Minimizing Birth Control Side Effects

How to choose the right birth control pill for you

With so many combination birth control pills available, how do you know which to use? Most are equally effective, so the best choice for you will likely come down to which is likely to produce no (or very few) side effects.

The healthcare provider who prescribes your contraceptive will be your ultimate guide, but it's always wise to be as informed as possible about any drug you take.

In this guide to making an informed decision about which birth control pill is best for you, you'll find a review of the differences between the types of pills, the potential side effects of each, and more.

Woman opening her package of birth control pills
PhotoAlto / Antoine Arraou / Getty Images

Choosing a Birth Control Pill

Combination hormonal contraceptives contain a synthetic estrogen (to stabilize the endometrium and reduce unwanted spotting) and a progestin (for its contraceptive effects). Knowing the differences between the progestins and about estrogenic effects, androgenic effects, and progestational selectivity can help you choose a pill with minimal side effects. 

To briefly explain how the combination of these activities may cause side effects, let's look at some specific combination of birth control pills.

Oral contraceptives that tend to have high androgenic effects and low estrogen activity, for example, are more likely to cause unwanted hair growth and acne side effects. Additionally, a progestin with higher androgenic effects may tend to produce less breast tenderness, bloating, and mood changes.

It is important to remember, though, that the majority of people using a pill with this combination do not end up developing acne; this side effect is more likely to occur in those who have a tendency toward androgenicity. Birth control pills containing this high androgenic/low estrogenic pattern include:

Since there are different types of progestins, they each have different potency in terms of progestational, estrogenic, and androgenic effects. The result of these effects is dependent on the combination of the type and levels of progestin and estrogen.

Typically, the balance (or ratio) between the estrogen and progestin in a pill brand may play a role in the side effects you are experiencing. Each person may respond differently to these components.

Also, the type of pill you may be using (monophasic/biphasic/triphasic or extended cycle) may help alleviate certain side effects. Because of that, please note that the following are general guidelines, and may not apply to all people.

To be a little more technical, in order to determine the total combination of these three effects, a person needs to multiply the actual dose of these three components (effects) times the relative potency of that component in order to classify a birth control pill brand as having high androgenic effects, being estrogen dominant, or progestin dominant.

Given the complexity of figuring this out on your own, the decision as to which birth control pill to use should be discussed with your healthcare provider. You can use this information to begin a conversation with your healthcare provider about which pill type may be best for you.

Give the pills you are currently taking a fair trial of at least two to three months. If you have switched your pill brand, you should also give the new ones a two- to three-month trial. It often takes a few months just for your body to adjust to the new hormones in your birth control pill.

Choices to Minimize Side Effects

The following chart is a relative classification, so it may not apply to every person. When choosing a combination birth control pill, you may be able to minimize side effects by switching to (or initially picking) a pill brand suggested in the below chart based on which side effect you are trying to lessen or alleviate.

Side Effect (Problem) Progestin/Estrogen/Androgenic Effects Try Using These Pill Brands to Minimize the Side Effect
Acne higher estrogen, lower androgen potency Demulen 1/50, Brevicon, Mircette, Modicon, Necon, Ortho-Cyclen, Ortho-TriCyclen, Yasmin
Breakthrough bleeding (spotting) higher estrogen, higher progestin potency, lower androgen potency Demulen 1/50, Desogen, Ortho-Cept, Ovcon 50, Yasmin, Zovia 1/50E, Estrostep FE**
Breast soreness lower estrogen, lower progestin potency Alesse, Levlite
Depression lower progestin potency Alesse, Brevicon, Levlite, Modicon, Necon 1/35, Ortho-Cyclen, Ortho-TriCyclen, Ovcon 35,Tri-Levlen, Triphasil, Trivora
Endometriosis or endometriosis prevention lower estrogen, higher progestin potency, higher androgen potency Demulen 1/35, Levlen, Levora, Loestrin 1.5/30, Loestrin 1/20 Fe, LoOvral, Nordette, Zovia 1/35E (used either continuously with no days of placebo pills or with only 4 days of placebo pills for prevention)
Headaches (not menstrual migraines) lower estrogen, lower progestin potency Alesse, Brevicon, Levlite, Modicon, Necon 1/35, Ortho-Cyclen, ​Ortho-TriCyclen, Ovcon 35, Tri-Levlen, Triphasil, Trivora
Moodiness or irritability lower progestin potency Alesse, Levlite, Loestrin 1/20 Fe, Yasmin, Yaz, Beyaz (or any pill with less estrogen than currently on)
Severe menstrual cramps higher progestin potency Demulen 1/35, Demulen 1/50, Desogen, Mircette, Loestrin 1.5/30, Ortho-Cept, Yasmin, Zovia 1/35E, Zovia 1/50E
Weight gain lower estrogen, lower progestin potency Alesse, Levlite, Loestrin 1/20 Fe, Yasmin, Yaz, Beyaz (or any pill with less estrogen than currently on)

Estrostep FE contains the progestin norethindrone acetate (this progestin typically has a higher androgen potency). Therefore, although Estrostep FE follows more of a high androgenic/low estrogenic pattern, this brand is a triphasic pill that was actually designed to help prevent breakthrough bleeding while attempting to keep hormone exposure as low as possible.

Estrostep FE is a good example as to why the information in this chart should be viewed more in terms of being general guidelines, and may not always hold from one woman to another.

A Word From Verywell

Remember, every person could react differently to specific birth control methods, so this information is meant to be a general overview. Also, it is important to point out that the main reason to use hormonal birth control is for contraception (to prevent an unintended pregnancy).

Considering potential non-contraceptive benefits of birth control, as well as unwanted side effects, can be part of the discussion you have with your healthcare provider when determining which hormonal method may be best suited for you.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Darney PD. OC practice guidelines: minimizing side effects. Int J Fertil Womens Med.

  2. Salvaggio HL, Zaenglein AL. Examining the use of oral contraceptives in the management of acneInt J Womens Health. 2010;2:69–76. doi:10.2147/ijwh.s5915

  3. Peters C, Burrows M. Androgenicity of the progestin in oral contraceptives does not affect maximal leg strength. Contraception. 2006;74(6):487-91. doi:10.1016/j.contraception.2006.08.005

  4. Cooper DB, Mahdy H. Oral Contraceptive Pills. In: StatPearls [Internet].

Additional Reading
  • Jelovsek, R. Which Oral Contraceptive Pill Is Best for Me?

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.