Birth Control: What’s Safe, What’s Not

This blog was originally published in 2018. It has been updated in 2025 for relevance and accuracy.

As a woman, you have a lot of choices today when it comes to birth control methods, giving you and your partner control over when (or if) you become parents.

But with birth control (also called contraception), different people have different needs. Each method has its pros and cons – including health risks. That’s why it’s extremely important that you have an honest discussion with your doctor about which approach to birth control is best for you, based on such considerations as your overall health and medical history, how well each method works, how often you have sex, possible side effects, and if you want to have children someday.

Types of Birth Control

There are 7 major categories of birth control options to choose from based on your unique situation and needs. These include:

• Abstinence: Avoiding vaginal intercourse altogether
• “Natural” birth control  (also referred to as the rhythm method or fertility awareness): You track ovulation in order to avoid intercourse when you’re most fertile
• Barrier methods: The contraceptive sponge; diaphragm, cervical cap and cervical shield; and male and female condoms. They work by creating a barrier that helps prevents sperm from reaching and fertilizing an egg, and are often used with spermicide (a substance that kills sperm)
• Hormonal methods: The birth control pill, patch, shot/injection, implantable rod and vaginal ring; all primarily work by using hormones to prevent ovulation (stopping the ovaries from releasing eggs)
• Implantable devices: An implantable intrauterine device (IUD) is a small T-shaped device inserted into the uterus to prevent pregnancy.  There are both hormonal and non-hormonal IUDs available.
• Permanent birth control: Includes surgical sterilization (tubal ligation) or a sterilization implant (Essure®), which blocks the fallopian tubes from carrying eggs to the uterus
• Emergency contraception: Emergency contraceptive pills prevent most pregnancies when taken within a few days after unprotected intercourse, contraceptive failure, incorrect use of contraceptives, or in cases of sexual assault. There are two methods: emergency contraception pills and a copper IUD.

Pros and Cons of Common Birth Control Options

While the hormonal methods of birth control are up to 99% effective when used correctly, and are safe for most women, the ones that contain the hormone estrogen are associated with a slightly increased risk of deep vein thrombosis (blood clot), heart attack and stroke. So if you smoke, are 35 or older, or have risks for cardiovascular disease (such as high blood pressure or diabetes), you should talk to your doctor before deciding to use birth control containing estrogen. In addition, if you get migraines, estrogen may trigger these painful headaches.

There is a progestin-only birth control pill that may be a better choice for women who cannot take estrogen. But if you have liver tumors, lupus or breast cancer, you should avoid this method.

Barrier methods of birth control can be anywhere from 71% to 98% effective when used correctly. If you’re prone to bladder infections, however, diaphragm use raises your risk of getting one. And if you’ve ever had toxic shock syndrome, you should avoid the diaphragm and the contraceptive sponge.

Selecting the Right Birth Control Option

The pros and cons outlined above are just a few of the things you need to think about as you consider your birth control choices. We urge you to talk to your doctor about it; they can provide objective information and guidance to help you make the choice that’s right for you.

And remember: today there are more and safer birth control options than ever. And while any birth control method can fail (except abstinence), the risk of failure is less than 1% for many methods – versus an 85% chance of pregnancy if you don’t use birth control!

Want to learn more about your birth control options? Need help selecting the right option for you? Women’s Health of Central Massachusetts is here for you. Request an appointment with one of our doctors to talk through the best birth control options for your needs.

Birth Control Frequently Asked Questions

Q: What’s the most effective form of birth control?

A: Long-acting reversible contraceptives (LARCs) like IUDs and implants are among the most effective, with failure rates of less than 1%. Permanent methods like tubal ligation are also very effective. When used correctly, hormonal methods like the pill, patch, and ring are also highly effective.

Q: Are hormonal birth control methods safe?

A: For most people, yes. Combined hormonal methods (those with estrogen) do carry a small risk of blood clots, heart attack, or stroke — especially if you’re over 35 and smoke or have other health conditions. If you’re unable to take estrogen, there are safe alternatives like progestin-only methods.

Q: I’ve heard about the “mini pill.” What is it?

A: The mini pill is a progestin-only birth control pill. It’s a good option for people who can’t take estrogen. It must be taken at the same time every day to work well.

Q: Is emergency contraception the same as the abortion pill?

A: No. Emergency contraception prevents pregnancy before it happens. It won’t end an existing pregnancy. Options include pills like Plan B or Ella, and in some cases, a copper IUD can be used for emergency contraception.

Q: What is Ella, and how is it different from Plan B?

A: Ella (ulipristal acetate) is a prescription emergency contraceptive pill that may work better than Plan B for people over a certain weight or when taken 3–5 days after unprotected sex.

Q: Is Essure still an option for permanent birth control?

A: No. Essure was discontinued in the U.S. in 2019 due to safety concerns. Today, tubal ligation is the standard option for permanent female sterilization.

Q: Do I have to be a certain age to use birth control?

A: No. Your doctor can help you choose a method that’s safe based on your age, health, and lifestyle. Teens, young adults, and people approaching menopause all have safe options.

Q: Do I need to take a break from birth control after a few years?

A: No. There’s no medical reason to take a break unless you’re having side effects or want to get pregnant. Many methods are safe for long-term use.

Q: How can I find out which birth control is best for me?

A: Talk to your healthcare provider. They’ll consider your medical history, preferences, and future plans to help you find a method that fits your needs.