Understanding birth control options: A guide from Ella Cook, WHNP at Boulder Women’s Care

Choosing the right birth control can feel overwhelming with so many options available. But don’t worry—we’re here to help guide you through your choices to find one that best fits your body and lifestyle.

We consulted Ella Cook, WHNP, at Boulder Women’s Care to break down the most common birth control methods, their effectiveness, and what to consider when choosing the right option for you.

Oral contraceptives: Combination pill vs. progestin-only pill

The birth control pill is one of the most widely used methods, but it comes in two main varieties: The combination pill and the progestin-only pill. Here’s how they differ:

Combination pill

The combination pill contains both estrogen and progestin, two hormones that work together to prevent pregnancy. It works by preventing ovulation, thickening cervical mucus to block sperm, and thinning the uterine lining to prevent implantation. This makes it a good option for people with ovarian cysts, as it can stop new cysts from forming.

Why it works:

• Highly effective: The combination pill is highly effective (99% when used perfectly).
• Regulative effects: It can also help regulate periods, reduce acne and alleviate menstrual cramps.

What to keep in mind:

• Estrogen risks: "Because the combination pill contains estrogen, it’s not recommended for people who smoke and are over 35, or for people with certain health conditions like high blood pressure or a history of blood clots," explains Ella.
• Daily commitment: "While it doesn’t need to be taken at the same time every day, it’s important to take it consistently to maintain its effectiveness," notes Ella.
• Not recommended for migraines with aura: "People who experience migraines with aura should avoid the combination pill, as it may increase the risk of stroke," says Ella.

Progestin-only pill

The progestin-only pill contains only progestin, not estrogen. This makes it a good option for women who cannot take estrogen for medical reasons, such as those who are breastfeeding or have certain health conditions. The progestin-only pill works by thickening cervical mucus and thinning the uterine lining. In some cases, it can also suppress ovulation.

Why it works:

• Highly effective: The progestin-only pill is 99% effective with perfect use.
• No estrogen: It’s a great option for people who cannot use estrogen-based contraception.
• Good option for high blood pressure and migraines with aura: Since the progestin-only pill doesn’t contain estrogen, it is a safer option for individuals with high blood pressure or who experience migraines with aura.

What to keep in mind:

• Daily consistency: "The progestin-only pill must be taken at the same time every day without fail. Missing a pill can significantly reduce its effectiveness," Ella advises.
• Spotting: Some people experience irregular bleeding or spotting, especially during the first few months.

Copper IUD vs. hormonal IUD

An IUD (Intrauterine Device) is a small, T-shaped device placed inside the uterus to prevent pregnancy. It’s a long-acting, reversible method of contraception and can last anywhere from 3 to 10 years, depending on the type. IUDs are highly effective and convenient, but some people may experience discomfort or pain during insertion. Boulder Women's Care can provide pain and anxiety mitigation options to make the placement procedure more comfortable. It comes in two types: The copper IUD and the hormonal IUD. They work in different ways.

Copper IUD

The copper IUD is a non-hormonal birth control option. It’s wrapped in copper, which creates a toxic environment for sperm, preventing fertilization.

Why it works:

• Highly effective: The copper IUD is over 99% effective.
• Long-lasting: It can provide protection for up to 10 years.
• Non-hormonal: "The copper IUD is a great option for people who prefer a hormone-free solution," says Ella.
• Safe for high blood pressure and migraines with aura: The copper IUD is a non-hormonal option, so it is a good choice for people who have high blood pressure or experience migraines with aura.
• Emergency contraception: The copper IUD can be used as effective birth control immediately after unprotected sex and can prevent pregnancy for up to 5 days when inserted by a health care provider.

What to keep in mind:

• Heavy periods: "One of the most common side effects is heavier or longer periods, especially in the first few months," notes Ella.
• Spotting: Some people experience spotting between periods, particularly in the initial months of use.

Hormonal IUD

The hormonal IUD releases a small amount of progestin into the uterus. This hormone thickens cervical mucus to prevent sperm from entering the uterus and thins the uterine lining to reduce the likelihood of implantation. In some cases, it also suppresses ovulation.

