Focus on Women

The pill, the ring or the patch? Birth control options.

Not quite ready to have a baby?

There’s a solution for that.

Today’s birth control options include everything from the tried-and-trusted pills to new LARCs, or long-acting reversible contraception, of which there are three varities: intrauterine devices, or IUDs; implants such as Nexplanon; and injections like Depo Provera.

While all of them do the job of helping to prevent pregnancy, each also comes with its own pros and cons. Which is why there’s no one size fits all when it comes to birth control.

“Contraception really is very personal,” said Dr. Chadburn Ray, an OB/GYN at Augusta University Health. “What doesn’t work for your friend or someone you know may be great for you.”

Your safest birth control option

First of all, what everyone should know is that some birth control options can increase your risk for a cardiovascular event, especially if you have a personal or family history of blood clots in the legs or lungs or if you have had migraines with an aura.

A very small number of women can have a genetic predisposition to blood clots that doesn’t come to light until they start on birth control. So if you’ve just begun taking birth control and suddenly notice swelling and/or pain in just one leg—that isn’t related to trauma or another cause you can identify—you may have a clot that will need to be treated by a doctor. If you develop shortness of breath too, it could be a pulmonary embolism, a potentially life-threatening situation where the clot has traveled up the leg into a lung. So get to an emergency room right away.

For certain individuals, there are also some special concerns when it comes to birth control. Read on:

If you’re a runner or athlete:

Those who are interested in Depo-Provera, a birth control shot that’s administered by your doctor’s office every three months, should talk to their doctor about the risk of bone loss. “Depo-Provera has long since been known to cause bone loss in women,” said Ray.

However, pregnancy also causes bone loss. So doctors and patients together need to judge what’s the acceptable risk, says Ray. Athletes too tend to be at less risk for bone loss since a balanced diet and weight-bearing exercise are bone-building activities.

Some athletes may be more concerned with another side effect of the injection: weight gain. (It’s also a risk with the implant Nexplanon.) But most reports say that if you continue to stick to a balanced diet and at least 30 minutes of exercise three to five times a week, you can avoid this.

If you’re overweight or obese:

Certain birth control options such as Depo-Provera and Nexplanon (as mentioned above) can increase your risk for gaining weight, so you may want to talk to your doctor about other options, especially if you’re working hard to lose weight.

Depo-Provera’s additional risk for bone loss should also be a worry for Caucasian women who are overweight or obese and tend to lead a sedentary lifestyle, since all of those are already risk factors for poor bone health.

If you’re heavier, you also have a higher likelihood of failure on Depo-Provera, said Ray: “In other words, you may become pregnant.”

But to help avoid that, your doctor could prescribe a higher dose—giving an additional injection if needed. “That’s part of the individualization that’s so necessary in everything we do in medicine now,” said Ray.

If you have or have had cancer:

Doctors don’t prescribe birth control for any woman who has or has had any hormonally active cancer—such as breast cancer. But anyone with cancer also has a higher risk for blood clots, another reason not to also add birth control—with its own risk for clots—on top of that.

But one good thing in the fight against cancer? The Mirena IUD has been shown to be very effective not just at birth control but also in treating precancers and cancers of the endometrium, or the lining of the uterus. It also can help with the pain of endometriosis since it essentially stops your periods.

If you are at risk for depression:

Hormones help regulate mood, so it makes sense that being on birth control can help balance your mood—or could make moods worse. For example, certain birth controls could cause worsening of depression over time.

A couple really good things about birth control

Although you should be cautious of the side effects of birth control, as with any medication, there are some really great side effects too. Here’s one: If you suffer from acne, birth control pills can help control the hormone androgen, which could help reduce acne and improve skin. But it’s not guaranteed—certain pills can also make acne worse.

And for anyone who hates having their period—which is probably the majority of us, if not all of us—the Mirena IUD can stop periods. Period. “And it may seem strange, but it’s OK to do that,” said Ray. “And most women report that it’s glorious, especially if they suffered from heavy bleeding previously.”

But no matter the risk or the benefit, it all goes back to that idea of individualized care. “We don’t want any woman to rule out something that could potentially be very beneficial for them because of something they’ve heard that may not be relevant for them at all,” said Ray. “So always talk to your doctor.”

Want more advice?
To find an OBGYN or schedule an appointment at Augusta University Women’s Health, visit or call 706-721-4959.

About the author

Augusta University Health

Based in Augusta, Georgia, Augusta University Health is a world-class health care network, offering the most comprehensive primary, specialty and subspecialty care in the region. Augusta University Health provides skilled, compassionate care to its patients, conducts leading-edge clinical research and fosters the medical education and training of tomorrow’s health care practitioners. Augusta University Health is a not-for-profit corporation that manages the clinical operations associated with Augusta University.