The Pill
What it is: Twenty-one prescription tablets containing a combination of estrogen and progestin—or, less frequently, progestin alone—along with seven or so hormone-free “placebo” pills that help you stay on your schedule.
How it works: The most common pills are combination versions, which prevent ovulation and thicken the cervical mucus so sperm can’t make it into the uterus. Which formulation is right for you: monophasic, with constant doses of hormones throughout the cycle, or triphasic, which gives you different doses throughout the month? Or should you try Yaz, a pill with a special progestin that might nix bloat, pimples, moodiness, and other side effects? Unfortunately, trial and error is the only way to know—but most pills are similar to each other, and many women like the first type they try.
Doctors prescribe progestin-only pills more rarely—usually for smokers over 35 and other women prone to clot problems. These so-called mini pills work mainly by thickening cervical mucus and by helping to reduce ovulation. The bottom line is that if one pill doesn’t work for you, don’t assume none of them will.Caveats: Not recommended if you smoke or have an immediate family history of blood clots (though your doctor may let you go for the mini pill). The mini pill is marginally less effective than combination pills (estrogen makes them better at preventing ovulation), and you have to take it at the same time every day without fail. All pills can cause spotting at first, but this can be a constant issue for mini-pill users.
Failure rate: .3 percent with perfect use; 8 percent with typical use.
Cost: $15 to $35 per month.
How soon you can get pregnant: One to three months after stopping.
The Vaginal Ring
What it is: Available by prescription, the Nuva-Ring releases estrogen and progestin directly into the vaginal walls.
How it works: Insert this flexible ring (about two inches in diameter) into your vagina by squeezing the edges together, and remove it after three weeks—at which point you should get your period. Each ring works for one month, preventing fertilization the same way combination pills do. The ring is better for women who’ve experienced nausea with the Pill, since its hormones aren’t absorbed through your GI tract, says contraception expert Régine Sitruk-Ware of the Population Council.
Caveats: Since your bloodstream takes in roughly the same dose of hormones as it does with the combination pill, side effects are similar—with the added risk of vaginal irritation, which often goes away within a few months. You might have heard stories about guys feeling the ring during sex, but that’s a rare 1 percent of the time, says Hope Ricciotti, a Harvard Medical School women’s-health expert.Failure rate: Less than 1 percent with perfect use; 8 percent with typical use.Cost: $30 to $45 per month.
How soon you can get pregnant: About two to four weeks after removal.