Why it works:

• Highly effective: The hormonal IUD is over 99% effective.
• Long-term protection: It can last up 7 years, depending on the brand.
• Reduced periods: "Many people experience lighter periods or even stop menstruating altogether while using the hormonal IUD," says Ella.

What to keep in mind:

• Side effects: Some people experience irregular bleeding or spotting, particularly in the first few months.
• Hormonal effects: "Though the hormonal dose is localized to the uterus, some people may experience side effects like mood changes or headaches," Ella notes.

Contraceptive implant

This small, flexible rod is placed under the skin of your upper arm by a healthcare provider. It releases progestin, which prevents ovulation and thickens cervical mucus.

Why it works:

• Highly effective: The contraceptive implant is highly effective, with over 99% success in preventing pregnancy.
• Long-term protection: It lasts up to three years, and you don’t have to worry about remembering to take a daily pill.

What to keep in mind:

• Spotting: Some people may experience irregular bleeding or spotting.
• Visit required: "The procedure to insert and remove the implant requires a visit to your healthcare provider, so it’s important to consider that when choosing this method," says Ella.

Condoms (male and female)

Condoms are a barrier method of contraception. Male condoms are worn over the penis, and female condoms are inserted into the vagina. Both create a physical barrier to prevent sperm from reaching the egg and can also help protect against sexually transmitted infections (STIs).

Why it works:

• STI Protection: Condoms are the only form of birth control that also protect against STIs.
• Convenience: They are widely available, affordable, and don’t require a prescription.

What to keep in mind:

• Less effective: Condoms are less effective than other methods, with typical use offering about 85% protection.
• Risk of incorrect use: "They must be used correctly each time to prevent breakage or slippage," Ella advises.

Birth control patch

The birth control patch is a thin, adhesive patch worn on the skin that releases estrogen and progestin to prevent pregnancy. You apply a new patch once a week for three weeks, then go patch-free for one week.

Why it works:

• Delivers consistent hormone levels through the skin.
• 99% effective with perfect use.
• Convenient weekly routine—no daily pill required.

What to keep in mind:

• Weekly commitment: Must be replaced on the same day each week.
• May cause skin irritation where applied.
• Weight dependent: Less effective for people over a certain weight (typically 198 pounds or more).
• Contains estrogen: Carries similar risks to other estrogen-containing methods (e.g., not recommended for smokers over 35).

Birth control shot (Depo-Provera)

The birth control shot is an injection of progestin that you get every three months from your healthcare provider. It works by preventing ovulation and thickening cervical mucus. 

Why it works:

• Highly effective: The shot is highly effective, offering 94% protection against pregnancy with typical use.
• Short-term protection: It lasts for three months, so you don’t have to worry about remembering to take it daily.

What to keep in mind:

• Visit required: "You need to visit your healthcare provider every three months for the shot," says Ella.
• Side effects: Some people experience side effects such as weight gain or mood changes, and fertility may take time to return after stopping the shot.

Vaginal ring (NuvaRing)

The vaginal ring is a small, flexible ring that you insert into your vagina once a month. It releases hormones (estrogen and progestin) that prevent ovulation and thicken cervical mucus. 

Why it works:

• Highly effective: The vaginal ring is highly effective (99%) when used correctly.
• Convenient: It’s a convenient monthly method — you insert it for three weeks, remove it for a week, and then repeat.

What to keep in mind:

• Potential for discomfort: "Some people find the ring uncomfortable or may feel it during sex," says Ella.
• Risk of incorrect use: Correct placement and removal are essential for maximum effectiveness.

Sterilization options

Sterilization is a permanent method of contraception for people who are certain they don’t want to have more or any children. There are options for people with both male and female anatomy.

Tubal ligation

Tubal ligation, often referred to as “getting your tubes tied,” involves a surgical procedure in which the fallopian tubes are cut, sealed, or blocked to prevent eggs from reaching the uterus. This procedure is typically done under general anesthesia.

