 91% Effective 

 

The birth control patch is exactly what it sounds like: a plastic adhesive that you can stick on your butt, arm, back or stomach. It is used to prevent pregnancy as it contains both estrogen and progestin, which stops ovulation, thickens the cervical music and thins the uterine lining. The patch is similar to the ring, in that you must replace it. You simply wear the patch for a week, then remove and stick on a new patch on the same day every week, and after three weeks, you go patchless for a week, in order to have your period. See below for a calendar example. The patch does require a prescription and can cost up to $100 a month, but is usually covered by insurance plans. 

 

 

Advantages of the Patch

  • Can have positive side effects due to hormones including clearer skin, lighter periods, and reduced cramps

  • Easily paired with other forms of birth control such as condoms

Disadvantages of the Patch 

  • Can have negative side effects due to the hormones including weight gain, mood fluctuations, and headaches 

  • You have to remember to change it on the same day every week and also if it falls off

  • Only have to remember once a week instead of every day like the birth control pill 

     

6. The Implant 

When perfect used: Over 99% Effective 

With real life use: Over 99% Effective 

The implant is a device that is implanted into an individual’s arm and releases progestin in order to prevent ovulation and thus pregnancy. The birth control implant can last up to four years and is an extremely effective and low maintenance birth control option. You do need a prescription in order to get the implant inserted and it can cost upwards of $800 but it is usually covered by insurance plans and ends up being one of the cheaper options when broken down month by month. 

Advantages of the Implant

  • Can have positive side effects due to hormones including clearer skin, lighter periods, and reduced cramps

  • Easily paired with other forms of birth control such as condoms

  • One of the most effective at pregnancy prevention 

  • Progestin only (safe for those who are sensitive to estrogen)

  • Can last up to 4 years 

Disadvantages of the Implant 

  • Can have negative side effects due to the hormones including weight gain, mood fluctuations, and headaches 

  • Costly at the beginning if not covered by insurance

As you can see, there are many types of hormonal birth control options that are available to choose from. Your health care provider can work with you to decide which method would be best for you. 

It is important to acknowledge that access to family planning information and birth control methods should not be considered a privilege for some, it should be a human right. While it may seem that most individuals have access to contraceptives this is not the case. An alarming number of Indigenous women in Canada are still fighting for sexual and reproductive rights as well as access to proper education surrounding contraceptive use. We must acknowledge the unique barriers to access faced by these groups and work towards reproductive justice for all. 

Posted on September 11, 2020
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