All Your Birth Control Questions, Answered by Experts

by Marjorie Korn Health Writer

So many options, so many questions. Whether you’re looking into birth control for the first time or have used it for years and are thinking about switching things up, you have more choices available right now than at any other moment in history. That’s great news (who doesn’t like choices?) but also a little overwhelming—it can be hard to figure out what’s best for you and it’s not really something you want to get wrong. Deep breaths. We went to the experts to get the answers to the questions you really want to ask.

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What's the most popular form of birth control?

There are about 9.6 million women on birth control in this country, according to the Guttmacher Institute. Of those, about a quarter take birth control pills—the most common form of self-protection for women. Implants, patches, shots, and rings are other ways to go, and increasingly, intrauterine devices, or IUDs, are gaining in popularity. And a new hormone-free gel is making waves on the market, too.

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How do I start birth control?

If you are sexually active or plan to be, your doctor will help you make a game plan that takes into account what you want out of birth control, and your physical health. No matter what form you choose, there’s no special timing about when to start it related to your menstrual cycle. However, starting within a few days of your menstrual period will help decrease some unwanted side effects like spotting and suppress ovulation sooner. Birth control doesn’t become effective for about seven days, so employ a backup method or abstain for a week—and always use condoms to prevent the transmission of sexually transmitted diseases.

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Where do I get birth control?

Unlike condoms, you can’t just buy BC off the shelf. Your ob/gyn or a practitioner at a women’s health clinic can counsel you on options and insert an IUD or an implant, if that’s your choice. (If you’re planning to have one of those inserted at the time of your appointment, call ahead to make sure they have it in stock.) For some forms of birth control, you can get a prescription from a general practitioner or an urgent care clinic. In 12 states plus Washington, D.C., pharmacists are also able to prescribe birth control.

Planned Parenthood
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How much does birth control cost?

Health insurance and Medicaid usually cover birth control, either partially or entirely. (Newer drugs may require out-of-pocket payments.) And under the Affordable Care Act, insurance plans are also usually required to cover birth control-related doctor’s visits. If you’re worried about your ability to pay for birth control, the folks at Planned Parenthood clinics can help find an affordable solution. Find a nearby clinic or set up a telehealth session at plannedparenthood.org/health-center.

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How long does it take for birth control to work?

One week, so use condoms in the meantime. One exception: A copper IUD starts working immediately and can even be used as a form of emergency contraception that’s 99.9% effective if inserted within five days of having unprotected sex. Also, if you’re taking a pill containing estrogen and miss one day by accident, you’re probably still protected from pregnancy, says Nicole Economou, M.D., a clinical instructor in ob/gyn and reproductive sciences at University of California, San Diego. But if you’re on progestin-only pills and miss a day, use condoms for the next 48 hours.

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Is it bad to take birth control pills while pregnant?

Relax. Taking birth control pills while you’re pregnant has not been shown to have adverse outcomes, says obstetrician and gynecologist Megan Evans, M.D., an assistant professor at Tufts University School of Medicine in Boston. It won’t harm the fetus. Which is a good thing, since about nine out of 100 women get pregnant because they forgot to take their meds for a day or two (before presumably resuming, only to realize they’re preggers), according to the Cleveland Clinic in Ohio.

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I have an IUD and still got pregnant—is that dangerous?

Let’s start with: This is extremely rare. Researchers at the Guttmacher Institute found that IUD and implants have the lowest failure rates of all birth control—less than 1 in 100. But…if your IUD failed, there’s an increased risk of ectopic pregnancy, in which the fertilized egg implants outside of the uterus. If it’s a normal pregnancy, you and your doctor will decide whether to remove the IUD (which increases the risk of miscarriage) or leave it in, which carries a higher risk of adverse pregnancy outcomes like water breaking early.

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Is it hard to switch methods?

Not at all. In fact, you may try a couple different methods before you find the one that’s right for you, says Dr. Economou. That’s why having an open dialogue with a provider you trust is so helpful. If you can, give it a month or two to see if some of the initial side effects resolve or if you can settle into a comfortable routine. “But if you’re really unhappy, come back to the clinician and tell her what you are experiencing,” Dr. Economou says. With so much to choose from, you will eventually find a good match.

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I have a family history of cancer. Is birth control safe?

Yes. Birth control actually reduces the risk of ovarian and endometrial cancer, Dr. Evans says. If you have a BRCA mutation, which puts you at a higher risk for breast or ovarian cancer, you should be getting screening more frequently and at a younger age than someone who doesn’t have the mutation, anyway. “Most breast cancer is sporadic and occurs randomly,” Evans says. “People take birth control for a variety of reasons, and if there is a family history, typically the benefits outweigh the risks.”

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I'm about to have a baby and intend to breastfeed. Can I take birth control?

Yes, but if you’ve just given birth, you’ll want to avoid birth control that contains estrogen for three weeks. In fact, many doctors will offer new moms a passive progestin-only birth control method like a shot, implant, or IUD just after giving birth. (A copper IUD works, too.) Another option: For women who are done having children or where subsequent pregnancy poses a life-threatening risk, talk with your doc about sterilization at the time of a c-section or laparoscopically afterwards, Dr. Evans says.

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If my birth control stops my period, how do I know if I’m in menopause?

Menopause is a retrospective diagnosis, meaning that it’s only when your period has stopped for 12 consecutive months that you know you’re in it. If your birth control means you don’t have a period anyway, there are other symptoms that’ll clue you in, like hot flashes and vaginal dryness. Some women find birth control helps with issues like mood swings, and if that’s you, it’s safe to stay on it after menopause, says Dr. Economou. Or you can consider switching to hormone replacement therapy, which uses a smaller dose of hormones than birth control. These methods should only be used in the short term, however, as long term use of hormones after menopause can increase your risk of some diseases.

Marjorie Korn
Meet Our Writer
Marjorie Korn

Marjorie Korn is a health, medicine, and features writer based in New York City. She is also a Narrative Medicine instructor at Columbia University College of Physicians & Surgeons.