By Vian Nguyen, MD, FACOG, an OB/GYN, and Medical Advisor to the Rowan Foundation

photo of Vian Nguyen, MDSelecting a contraceptive method is highly individualized because no single approach is universally appropriate. Factors such as medical history, genetic predisposition, future reproductive plans, lifestyle, comfort, and personal preferences all influence the optimal choice. Therefore, informed discussions with a healthcare provider are essential.

Overview of Hormonal Contraception

Hormonal contraception uses exogenous hormones, which are hormones from outside the body, to prevent pregnancy. Depending on the method, these hormones may inhibit ovulation, thicken cervical mucus, or alter the uterine lining. Common hormonal methods include oral contraceptive pills, transdermal patches, vaginal rings, injectable formulations, subdermal implants, and certain intrauterine devices (IUDs).

Hormonal contraceptive methods differ in their composition. Some formulations contain both estrogen and progestin, while others are progestin-only. Combined hormonal methods are commonly prescribed for many women, whereas progestin-only options are often recommended when estrogen is contraindicated or when specific risk factors, such as risks for blood clots, are present. However, interest in nonhormonal birth control has grown among people who want to avoid hormones, cannot use estrogen safely, or prefer options that better fit their personal needs and family-planning goals.

Hormone dosages vary widely across contraceptive methods, especially among oral contraceptive pills. Combined oral contraceptives contain both estrogen and a progestin, and available formulations use different hormone types and dose levels.

Patient-Centered Reproductive Care

female patient consulting with female doctorMany modern or newer-generation contraceptive pills contain lower doses of estrogen than earlier generations. Lower-dose formulations may be appropriate for some women based on their health profile, tolerance of side effects, cycle-control needs, and therapeutic goals, although individual trade-offs, such as breakthrough bleeding or symptom control, may also be considered.

Contraceptive choice should be personalized through shared decision-making with a healthcare provider, taking into account medical history, preferences, effectiveness, and risks. The American College of Obstetrics and Gynecology recommends patient-centered contraceptive counseling to help patients obtain methods that best align with their values and needs.1

Overview of Nonhormonal Contraception

Nonhormonal contraception does not use hormones. Available options include copper intrauterine devices (IUDs), condoms, diaphragms, fertility awareness-based methods, and permanent contraception for individuals certain they do not want future pregnancies.

Many women are interested in nonhormonal options due to personal preference, concerns about side effects, or specific medical considerations.

Hands,Holding,Contraceptives,,A,Collage,In,The,Style,Of,PopBenefits and Considerations of Contraceptive Methods

Hormonal contraceptive methods may be prescribed for use beyond pregnancy prevention, including menstrual cycle regulation, reduced menstrual bleeding, alleviation of dysmenorrhea, improvement in acne, and management of certain gynecologic conditions. Conversely, some individuals may avoid hormonal methods due to personal preference or medical contraindications.

Nonhormonal methods may be preferred by individuals seeking to avoid hormones or by those who favor barrier-based or long-acting contraceptive options. Contraceptive methods vary substantially in effectiveness. Long-acting reversible contraceptives (LARCs), including hormonal and copper IUDs and contraceptive implants, have failure rates of less than 1% with typical use, while condoms and fertility awareness-based methods have higher typical-use failure rates due to user variability.

Blood Clot Risk Associated with Contraception

When considering contraceptive options, the risk for blood clots is an essential part of the conversation. According to the CDC Medical Eligibility Criteria and ACOG guidance, combined estrogen-containing contraceptives are associated with an increased risk of venous thromboembolism (VTE), particularly among individuals with additional risk factors such as smoking, migraine with aura, inherited thrombophilia, obesity, or age over 35. 

Although combined hormonal contraceptives are associated with an increased relative risk of venous thromboembolism, the absolute risk remains low for most healthy reproductive-age women. Pregnancy and the postpartum period are associated with substantially higher clotting risk than contraceptive use. Personal and family history, smoking status, migraine history, age, and other health factors can all affect which options might be safest. With that said, it’s important all patients understant that there are options including hormonal vs non-hormonal. 

Evolving Preferences and the Future of Nonhormonal Birth Control

Contraceptive preferences have shifted in recent years. National survey data indicate that many individuals use a combination of methods over time, and interest in long-acting reversible contraception, permanent methods, and nonhormonal options remains substantial.1  These trends reflect the dynamic nature of reproductive needs and priorities throughout life.

Ongoing research into nonhormonal contraceptive technologies reflects continued demand for expanded contraceptive choice and individualized care. Researchers are exploring new approaches, including nonhormonal vaginal gels, next-generation copper IUD designs, and other targeted methods under development to improve convenience, tolerability, and patient choice.2 

When discussing contraception with a healthcare provider, women may find it helpful to ask:

  • Which options best match my medical history, family health history, and lifestyle?
  • Are there any clotting risks or other concerns I should be aware of?
  • What side effects are common with this method?
  • How effective is this option with typical use?
  • How easily can I stop or switch methods later?
  • Are there nonhormonal alternatives that may work for me?
  • What benefits beyond pregnancy prevention might this option offer?
Making an Informed Contraceptive Choice

The most important consideration is choosing the option that aligns with your individual needs, rather than relying on what has worked for others. Engaging in a thorough discussion with a qualified healthcare provider can facilitate a comprehensive review of your health history, an assessment of benefits and risks, and the identification of options that align with your goals and preferences.

At the Rowan Foundation, we encourage women to seek reliable information and to feel empowered to ask questions.

To learn more, check out the Foundation’s educational resources about hormonal and nonhormonal contraception, women’s health, and informed decision-making.  
Read more and access downloadable resources about contraception decision-making here.