Expert Advice on What to Know Before Starting Birth Control

As the very first over-the-counter birth control pill becomes available to people across the country, an OB-GYN tells Healthnews what to consider before starting the contraceptive pill.

The first non-prescription birth control pill — called Opill — went on sale in the United States earlier this month, significantly increasing access to contraception across the country.

The Food and Drug Administration (FDA) approved the first daily non-prescription pill, which is progestin-only and contains no estrogen (also known as a mini pill) in July of 2023, stating that it is extremely safe, effective, and simple enough to use without a doctor’s guidance.

While Opill is now arguably the most accessible birth control pill in America, it is far from the only option for those interested in hormonal contraception.

There are many factors to consider when choosing a form of contraception and deciding whether — and which — birth control pill is right for you. Dr. Melanie Bone, an OB-GYN and the U.S. medical director at the gynecological health company Daye tells Healthnews what you should consider before deciding to go on the pill.

Make sure it’s the right form of contraception for you

Before deciding which kind of birth control pill to take, it’s important to determine whether oral contraceptives are right for you, Bone says. If you’re worried about remembering to take the pill daily, for example, it may not be the right choice.

“Remember that for the pill to be the most effective, you should take it at the same time every day,” Bone says.

Your current health status and family history are also important to consider, she says. If you have a family history of blood clotting disorders, high blood pressure, or migraines, for example, the pill may not be the best option — especially combination pills that contain both estrogen and progestin.

If STI protection is your main concern, the pill is also not the right option for you. No pill or hormonal contraception protects against STIs, Bone says, so you will still need to use barrier contraceptive methods to help prevent chlamydia, HPV, HIV, and more.

Condoms are the only form of birth control that protects against both pregnancy and STIs.

“Consult with your OB-GYN or conduct independent research to confirm if the pill is the right form of contraception for you,” Bone suggests.

You may experience side effects

Before deciding to go on the pill, Bone says it’s important to familiarize yourself with the known side effects of the pill.

The most common side effects of hormonal birth control pills are similar to those you might already experience during PMS, she says, including mood fluctuations, nausea, breast tenderness, weight gain, and headaches.

Some patients also report that the pill reduces their libido and makes it harder to reach orgasm, she says.

“Understanding these potential side effects and how to manage them is important before starting the pill,” she says. “Remember that most side effects will go away after an initial three to six-month adaptation period.”

Some studies have found that oral contraceptives may increase the risk of blood clots, stroke, and cervical and breast cancers. However, research has also found that they may reduce the risks of iron deficiency anemia; endometrial, colorectal, and ovarian cancers; pelvic inflammatory disease; and ectopic pregnancies.

The different types of birth control pills

Once you’ve decided on the pill, Bone says you should inform yourself of the different types. The most common form of birth control pill is the combination pill, which contains both estrogen and progestin.

“They come in various formulations with different hormone levels, so your healthcare provider can help determine which one is best for you based on your medical history and lifestyle,” Bone says.

Then there are progestin-only pills/mini pills, such as the one that is now available over-the-counter in the U.S. Bone says these pills do not contain estrogen and are suitable for individuals who cannot take estrogen-containing pills due to health reasons, such as breastfeeding mothers or those with a history of blood clots.

There are also extended or continuous cycle pills, which allow you to have fewer periods by extending the time between pill packs. Bone says they can be beneficial for individuals who prefer fewer menstrual cycles or experience severe menstrual symptoms.

Some research also shows that taking the pill continuously reduces the risk of the side effects caused by a drop in hormones during the pill break, Bone explains.

The final type is the low-dose pill, which contains lower hormone levels than traditional birth control pills. Bone says these may be the right choice for individuals who experience side effects with higher hormone doses.

It can impact your period

Going on a birth control pill may have an impact on the heaviness, duration, regularity, and symptoms of your period, Bone says.

Many patients experience lighter breakthrough bleeds with less bleeding and shorter duration after starting the pill, she says, and the pill can also help regulate menstrual cycles and make periods more predictable for some.

“You can also use hormonal contraception to stop menstruating altogether if that's what you would prefer,” Bone says.

The pill may also reduce menstrual cramps and other symptoms. Bone says some patients with endometriosis, adenomyosis, fibroids, and PCOS find relief from their menstrual symptoms with the pill.

Other birth control options are out there

Before choosing the pill, don’t forget that it’s simply one of many birth control options.

Other forms of contraception, some of which can be used in tandem with one another, include the copper IUD, hormonal IUD, diaphragm with spermicide, male and female condoms, and natural contraception apps that can help you track your fertility.

“Research institutions are also currently working on non-hormonal contraception for women and individuals assigned female at birth, which works by creating a cervical mucus plug and makes it impossible for sperm to fertilise an egg,” Bone adds. “They are also working on male contraception, which prevents semen from leaving the penile tubes.”

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