Types of birth control pills: Efficacy and risks

Birth control pills are drugs that can stop ovulation and thicken the cervical mucus to prevent pregnany. Some may be suitable for people with health conditions, but they may also cause side effects or increase the risk of some cancers.
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A quick look at the best places to get birth control pills online
Best for choice: Nurx | Skip to review
Nurx
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Best free trial: Wisp | Skip to review
Wisp
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Best for medical support: The Pill Club | Skip to review
The Pill Club
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The Centers for Disease Control and Prevention (CDC) note that over 65% of females in the United States made use of birth control between 2017-2019. 14% used contraceptive pills.
over 65%
This article explores birth control pills and the different types. It also provides a list of online platforms where birth control pills are available.
Learn more about the birth control pill here.
Learn more about the birth control pill here.
What are birth control pills?
In the U.S., birth control pills are the most common form of contraception.
most common
A person takes one birth control pill daily, containing hormones preventing ovulation. They can also thicken cervical mucus to prevent sperm from reaching an egg.
thicken cervical mucus
Some pills, such as those containing levonorgestrel or ulipristal, can prevent pregnancy if a person takes them as soon as possible after having sex without other forms of contraception. The sooner a person takes emergency contraception, the more effective it can be. Emergency contraceptive pills do not have any effect on an already established pregnancy.
more effective
Learn more about emergency contraception here.
Learn more about emergency contraception here.
Who is birth control good for?
Birth control pills are suitable for individuals having penetrative sex that do not wish to become pregnant.
They may also suit people who:
may also suit
need a reversible option, as they can conceive once they stop taking the pill.
wish to reduce acne breakouts and premenstrual syndrome (PMS) episodes
acne breakouts
premenstrual syndrome (PMS)
regulate their menstrual cycle
are looking for a convenient option, as the pills are small and easy to carry
Birth control pills may also be an option for those with a lower budget. Insurance providers may pay for part or all of the cost of contraceptives, and some organizations may provide free birth control.
Learn how to get free or low cost birth control here.
Learn how to get free or low cost birth control here.
Combination pills
Combination pills are usually the first thing a doctor would consider prescribing to a person.
first thing
This pill contains both estrogen and progestin. Estrogen prevents the eggs from developing, and progestin prevents ovulation and helps thicken the cervical mucus.
estrogen
progestin
Combination pills are either monophasic or multiphasic. Monophasic means that each active pill has the same dose of estrogen and progestin; multiphasic means that each hormone’s dose varies weekly.
There are several ways of taking combination pills:
There are two conventional ways of taking combination pills, depending on whether the brand contains placebo pills.
two conventional ways
The pill without placebo pills will usually consist of 21-day packs. A person takes one pill for 21 days and then does not take any for the next seven days. People will often experience breakthrough bleeding during pill-free days.
breakthrough bleeding
28-day packs also contain placebo pills. People take one pill daily for 28 days and immediately start another 28-day pack on the 29th day. The last few pills in each 28-day pack are placebo pills.
Some brands offer 91-day packs. People will take 12 weeks of active pills, followed by one week of placebo pills, before resuming the next pack of active pills.
Learn more about placebo pills in birth control here.
Learn more about placebo pills in birth control here.
Continuous dosing means only taking active pills with no break between packs.
Continuous dosing
While monophasic and multiphasic pills are suitable for continuous dosing, healthcare professionals are most likely to recommend monophasic ones.
The main side effect of this method is unwanted breakthrough bleeding.
Progestin-only pills
The progestin in these pills works by thickening the cervical wall, thinning the uterine lining, and stopping ovulation.
thickening the cervical wall
People take this pill once every day, without breaks, to protect from unintentional pregnancy. It is important to take it at the same time every day to ensure its effectiveness. If a person forgets or misses their next dose, they should use another method of contraception, such as condoms, for the next 48 hours.
Pros and cons of oral contraceptives
The following are some advantages and disadvantages of combination pills:
Some brands of combination pill have FDA approval to treat acne.
FDA approval
These pills are suitable for people with polycystic ovary syndrome (PCOS) and period pains.
are suitable
Combination pills are an easily reversible method of birth control, as a person can stop taking them at any time.
Taking oral contraceptives can lower the risk of endometrial and ovarian cancer.
lower the risk
People can continuously take the combination pill without breaks or choose packs with placebo pills.
Side effects include breakthrough bleeding, nausea, abdominal cramping, breast tenderness, and loss of libido.
include
Oral contraceptives increase the risk of breast and cervical cancer.
increase
Missing or skipping pills reduces the effectiveness, leaving people at risk of unintentional pregnancy.
Combination pills are unsuitable for smokers over 35 years of age or people with hypertension, breast or endometrial cancer, ischemic heart disease, or migraine with auras.
unsuitable
Combination pills increase the risk of developing deep vein thrombosis (DVT).
increase the risk
They can increase a person’s risk of having deep vein thrombisis (DVT), a stroke, or a heart attack. This mostly affects those who are older than 35 years and smoke.
can increase
Doctors do not recommend them for the first three weeks after a person goes into labor, as the risk for venous thromboembolism may increase.
do not recommend
They can increase people’s risk of developing blood clots if they have obesity.
increase
They are effective when taking them at the same time every day. Individuals who miss four pills may have an increased chance of getting pregnant.
increased chance
Similarly to combination pills, progestin-only pills also have pros and cons:
Progestin-only pills may lessen or stop any bleeding.
lessen or stop
Like combination pills, the progestin-only pill is an easily reversible form of birth control.
