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Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
As a family doctor, the conversations I have with patients about birth control are about choice. There are more safe and effective options than ever before, and when people have accurate information about the various methods and consider what fits best for their individual needs, birth control can support autonomy and flexibility.
These conversations are happening amid concerns that contraceptive use may be declining among younger women, driven in large part by misinformation on social media.
At the same time, several provinces are moving toward publicly funded prescription contraception, reducing cost barriers.
Taken together, this is an opportunity to review this reproductive health tool – and how people can choose the birth control method that is best for them.
Know your purpose for treatment
A helpful place to start when choosing birth control is to clarify the goal of treatment. For some, the primary aim is pregnancy prevention. For others, hormonal contraception is also used to regulate cycles, reduce heavy or painful periods, improve acne and reduce unwanted hair growth, or manage other symptoms related to hormonal fluctuations.
For example, for my perimenopause patients, low-dose birth control pills and hormonal intrauterine devices (IUDs) are commonly used to manage irregular bleeding that can occur at this time of life.
Non-hormonal options, such as copper IUDs or barrier methods (condoms, diaphragms), may be preferred by those who want effective pregnancy prevention without hormones. However, copper IUDs may also lead to heavier periods and cramping.
Starting with purpose helps narrow the field and reframes the conversation away from “What should I be on?” toward “What am I hoping this will do for me at this stage in life?”
Review your medical history
It’s important to discuss your individual medical history with your care provider so you can choose the safest birth control method possible.
Combined hormonal contraception – for instance pills, patches or vaginal rings that contain both estrogen and progestin – is well-studied and considered safe for most healthy, non-smoking individuals.
However, certain types are associated with a small increased risk of blood clots, heart attack or stroke, particularly in those with specific risk factors.
Estrogen-containing options are not recommended for individuals with:
- migraine with aura
- smoking history over 35 years of age
- a history of blood clots/clotting disorders
- uncontrolled high blood pressure
For these individuals, progestin-only methods are a good option. These include hormonal IUDs, the depo injection (a progestin shot given every three months), progestin implants (a small rod placed under the skin of the arm), and some pills.
What’s safe for one person may not be the best option for another, a gentle reminder that online advice can’t replace individualized care.
Canadian gynecologists concerned social media is reshaping perspectives about effective contraeption methods
Consider the additional health benefits
While birth control (in particular hormonal contraception) is often discussed in terms of weighing the benefits against potential risks, it’s important to also keep in mind that there are well-established health benefits that extend beyond pregnancy prevention itself.
For instance, combined hormonal methods are associated with a reduced risk of ovarian and uterine cancer compared to people who do not use hormonal contraceptives.
Many hormonal options, such as hormonal IUDs, also reduce menstrual blood loss, which can improve iron deficiency and anemia, and help ease cycle-related pelvic pain, headaches, migraines and mood changes.
Factor in your lifestyle
Whatever birth control option you choose, it will only be as effective as how consistent you are with its use, so consider how a method fits into your everyday life.
Birth control pills work best when taken consistently. Patches and vaginal rings don’t require daily effort but still need to be changed on a set schedule.
For some people, birth control methods requiring a regular routine can be manageable but for individuals with inconsistent schedules or who may struggle to remember, they can add stress and be difficult to maintain.
In these situations, I suggest considering a “set it and forget it” option like IUDs, implants or depo injectables. Once in place, they work quietly in the background, without requiring ongoing action.
Consider your budget
Short-acting methods such as pills, patches and vaginal rings often have lower upfront costs, typically ranging from $15 to $40 per month depending on formulation and insurance coverage. Over time, those monthly costs can add up. Finding a sexual health clinic that sells medication at cost can be helpful.
Long-acting options, including hormonal and copper IUDs and implants, come with higher upfront costs, often several hundred dollars, which can be difficult to cover. However, they last between three and 10 years so spread over time, they are cost-effective.
Choosing birth control doesn’t need to happen in a single doctor’s visit, and changing your mind is common as it can take some trial and error to find the right fit. With more options than ever before, and provincial moves to reduce cost barriers, the goal is to find the one that suits you best based on your current goals.
Dr. Sheila Wijayasinghe is a menopause-certified family physician practising at St. Michael’s Hospital in Toronto and the medical director of primary care outreach at Women’s College Hospital. She is also the resident health expert on CTV’s The Social and co-host of The Doc Talk Podcast.
