What is a good birth control pill?

Recommended Birth Control Pills

For most women seeking contraception, a monophasic combined oral contraceptive pill containing 30-35 μg of ethinyl estradiol with levonorgestrel or norgestimate is the recommended first-line option due to its optimal balance of efficacy, safety, and side effect profile. 1

First-Line Recommendations

• Monophasic combined oral contraceptive pills (COCs) containing 30-35 μg ethinyl estradiol with either levonorgestrel or norgestimate provide an excellent balance of effectiveness and safety 1, 2
• These formulations have extensive long-term safety data and are considered first-line options by major medical organizations 1
• These options are associated with lower risk of venous thromboembolism compared to newer progestins 3
• Pills in this category have a failure rate of less than 1% with perfect use, though typical use failure rates are higher 2

Benefits Beyond Contraception

• COCs provide numerous non-contraceptive benefits including decreased menstrual cramping and blood loss 1
• They can improve acne and provide protection against endometrial and ovarian cancers with more than 3 years of use 1
• Regular, predictable menstrual cycles are achieved with standard 21/7 regimens (21 active pills followed by 7 inactive pills) 2

Safety Considerations

• While COCs increase the risk of venous thromboembolism (VTE) three to fourfold (from 1-5 per 10,000 woman-years to 3-9 per 10,000 woman-years), this risk is still significantly lower than pregnancy-associated VTE risk 3, 2
• Pills containing drospirenone may have a higher risk of blood clots compared to those containing levonorgestrel 3
• Absolute contraindications include history of blood clots, stroke, heart attack, certain types of migraines with aura, uncontrolled high blood pressure, liver disease, and breast cancer 3
• Smoking in women over 35 years is a contraindication to combined hormonal contraceptives 3

Alternative Options for Special Situations

• For women who cannot take estrogen (due to medical contraindications or side effects), progestin-only pills are an option, though they require very strict adherence to timing 2
• For women who frequently miss pills, consider long-acting reversible contraceptives like IUDs or implants, which have higher effectiveness in typical use 1
• Emergency contraception options include ulipristal acetate (most effective oral option), levonorgestrel, and copper IUDs (most effective overall) 4, 2

Managing Common Side Effects

• Breakthrough bleeding is common in the first 3 months of use and often improves with time 2
• Nausea, breast tenderness, and headaches are common transient side effects that typically resolve within the first few months 3
• If side effects persist beyond 3 months, consider switching to a different formulation 2

Proper Usage Guidelines

• Pills should be taken at approximately the same time each day 3
• If one pill is missed (<24 hours late), take it immediately and continue the regular schedule with no backup needed 1
• If more than one pill is missed or pills are >24 hours late, take the most recent missed pill immediately, continue the regular schedule, and use backup contraception for 7 days 1, 3

Pitfalls to Avoid

• Avoid substituting brand-name low-dose pills with generics without considering potential differences in bioavailability, which could affect efficacy and increase breakthrough bleeding 5
• Be aware that certain medications, particularly some antibiotics and anticonvulsants, can reduce contraceptive efficacy 3
• Recognize that the effectiveness of combined hormonal contraceptives depends heavily on consistent and correct use 1

By following these recommendations and considering individual risk factors, most women can safely and effectively use combined oral contraceptives for pregnancy prevention while enjoying additional non-contraceptive benefits.