If you get a period, there’s a decent chance you’ve tried the birth control pill. In fact, a report published in National Health Statistics Reports found that four out of five sexually experienced women had been on the birth control pill at some point.
This is likely because birth control pills are one of the most effective forms of birth control, with a 99 percent efficacy rate with perfect use, according to Planned Parenthood.
The most recently published findings of the National Survey of Family Growth found that, after female sterilization, birth control pills were the most commonly-used form of contraception from 2015 to 2017.
In addition to preventing pregnancy, birth control pills can be used for people with polycystic ovary syndrome (PCOS), painful periods, acne, uterine fibroids, and endometriosis, according to Aimee Eyvazzadeh, MD, an OB-GYN.
Birth control pills contain artificial versions of the hormones estrogen and progestin, which work to prevent pregnancy in two main ways.
First, the pills level out the estrogen and progesterone in your body, so your ovaries don’t get the message from your brain to ovulate, or release an egg.
“Without ovulation, there’s no egg for sperm to fertilize, and pregnancy isn’t possible,” says Jennifer Conti, MD, an OB-GYN and medical advisor at Modern Fertility.
Secondly, birth control pills work by thinning out the lining of the uterus and thickening cervical mucus, two things that further prevent a potential pregnancy from forming.
Birth control pills may also help PCOS, painful periods, acne, uterine fibroids, and endometriosis by controlling estrogen and progesterone levels.
Types of birth control pills
- Monophasic. “These have the same amount of estrogen and progestin in each active pill in the pack,” says Kecia Gaither, MD, MPH, FACOG, a double board certified physician in OB-GYN and maternal fetal medicine.
- Biphasic. These change the level of hormones once within the pill pack. “The first half of the cycle, the progestin/estrogen ratio is lower. During the second half of the cycle, the progestin/estrogen ratio is higher,” Gaither explains.
- Triphasic. Three different doses of hormones are used in triphasic birth control pills, with the dose changing every 7 days, according to Gaither.
In terms of what’s most popular, monophasic pills are most commonly prescribed, Conti says. This is because they’re the most well-studied and generally well-tolerated.
“Triphasic pills came around as an attempt to try to decrease some side effects of birth control pills like vaginal spotting,” Conti adds. “There is no evidence to suggest that they are better at actually doing this or that they are more effective than typical pills.”
In all three types, there are usually 7 days of placebo pills, which don’t contain medication. Some birth control pills skip the placebos, instructing users to skip taking pills for 7 days. During the placebo or no-pill week, you get a withdrawal bleed, which is similar to having a period.
There’s also a special category of pills that contain progestin only, also known as the “minipill,” points out Eric Flisser, MD, a board certified reproductive endocrinologist and OB-GYN at RMA of New York.
“[Minipills] are available for women who are lactating, to avoid interfering with breast milk production. They can also sometimes be appropriate for [those] who shouldn’t be taking estrogen, but it may not be as effective compared to pills that contain both hormones,” he says.
These days, getting the birth control pill is relatively easy by getting a prescription from a healthcare professional, or from one of the many online birth control pill services.
Birth control pills are deemed safe for most people who have periods, according to the American College of Obstetrics and Gynecologists. In fact, the organization advocated to make birth control pills available over the counter in 2019. That hasn’t happened yet, but it might in the future.
“Hormonal pills, whether you use them for birth control, menstrual regulation, or other symptom control, are incredibly safe and effective,” Conti says.
“We have now 6 decades of high quality research to back it up, as well as safety organizations, like the World Health Organization and Centers for Disease Control and Prevention’s Medical Eligibility Criteria for Contraceptive Use (MEC),” Conti adds.
The MEC outlines which contraceptive options are safe for which medical conditions.
The biggest concern with combined birth control pills is deep venous thromboembolism or vascular blood clots, which can occur with added estrogen.
Risk of blood clots is part of the reason combined birth control pills are not recommended for those over 35 who smoke.
According to Planned Parenthood, people should avoid using combined birth control pills if they’ve had the following conditions:
- breast cancer
- blood clots, an inherited blood-clotting disorder, or vein inflammation
- migraine with aura
- uncontrolled high blood pressure
- advanced diabetes or liver disease
People should avoid the progestin-only pill if they’ve had the following conditions:
- breast cancer
- certain forms of lupus
According to the National Cancer Institute, observational research has shown that birth control pill use may increase risk of breast and cervical cancer, and decrease risk of endometrial, ovarian, and colorectal cancers.
But, as they point out, this research doesn’t establish that birth control pills cause or prevent cancer directly.
To select the best birth control pill services, we spoke to OB-GYNs for their recommendations.
“The ease of refilling a prescription is important, but so is the availability of expert advice, if needed, especially on an emergency basis,” Flisser says.
Services with easy access to doctors, nurses, and other health care professionals rank high.
We also read reviews for each service, noting positive and negative customer experiences. Lastly, we looked for services that are widely available and offer a range of different birth control pills.
Nurx is one of the most well-known birth control pill delivery services. In addition to the birth control pill, they also offer birth control in the form of the ring, shot, and patch.
