Finding the best birth control for you can feel a little like finding a life partner: There’s some trial and error, maybe some bad experiences, and then finally (hopefully), a committed relationship. It may be surprising to learn that birth control options haven’t radically changed since 1960, when both the IUD and the pill became available, ushering in the modern era of contraception. But thankfully, the options we do have are effective.
So how do you know which method of birth control to choose? Allow us to break it down and help you find the best birth control for you.
How the pill works: The pill is a hormonal contraceptive, meaning it prevents pregnancy by tinkering with your hormones—specifically by supplementing your levels of estrogen and progestin. “These hormones suppress ovulation and thicken the cervical mucus and thin the lining of the uterus,” which makes pregnancy highly unlikely, says Amy Bryant, MD, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine.
Effectiveness of the pill: If you use birth control pills perfectly—meaning you take it at the same time every day—it’s about 99% effective. But since most people aren’t perfectly on point all the time, the actual effectiveness for typical use is really closer to 92%, Dr. Bryant says.
Side effects of the pill: Common side effects of the pill are pretty mild: nausea, breast tenderness, and headaches (especially in the first few months of use, Dr. Bryant says). If you miss a pill, you might also experience some breakthrough spotting. The side effects aren't all negative: Going on oral contraceptives can improve menstrual cramps, PMS, and heavy bleeding, and help rein in an irregular cycle. There are two types of pills: combination pills that contain progestin and estrogen, and progestin-only pills, or mini pills. The mini pill is slightly higher-maintenance because you have to take it at the same time every day. But it makes more sense for women who are breastfeeding or have a history of migraines or blood clots. And while it has fewer good side effects—the combination pill can make your skin better and even prevent certain cancers, including endometrial and ovarian cancer—it’s also less likely to cause negative side effects.