• Nan Wang, MD

The “pill” doesn’t work for me, but I don’t want to be pregnant. Is there anything else I can do?


The birth control pill is the most common reversible form of birth control, but there are also many reasons the birth control pill is not right for everyone (whether you have medical conditions like high blood pressure, prior blood clots, or have a difficult time taking the pill every day). Even if the pill does not work for you, there are still many excellent options for birth control available.

The most effective birth control methods are long acting reversible contraceptives which include the implant (Nexplanon) and intrauterine device (IUD). These birth control methods are over 99% effective and methods that your doctor can help you get. After you get these methods placed, you do not have to worry about birth control for 3-10 years.

  • The Nexplanon is an implant that sits under the skin of your arm. It is about the size of a matchstick and the main side effect is irregular bleeding (most of the time it is similar to the number of days of bleeding for your normal period or less, but some people have more bleeding). The implant can be placed during an office visit, and the area is first numbed with numbing medication. Once placed, it is effective for 3 years (and many new studies show that it is effective for 4 years).

  • Intrauterine devices (IUDs) either have a low dose hormone (a progestin) or are hormone-free with copper. Both are small, T-shaped, and require a pelvic examination for placement by your doctor. The IUD sits inside your uterus and although you may have some cramping during placement or for the first few days, you should not feel the IUD afterwards.

  • The hormonal IUD releases a low dose progestin (levonorgestrel) which causes irregular bleeding, but most of the time the bleeding is lighter than your normal period and some women stop having periods with the hormonal IUD. The hormonal IUD is effective for 3-7 years based on the type of IUD you get.

  • The copper IUD is hormone-free. So you will still have normal, monthly periods, but you may have heavier bleeding or more cramping with periods. The copper IUD is effective for 10 years.

Another option for birth control is the depo-provera injection (the shot). You would have to return every 3 months for a shot. The main side effect is irregular bleeding, which may mean heavier bleeding especially in the first 6-12 months. The depo-provera shot is also associated with weight gain and changes in appetite. The shot is about 95% effective.

There are other methods similar to the pill such as the patch (which you can change out every week) or the vaginal ring (which can be changed out once a month) which may be more convenient. These methods are over 90% effective.

There are other methods such as the male condom, female condom, or diaphragm which you can use every time you have intercourse. Or you can choose abstinence.

Will birth control make me gain weight? The only birth control method that is associated with weight gain is depo-provera (the 3 month shot). The other methods of birth control are not associated with weight gain.

Can I get an IUD even if I haven’t had a baby yet? Yes.

Which birth control methods protect against sexually transmitted diseases? Only barrier methods of birth control – condoms, protect against sexually transmitted diseases. So even if you are using an effective form of birth control, you will need to use condoms for protection from sexually transmitted diseases.

What if I have more questions about birth control? You can go to www.bedsider.org for additional information and explore the different birth control options available. You can also schedule an appointment with your doctor to talk about the best birth control method for you.

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