What Are The Safest Birth Control Options?
You, like countless other women of childbearing age, are doing research on the safest birth control options. Staring into the glow of your laptop screen, you're left to your own devices while figuring out the best keywords to search for answers to your birth control questions. Sure, you had a doctor’s appointment last week, but they had 15 minutes to fly through the options, most of which were some variation of hormonal contraceptives, and they didn’t really have time to address all the questions you had.
I’ve been there too. And with the emerging evidence on the dangers of hormonal birth control, you’re right to want to make an informed decision. In this post, we’ll go through some of the safest birth control options out there right now, starting with the least invasive, and give you the pros and cons for each one.
Fertility Awareness Method
The fertility awareness method, sometimes called FAM, is a scientifically based combination of indicators to listen to your body and understand what days of the month are your most fertile. From there, you can either target that time, or avoid it based on your pregnancy goals.
FAM is often conflated with the “rhythm method” and discounted as ineffective, if you truly follow its outlined steps and learn your own cycle, it has been shown to be 90% effective. (1) The three main indicators of the method are tracking your cycle (noting the days your period starts and stops), measuring basal body temperature (BBT) every morning, and assessing cervical mucus (CM).
The obvious pros for this method include the fact it doesn’t require any doctor’s visits, copays, pills, etc. – just you and a $10 thermometer! In addition to being practically free and non-invasive (you get used to the CM check, I promise), there are no side effects, and of course, it’s totally reversible should you want to get pregnant at any point. Another, perhaps less obvious pro is that you really get to know your body and can see how things like stress or sickness or travel affect your cycle and hormones.
The cons you could probably guess – admittedly it does take some diligence on your part to get into the routine of taking temperatures and measurements every day. It also requires either abstinence or backup contraception for the week each month that you are fertile if you are looking to avoid pregnancy. If you are interested in learning more details about this method, be sure to check out my full-length post on FAM.
Barrier Methods (2)
While you may be thinking “why are you telling me about this category when kids have been learning about condoms in high school for decades?”
Hear me out. While perhaps not innovative, these types of barrier method options should not be discounted. They can include things like condoms, a sponge, or a diaphragm. Sure, they have some annoying cons (I’ll get to those in a second) but they are also super safe and easy to access.
A definite pro, especially for those who may not be in a serious relationship, is that you only have to use it when you have sex. No need to remember a daily pill or get something implanted in you when you aren’t even sure when the next opportunity will be. It’s also a pretty affordable option.
Another advantage is that male condoms protect against sexually transmitted diseases, whereas most birth control options do not. However, one of the more serious cons is that they can sometimes rip or fail, especially due to user error. They also require some conversation between you and your partner before getting into it, which can be any level of awkward depending on your relationship.
If you’re not into trusting the guy you’re with to handle this sensitive and important issue, there are female options as well, including female condoms, a contraceptive sponge (which protects up to 24 hours), or a diaphragm (which is inserted 4 hours ahead of time but is only available with a prescription).
On the upside, all of these have no long-term health risks, no effect on your hormones, and are all controlled by YOU. But, they are all a little less effective than male condoms at preventing pregnancy, take some practice to use, and don’t always protect against STDs.
Copper (non-hormonal) Intrauterine Devices
Taking another step up in terms of “invasive”, IUDs have become incredibly widespread. There are more than 150 million women using them around the world, primarily in the form of the copper IUD, which does not use hormones for contraception. (3)
One of the reasons driving its high utilization is the incredibly low failure rate – after 12 years of use, the cumulative pregnancy rate worldwide for those with IUDs was just 2.2 per 100. (4) Researchers have also found a low number of reported adverse events, and discontinuation (removal) rates that are lower than other methods, showing copper IUDs to be a safe and acceptable option.
Pros include the long-acting nature of the IUD, so after the initial insertion, you could be protected against pregnancy for 3 years or more without even thinking about it! It’s reversible, so if you change your mind, you can always have it removed. (5) It also doesn’t use hormones and can make your period lighter and reduce the severity of cramps.
The downsides though include cost (depending on insurance costs can be around $1300), and the inconvenience of the initial appointment. It needs to be inserted by a doctor or nurse, and though it is small, getting anything shoved up there is not pleasant. And, perhaps unsurprisingly, there are some side effects that can include pain and inflammation upon insertion, cramping, spotting between periods, or occasionally, an infection. For most women, these effects will go away in 6-12 months (but let’s not pretend that’s a short amount of time to be uncomfortable).
But is that the whole story? As some women are realizing, there is also the potential for copper buildup in the body which can lead to toxicity and may manifest in various health issues. These copper buildup effects can include brain fog, fatigue, dizziness, mind racing, and then eventually more noticeable effects like depression and irritability. (6) High estrogen can also increase copper retention, so with the high levels of estrogen-mimicking chemicals found in the environment, this is definitely something to keep an eye on if you choose this option.
As in some of my other posts, I can’t overstate how great it is that there are so many birth control options on the table for women to choose from. But – as society is slowly learning – every woman is different, and that means a great choice for one might be a terrible idea for another. What is important is learning the ins and outs of each method and matching that up against your own background, health issues, and life plans.
These are the safest birth control options available, but they all have their drawbacks. I encourage you to stay informed and challenge your doctor with questions you have and if they dismiss your concerns or can’t answer you – find a new doctor. You are your best advocate.
- American Pregnancy Association. Fertility Awareness: Natural Family Planning. 2016. Available from https://americanpregnancy.org/preventing-pregnancy/natural-family-planning/
- American College of Obstetricians and Gynecologists. Barrier Methods of Birth Control: Spermicide, Condom, Sponge, Diaphragm, and Cervical Cap. 2018. Available from: https://www.acog.org/Patients/FAQs/Barrier-Methods-of-Birth-Control-Spermicide-Condom-Sponge-Diaphragm-and-Cervical-Cap?IsMobileSet=false
- Kaneshiro, B. and Aeby, T. Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device. International Journal of Women’s Health. 2010: 2 211-220.
- UNDP, UNPF, WHO, World Bank. Long-term reversible contraception: Twelve years of experience with the TCu380A and TCu220C. Contraception. 1997. 56:341-352.
- Planned Parenthood. IUD. Available from: https://www.plannedparenthood.org/learn/birth-control/iud/what-are-the-benefits-of-iuds
- Copper Toxicity. Copper’s Connection with Estrogen/Hormones & Birth Control. Available from: https://coppertoxic.com/estrogen%2Fiud