Progestin-only pills have fewer side effects than combination pills.
fewer side effects
Suitable for most people, including those who cannot use medications containing estrogen
While progestin-only pills do not have as many side effects as combination pills, researchers are unsure of the long-term effects of this medication.
unsure
Progestin-only pill users have reported acne and follicular ovarian cysts as side effects.
have reported
This pill’s most common side effects are changes in menstruation and irregular bleeding.
Does birth control really work?
The NHS states that the combined pill is more than 99% effective if a person takes it correctly.
more than 99%
The NHS also says that the progestin-only pill is also over 99% effective with perfect use — meaning a person takes the medication at the same time, every day, without fail.
over 99%
Does birth control suit everyone?
Healthcare professionals will take any health conditions and medications into account before prescribing contraceptive pills.
Pills containing natural or synthetically derived estrogen may not suit everyone, including people who smoke or those with specific conditions, such as:
specific conditions
heart disease
heart disease
deep vein thrombosis
deep vein thrombosis
history of stroke
stroke
seizure disorders
seizure disorders
hyperlipidemia
hyperlipidemia
Progestin-only pills are not suitable for people who take rifampin or drugs that prevent seizures or treat HIV. According to the American College of Obstetricians and Gynecologists (ACOG), these medications may reduce the effectivess the pill.
HIV
American College of Obstetricians and Gynecologists (ACOG)
Oral contraceptives do not suit those who prefer a non-hormonal method of birth control. Barrier methods, such as using a condom, are temporary solutions, whereas long-term or permanent solutions include IUDs and sterilization.
Learn more about non-hormonal birth control here.
Learn more about non-hormonal birth control here.
Product list
Many online companies offer birth control pills. Below are some options for a person to consider.
Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.
Medical News Today follows a strict product selection and vetting process. Learn more here.
Learn more here
Nurx
Consultation fee: from $15
Medication price: from $15
Accepts insurance: yes
Nurx stocks over 50 different brands of pills, including generic forms. These include combination and progestin-only pills. It also offers emergency contraception.
In addition, Nurx sells other types of birth control such as a ring, shots, and a patch.
Nurx accepts most private health insurance plans, apart from Medicaid and Medicare. How much an insured person pays each month will depend on the copayment set by their insurer.
Consultation fees start from $15, as the price depends on the health concern that a person may have. It is generally not eligible for insurance coverage, and uninsured people could pay around $15 per month for their medications.
Read our review of Nurx here.
Read our review of Nurx here.
SHOP NOW AT NURX
a wide array of brands and prices to choose from
free shipping
accepts most forms of health insurance
also provides medications for acne, migraine, cold sores, and mental health
not available in all states
insurance providers do not usually cover the consultation fee
does not accept government healthcare programs
Wisp
Consultation fee: $39
Medication price: from $15
Accepts insurance: no
Wisp offers new customers their first month free.
The company has 15 different types of birth control pills, including combination and progestin-only. They also have two types of pills for emergency contraception.
Prices start at $15 per month.
Wisp ships products for free in discreet packaging, or same-day pickup is available at a person’s local pharmacy. The company also provides medical advice 24 hours a day.
Read our review of Wisp here.
Read our review of Wisp here.
SHOP NOW AT WISP
free shipping
available in all 50 states
offers a free trial
does not accept insurance
one-off consultation fee is more expensive than some competitors
The Pill Club
Consultation fee: $20
Medication priced: from $7
Accepts insurance: yes
The Pill Club offers contraceptives and ongoing personalized medical care.
It claims to have over 120 brands of birth control pills available, including combination and progestin-only pills. A person may also purchase emergency contraception and the contraceptive ring.
The company accepts many insurance plans, but individuals may need to pay a $20 consultation fee that insurers will not cover. Without insurance, prices start from $7 per pack for a 1-year supply.
SHOP NOW AT THE PILL CLUB
available to all 50 states
offers free delivery
provides ongoing medical support
the company may require some states to have a video consultation
Birth control pills at a glance
Nurx
Wisp
The Pill Club
How to choose
Here are some considerations when a person is looking for a contraceptive pill.
Speak with a doctor: A person should first consult a doctor or healthcare professional to discuss health conditions or medications that could negatively interact with a pill’s ingredients.
Menstrual cycle: Some pills may affect a person’s menstrual cycle, so discussing this with a medical professional may help to manage their expectations.
Costs: It is important to consider costs with prescribed medication. Some contraceptive pills may cost more than others, and some health insurance plans may cover only part of the costs. Individuals should explore all options to ensure they stay within budget.
When to contact a doctor
A person may experience minor side effects when first taking or switching birth control pills, including:
side effects
tender breasts
decreased libido
libido
increased vaginal discharge
vaginal discharge
bleeding
nausea
nausea
headaches
headaches
abdominal cramping
If the side effects worsen or do not resolve after a few weeks, a person should consult a doctor.
Frequently asked questions
Below, we look at some common questions relating to birth control pills.
It is still possible to get pregnant while taking birth control.
However, the NHS estimates that fewer than 1 in 100 people become pregnant when taking the birth control pill perfectly. With typical use, this statistic rises to 9 in 100 people.
1 in 100
9 in 100
Individuals can stop taking birth control pills whenever they choose. However, anecdotal evidence points to some side effects when discontinuing use, such as irregular menstrual cycles, weight changes, and acne.
irregular menstrual cycles
acne
A person can choose to take a pill to stop their periods completely. They may also take a series of active and inactive pills. A person takes the inactive pills seven days each month.
Summary
There are two main types of birth control pills — combination and progestin-only. They both aim to prevent pregnancy by either thickening cervical mucus, preventing ovulation, or both.
A person can receive the pills via an online service or an in-person prescription. Insurance companies typically cover the costs associated with birth control pills.