Finding the right contraceptive
Fallen out of love with your birth control? Maybe you’re put off by side effects. Or remembering to pop a pill isn’t your strong suit.
Problem is, going without isn’t a good choice, even as you get older: Nearly 40% of pregnancies among women in their 40s, for instance, are unplanned.
Which one is best for you? We’ve assembled some popular choices here. (However, there are other methods, such as the diaphragm, female condom, NuvaRing, and the Patch, that we didn't include).
Combo pill
: Who can try it?
Almost all women.
Surprised? Truth is, a growing body of research debunks some myths surrounding this 99%–effective form of contraception—like the notion that it brings on menopause or ups the risk for some cancers.
The Pill can ease maddening perimenopausal symptoms like hot flashes, hormonal mood swings, and irregular bleeding.
What’s more, it may help prevent ovarian and uterine cancers.
Combo pill
: Who should avoid it?
If you’re a migraine sufferer, you may want to steer clear; the Pill is thought to trigger headaches and raise the risk of stroke in some migraineurs. (Experts aren’t sure why, but the dip in estrogen during the “off week” is one suspect.)
And smokers older than 35—that includes the I-only-light-up-when-I-drink crowd—should avoid the Pill, as both estrogen and smoking cause blood to clot more easily.
Progestin-only pill
: Who can try it?
Women who are breast-feeding (this oral contraceptive will not lower milk supply), or those who can’t take estrogen-based pills due to cardiovascular disease or blood-clot risks, or because they smoke.
Like the combo type, this “mini-Pill” protects against pregnancy via a low dose of hormones, but it’s estrogen-free.
Note: The progestin-only Pill is slightly less failure-proof than the combo kind.
Progestin-only pill
: Who should avoid it?
If you’re schedule-challenged, take heed: Progestin-only pills must be taken every day at the same time to be fully effective; use a backup method if you get off-schedule.
Extended-cycle pill
: Who can try it?
Women who really loathe their periods.
If you suffer from severe PMS, or if your period exacerbates an existing condition such as endometriosis or anemia, these pills may be your new best friend.
Two brands, Seasonale and Seasonique, allow you to go three months without menstruating—you’ll have just four periods a year.
Another brand, Lybrel, stops periods for an entire year, but you do have to take a pill every day, year-round. Like combo pills, all of these contain estrogen and progestin.
Extended-cycle pill
: Who should avoid it?
If you’re not a candidate for the combo Pill, don’t go the extended-cycle route.
Ditto if you tend to be cautious about new medical trends: Although there’s no evidence suggesting that it’s dangerous not to have regular periods, there is less long-term research behind extended-cycle pills than the combo type.
Intrauterine device (IUD)
: Who can try it?
Women who don’t want to think about birth control for a long, long time.
The IUD is more than 99% effective and lasts for up to 12 years—get one at 40 and you’re set until menopause.
The traditional IUD is a small, T-shaped plastic device that’s inserted into the uterus to block egg fertilization. Insertion can cause mild discomfort for some women, but that doesn’t last.
Downsides: possibly, heavy periods and increased menstrual cramping. That’s where Mirena—a newer model that also delivers a steady dose of progestin—wins points. Though it taps out after five years, you can expect lighter bleeding over time.
Intrauterine device (IUD)
: Who should avoid it?
If you think you’ll want a baby in a year, other methods may be better.
You’ll be unprotected as soon as you remove the IUD, but its cost—ranging from $150 to $500—can make it a bad investment for short-term contraception.
Implant
: Who can try it?
Women looking for no-fuss, long-term (three years) contraception, or those who aren’t a fit for the combo Pill.
A matchstick-size plastic rod called “Implanon” is inserted in your upper arm, where it releases progestin to suppress ovulation.
Effectiveness? Nearly 100%. Your insurer may cover the $400-to-$800 cost.
Implant
: Who should avoid it?
If you take the herb St. John's wort or are significantly overweight, be warned: Implanon may not work as well for you.
Condoms
: Who can try them?
Women 40 and older who aren’t monogamous and haven’t finished menopause.
Unlike other forms of birth control, condoms protect against most STDs and HIV, and are up to 98% effective at preventing pregnancy when used correctly.
This method also is an easy (and cheap) choice if you’re not all that busy in bed.
Condoms
: Who should avoid them?
If you’re younger than 40, condoms simply aren’t the most foolproof pregnancy-protection, unless they’re paired with another contraceptive (such as the Pill or an IUD).
Sterilization
: Who can try it?
Women older than 35 who are done having kids but OK with having a period.
There are two kinds of permanent sterilization. Tubal ligation is a surgical procedure in which the Fallopian tubes are blocked by an incision, clamp, or cauterization.
And a newer option, called “Essure”, is less invasive and involves the placement of a small metal insert to obstruct the Fallopian tubes.
Sterilization
: Who should avoid it?
Ask yourself some hard questions: If you remarried or lost your only child, would you want the option to have another?
If you’re not 100% sure, a long-term, reversible method such as an IUD may be better.
Emergency contraception
Plan B—emergency contraception—uses a high dose of progestin to halt ovulation or fertilization, or prevent a fertilized egg from attaching to the uterus.
It’s designed as a backup if you forget to take your oral contraception, have a condom malfunction, or fear an unwanted pregnancy for another reason. Like other birth control, Plan B prevents pregnancy.
Although it’s called the morning-after pill, Plan B is effective up to five days after intercourse.
The sooner it’s started, the more effective it will be.
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