With so many different brands and types of birth control pills, it can be tough to find the best birth control pill for you. After all, everyone’s body is different, and your medical history and what you’re hoping to use the pill for will help inform which birth control is best for you.
We’ve compared the different types of birth control and their advantages and disadvantages as well as popular brands of the pill so you can better understand which pill might be right for you.
Types of birth control pills
All oral contraceptive pills contain synthetic hormones in them, but not every pill is made equal. There are different types of estrogen and progestogen and various combinations of each that comprise different brands and types of birth control pills.
- Combination pills - contain a blend of both estrogen and progestogen hormones
- Progestogen-only pills (the mini pill) - contain just progestogen hormones
- Extended cycle pills - contain a blend of both estrogen and progestogen hormones, but are designed to extend the menstrual cycle so you’ll get periods less often
- Low dose pills - available as both combination and progestogen-only pills, but contain a lower dose of hormones than their regular counterparts
What is the best birth control pill?
There is no one answer to this question because everyone’s body is different. That’s why in order to find the best birth control pill for you, you’ll need to review your medical history and needs with a doctor who can help identify which types of hormonal birth control make sense for you to try. Many women will try a few different brands and types of pills before finding the one they like best.
Combination birth control pills
Combination pills have both estrogen and progestogen in them. In general, most combined pills will have ethinylestradiol for its estrogen component in the doses of 20 mcg, 30 mcg, 35 mcg and 50 mcg. There are many different types of progestogens available including levonorgestrel, norethisterone, drospirenone and cyproterone.
How does the combined pill work?
The typical combined pill comes in a pack of 28 pills (21 “active” pills and 7 “inactive” pills for the week of your period) or 21 pills. If you have 21-day packs, you don’t take any pills for 7 days at the end of the pack during your period week.
The combined pill is taken orally once per day at the same time everyday. It works by stopping ovulation from happening during a monthly cycle, thickening cervical mucus to prevent sperm from entering the womb and thinning the uterine lining to make it difficult for eggs to implant into the uterine wall.
Advantages of the combination pill
With perfect use, the combined pill is 99% effective at preventing pregnancy. Perfect use means taking it at the exact same time every single day. However, the way most normal women take it reduces its efficacy down to about 92%.
Beyond preventing pregnancy, the combination pill also helps with:
- Managing hormonal acne - certain combination birth control pills can be used to manage acne. The hormones in the pill help counteract overproduction of androgens that cause acne.
- Regulating your period - most combination birth control pills have a 21 to 28 cycle length, meaning you’ll start your period at a predictable, consistent time every month.
- Milder, less painful periods - because combined pills thin the uterine lining, there is less buildup to be shed each month, making your period lighter. The hormones also help reduce the prostaglandin chemicals that cause your uterus to contract, minimising pain and cramping.
- Reducing risk of ovarian cysts and cancer - a study in Denmark found that women who used combined hormonal contraceptives had a reduced risk of developing ovarian cancer. It has also been shown to reduce the risk of endometrial and bowel cancer.
- Managing PCOS symptoms - PCOS (polycystic ovary syndrome) is a common condition that could cause irregular periods and hormonal acne. The combined pill can help manage these symptoms of PCOS.
Disadvantages and side effects of the combination pill
While many women find success with the combined pill, there are a few disadvantages and side effects to be aware of, including:
- Breakthrough bleeding or spotting
- Breast tenderness
- Weight gain
- Health risks for smokers - smoking while taking the pill increases the risk of blood clots, strokes and heart attacks
- Potential increased risk of breast and cervical cancer
Popular brands of the combined pill
Because there are different types of estrogen and progestogen that can be used in the combined pill, there are many different options and combinations to try. Talk to your doctor about your medical history, lifestyle and goals to find the best combined pill for you.
Some popular brands of the combined pill in Australia are:
- Levlen ED
- Estelle-35 ED
- Lenest 30
- Brenda-35 ED
- Diane-35 ED
- Micronelle 20
The mini pill (progestogen-only)
The mini pill only has progestogen instead of a combination of both estrogen and progestogen. In Australia, the only option of progestogen for the mini pill is levonorgestrel.
How does the mini pill work?
The progestogen-only mini pill comes in a continuous 28 day pill pack. There are no inactive pills, meaning you have to continuously take the progestogen pill every single day. Withdrawal bleeding (your period on the pill) while taking the mini pill can occur erratically with no specific pattern.
Like the combined pill, the mini pill is taken orally once per day at the same time each day. However, it’s much more finicky in its administration and only has a short 3 hour window for you to take the pill before it is considered missed. For comparison, the combined pill has a window of 24 hours before it is considered missed. That’s why it’s super important for women on the mini pill to take it at the exact same time every day to avoid risking getting pregnant.
The mini pill works by thickening the cervical mucus to make it more difficult for sperm to enter the uterus and thinning the uterine lining to prevent implantation. In some women, it also prevents the ovaries from releasing eggs.
Advantages of the mini pill
Like the combined pill, the mini pill is extremely effective at preventing pregnancy when taken perfectly - 99% effective. However, the way most women take it reduces the effectiveness rate down to 92%.
