Minimizing Birth Control Side Effects

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.

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:

• Alesse
• Estrostep FE
• Levlen
• Loestrin 1.5/30
• Loestrin 1/20 Fe
• Ovral

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.

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.

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.

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.