Why it works:

• Permanent: It’s a highly effective and permanent form of birth control.
• No maintenance required: Once done, no further action is needed, and you won’t have to worry about birth control methods ever again.

What to keep in mind:

• Irreversible: This is a permanent decision, so it’s important to be certain that you don’t want more children.
• Surgical risks: As with any surgery, there are risks involved, such as infection or complications from anesthesia.

Hysterectomy

A hysterectomy is a surgical procedure in which the uterus is removed. It’s often recommended for people with certain medical conditions, such as fibroids, endometriosis, or cancer, or for those seeking permanent contraception.

Why it works:

• Permanent solution: A hysterectomy removes the uterus entirely, making pregnancy impossible.
• No need for birth control: Once the uterus is removed, pregnancy is no longer possible, so you won’t need any further birth control methods.

What to keep in mind:

• Irreversible: A hysterectomy is a permanent decision, so be sure that you do not want to have children in the future.
• Surgical risks: As with any major surgery, there are risks such as infection, bleeding, or complications from anesthesia.
• Hormonal changes: If both the uterus and ovaries are removed, it leads to immediate menopause, which can cause symptoms like hot flashes, mood swings, and changes in libido.

Vasectomy (male sterilization)

A vasectomy is a surgical procedure in which the vas deferens — the tubes that carry sperm from the testicles to the urethra — are cut, sealed, or blocked. This prevents sperm from being released during ejaculation, making it a permanent form of contraception.

Why it works:

• Permanent solution: A vasectomy is highly effective and can be used as a permanent option.
• No maintenance required: Once completed, no further birth control methods are needed, and there’s no need to worry about contraception going forward.

What to keep in mind:

• May be reversible: A vasectomy is intended to be permanent, so it’s important to be certain you don’t want more or any children. It is possible in some cases to reverse a vasectomy through a surgical procedure called a vasovasostomy.
• Surgical risks: As with any surgery, there are risks, including infection, bleeding, or complications from anesthesia.
• Not immediately effective: It can take a few months for sperm to be cleared from the system, so another form of contraception should be used until follow-up testing confirms no sperm are present.

Natural family planning (fertility awareness)

Natural family planning involves tracking your menstrual cycle to identify when you’re most fertile and avoiding sex or using barrier methods during that time.

Why it works:

• No hormones needed: Natural family planning involves no hormones or devices and is completely natural.
• It’s free, other than the cost of any tools you use to track your cycle.

What to keep in mind:

• Requires careful monitoring: You need to carefully track your cycle and avoid mistakes.
• Less effective: With typical use, it’s less effective than other methods, offering 76-88% protection.

Choosing the right birth control for you

When it comes to birth control, there’s no one-size-fits-all solution. Your ideal method depends on your health, lifestyle, and future family planning goals. It’s important to have a conversation with your healthcare provider to explore the options that work best for you.

At Boulder Women’s Care and Foothills Community Midwives, we’re here to help guide you through your options and ensure you make an informed decision. Whether you’re looking for a temporary or permanent solution, we’re here to support you every step of the way.

If you’re ready to talk more about your birth control options or have any questions, don’t hesitate to reach out. Our team is here to help you make an informed, confident decision about your reproductive health.

Boulder Women's Care

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Phone: 303-441-0587

Fax: 303-996-0801

Hours

• Monday: 8 a.m. - 5 p.m.
• Tuesday: 8 a.m. - 5 p.m.
• Wednesday: 8 a.m. - 5 p.m.
• Thursday: 8 a.m. - 5 p.m.
• Friday: 8 a.m. - 5 p.m.
• Saturday: Closed
• Sunday: Closed

Foothills Community Midwives

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Phone: 303-415-4045

Fax: 303-415-4046

Hours

• Monday: 8 a.m. - 5 p.m.
• Tuesday: 8 a.m. - 5 p.m.
• Wednesday: 8 a.m. - 5 p.m.
• Thursday: 8 a.m. - 5 p.m.
• Friday: 8 a.m. - 5 p.m.
• Saturday: Closed
• Sunday: Closed