Other advantages of the mini pill for birth control include:
- Fewer estrogen-related side effects - estrogen can contribute to some common side effects of the pill, such as headaches, nausea and fluid retention. If you are sensitive to estrogen, taking a progestogen-only pill could be a good option.
- Lower risk of cardiovascular side effects - while all birth control pills come with a slight risk of causing blood clots of stroke, the risk is lower with a progestogen-only pill than it is with a combined oral contraceptive. If you have a history of blood clots or migraine headaches with visual aura, it’s recommended that you take the progestogen-only contraceptive pill.
- Safer breastfeeding - the mini pill is often prescribed for women who have just given birth and are actively breastfeeding but want to be back on birth control. Because there is a lower dose of hormones in the mini pill compared to the combined pill, it typically doesn’t affect your breast milk. Combined pills that contain estrogen also lower the milk supply and so are not recommended during breastfeeding.
Disadvantages and side effects of the mini pill
The mini pill is generally safe to use, but there are a few disadvantages and side effects for this method of birth control to be aware of, like:
- Higher risk of pregnancy if you take a pill late (you have about a 3 hour window to take your pill, otherwise you’ll need to use backup protection for 3 days and continue taking your pill as normal)
- No impact on improving hormonal acne
- Breast tenderness
- Decreased sex drive
- Irregular menstrual bleeding
Popular brands of the mini pill
In Australia, there are a few brands of mini pill available with different synthetic progestogen hormones. Your doctor will be able to prescribe the best pill for you based on your medical history and needs.
The only brand of mini pill available in Australia is Microlut.
Extended cycle pills
Extended cycle birth control pills are combination pills that have both estrogen and progestogen in them. They are designed to have a longer-than-normal cycle length, meaning that you won’t get your period as often as you normally would. Some extended cycle pills will only give you one period every three months.
How does the extended cycle pill work?
The extended cycle birth control pill is taken orally once per day at the same time everyday. The difference between these pills and the regular combined pill is the extended cycle pill pack will have 91 days worth of pills: 84 “active” pills and 7 sugar pills for the week of your period.
Advantages of the extended cycle pill
Like other birth control pills, the extended cycle pill is 99% effective when used perfectly, but drops down to around 92% when used “normally.” Beyond that, the most obvious advantage of the extended cycle pill is that you will only get your period 3 or 4 times per year instead of 12. You may also experience lighter and shorter periods when you do get them.
This is a huge draw for women who have intense period pain, cramps or menstrual headaches as you’ll reduce the number of times you get your period in a year.
Disadvantages and side effects of the extended cycle pill
Because extended cycle pills are a type of combination pill, you may experience similar side effects such as:
- Breast tenderness
- Weight gain
You may also experience spotting and breakthrough bleeding between periods.
Popular brands of the extended cycle pill
The only available brand of extended cycle pill in Australia is Seasonique.
Low dose pills
As the name suggests, low dose birth control pills contain a lower dose of hormones than their regular counterparts. They are just as effective in preventing pregnancy, but are believed to cause fewer side effects.
How does the low dose pill work?
As a combination pill, but with lower doses of hormones than regular combined pills, they work in the same way: preventing ovulation, thickening the cervical mucus to keep sperm from reaching an egg and thinning the uterine lining to make it tough for a fertilised egg to implant. You take it orally at the same time every single day.
Advantages of the low dose pill
When used perfectly, the low dose pill is also 99% effective at preventing pregnancy. When taken as most women do, this rate drops to 92%.
Other advantages and reasons why a doctor might prescribe a low dose pill include:
- Reduced estrogen-related side effects - because there is a lower dose of estrogen than in a regular combined pill, there is a lower chance of experiencing estrogen-related side effects like headaches and fluid retention
- Lessened menstrual cramping and period pain - in the same way a higher dose pill works to reduce period pain by lowering the amount of prostaglandin chemicals that cause your uterus to contract, the low dose pill helps minimise pain and cramping from your cycle.
- Managing hormonal acne - the hormones in the low dose pill help counteract overproduction of androgens that cause hormonal acne.
Disadvantages and side effects of the low dose pill
As with most medications, there are some potential side effects. Most of the potential side effects are similar to ones that you might experience on a higher dose combined pill, like:
- Spotting between periods
- Slight risk of increased blood pressure
- Slight risk of blood clots
Popular brands of the low dose pill
There are many different brands of low dose pills available in Australia, including:
- Microgynon 20
- Femmetab 20
Everyone’s body is different, and you might try a few different brands and types of birth control pills before you find your favourite. Talk to your doctor about your medical history, lifestyle and goals with the pill and they will be able to recommend and prescribe the best birth control for your needs.
If you’re already on the pill, you can get your brand delivered for free anywhere in Australia. With Rosemary’s subscription pill service, you get an annual doctor consultation, the same low pharmacy prices and your favourite brand of birth control pill delivered straight to your door. Get a Rosemary membership today and never miss a pill again.
- Australian Family Physician (October 2002) - Oral contraceptives
- BMJ (July 2018) - Association between contemporary hormonal contraception and ovarian cancer in women of reproductive age in Denmark: prospective, nationwide cohort study
- National Museum of Australia (April 2020) - The Pill
- Cleveland Clinic (July 2020) - Birth Control: The Pill