Hormonal contraceptives: what works, risks, and how to pick

Hormonal contraceptives are the most common way to prevent pregnancy, but they vary a lot. Some are pills you take every day, others are implants, injections, patches, rings, or intrauterine devices. Many people get clear benefits like lighter periods and reduced cramps, but side effects and health checks matter. This guide gives straight answers so you can ask your clinician the right questions.

Quick facts and types

Combined oral contraceptives contain estrogen and progestin. They stop ovulation and are very reliable when taken daily. Progestin-only pills, implants (like Nexplanon), hormonal IUDs (like Mirena), the shot (Depo-Provera), the patch, and the vaginal ring work mainly by thickening cervical mucus and thinning the uterine lining; some also stop ovulation. Hormonal IUDs and implants are long-acting and low-maintenance; pills, patch, and ring need more routine.

Effectiveness: implants and hormonal IUDs are over 99% effective. Pills, patch, and ring are about 91% typical use because of missed doses. The shot is around 94% but can delay return to fertility for months after the last dose.

Risks, interactions, and practical tips

Common side effects include nausea, breast tenderness, spotting, mood changes, and headaches. Serious risks are rare but include blood clots linked to estrogen. The risk rises for people over 35 who smoke and for those with a history of clots or certain types of migraine. Tell your clinician if you smoke, have high blood pressure, or a clotting disorder.

Drug interactions matter. Enzyme-inducing drugs like rifampin and many seizure medicines can lower effectiveness. Herbal remedies like St. John’s wort may also interfere. If you take antibiotics only rifampin is known to matter; most short courses like azithromycin do not lower effectiveness. Always list your medicines before you get a prescription.

Missed dose rules differ. If you miss one combined pill, take it as soon as you remember. If you miss two or more, follow your pill’s leaflet, use a backup method for seven days, and consider emergency contraception if you had unprotected sex. For progestin-only pills, timing is stricter—missing by a few hours can reduce protection.

Want to get pregnant soon? Implants and IUDs reverse fertility quickly after removal. The pill and ring usually allow rapid return to fertility. The shot can take several months for cycles to normalize. If planning pregnancy, talk to your clinician about the best timing and method to stop.

Choosing a method comes down to risk factors, how reliable you want it to be, how often you want to think about it, and side effects you can live with. Bring a list of current medicines, your smoking status, and any history of clots or migraines to your appointment. If you're unsure, ask for a follow-up appointment after a trial month to check side effects and satisfaction.

If you notice sudden leg pain, shortness of breath, severe headache, or vision changes, seek urgent medical help. Keep a small contraception card with your method, start date and clinician contact and emergency number.