In total, Nurx offers more than 100 different generic and name-brand contraceptive options.
To get a prescription for birth control pills, you need to have a consultation, where a professional will review your medical information and recommend a birth control pill that works for your needs.
If you’re taking advantage of the other services Nurx offers, they’ll provide a prescription for those as well.
The consultation costs $15 and isn’t covered by insurance. The consultation includes a year of free messaging with their medical team.
Nurx uses a subscription-based model. Once you sign up, you’ll get your birth control pills every 3 months — unless you cancel.
Overall, reviews for Nurx are very positive. Reviewers say using Nurx has made getting access to birth control so much easier. Many say it’s saved them money, since the copay to see a doctor for a prescription was higher than the $15 consultation fee.
Some reviewers say customer service doesn’t respond as speedily as they would’ve liked, but the positive reviews far outweigh the negative ones.
Nurx also provides a host of other services, including access to emergency contraception, acne treatment, and STI testing. Nurx operates in 30 states, plus Washington D.C.
Price: It varies, depending on whether you’re using health insurance or not, and which health insurance you have. If you don’t have health insurance, Nurx has options available from $15 per month.
Best for fun extras
The Pill Club
With over 120 different brands of birth control, The Pill Club has a ton of options to choose from.
After filling out a questionnaire on their site, The Pill Club’s medical team will work with you to pick the best birth control pill for you (if you don’t already have a prescription).
From there, they’ll ship you your birth control pill supply, and you can choose between a 1 or 3 month supply, depending on your insurance situation. (And, sometimes, you might be able to order a larger supply.)
Every delivery includes your birth control, a sample self-care product, a sweet treat, and a sticker. You can also add an internal condom or generic Plan B pill to your delivery.
One of the biggest advantages of The Pill Club is that they deliver to all 50 states and Washington D.C. (At the moment, they can only prescribe in 43 states.)
In terms of reviews, they’re mainly positive. Reviewers love that the questionnaire to get your prescription is fast and easy, and the medical team takes your preferences into account.
There are some negative reviews, mostly about people who are unhappy with the generic versions of the birth control pills they’re used to.
Price: If you have health insurance, your consultation and birth control pills are fully covered. If you pay out-of-pocket, The Pill Club offers pricing from $9 per pack for a 1-year supply, or $10.66 per pack for a 3-month supply.
Best for simplicity
If user experience and millennial-friendly packaging are important to you, Hers is a great option.
It’s also an ideal service if having way too many choices sounds stressful. Hers offers the birth control pill only, with 13 different generic types — so, if you need a specific name-brand pill, this is not the service for you.
Hers clearly labels each pill they offer by what it can help with besides contraception, such as PMS, heavy periods, and acne.
Similar to most other services on this list, the process starts with a questionnaire, which is reviewed by the Hers medical team.
From there, you’ll have a consultation where a professional will help you choose your best birth control pill. Plus, you can follow up with them to ask questions or make changes whenever you need to.
Hers is available in all states, and also sells other products you can add to your order, such as yeast infection treatments, condoms, and lube.
Reviewers especially like the convenience of being able to add other Hers products to their order. On the other hand, some reviewers say they had trouble canceling their subscription when they wanted it to end.
Price: Hers doesn’t accept health insurance, so you have to pay out of pocket. They offer plans as low as $12 per month, but some pills are more expensive than others.
Best for multiple prescriptions
Going beyond just birth control pill prescriptions, GoodRx Care (formerly HeyDoctor) can also prescribe meds for urinary tract infections, anxiety, depression, thyroid conditions, and more — all without insurance.
For a birth control prescription, you’ll start by filling out some forms. Then, you’ll chat with a doctor or nurse about your birth control needs. From there, they’ll write you a prescription, and you’re good to go.
GoodRx Care accepts insurance, but they also aim to make their services affordable without it.
When it comes to delivery, you can choose between picking up your birth control pills at a local pharmacy or having them delivered by mail in any state.
Reviewers say GoodRx Care is a great choice for anyone who needs birth control quickly and doesn’t have insurance.
People also love how fast the response time is, and how quickly they have their prescription in-hand. Some reviewers say they don’t like that they were charged extra for follow-up.
Price: The consultation costs $19, and prescriptions start at $15 per month without insurance.
Best for female doctors
Pandia Health is the only birth control delivery service that’s female-founded and led. Pandia Health was co-founded by Sophia Yen, MD.
If you have a prescription, just upload it, and you’re good to go. Otherwise, you’ll pay $20 for a doctor consultation.
In addition to birth control pills, they also offer the birth control patch and ring in all states.
With Pandia Health, you have unlimited access to their team of doctors (which is mostly women) for any questions or concerns you have about your birth control pills.
They’ll even check in with you periodically to see how your birth control is working. Your pill pack comes with some sweet treats, too.
Reviewers say Pandia Health is easy to use, super convenient, and, above all, affordable. People also note that customer service is extremely responsive and knowledgeable.
One reviewer says they received unwanted calls from the service after deciding not to purchase from them. But, overall, customer feedback is very positive.
Price: With insurance, most people pay $0. Without insurance, prices start at $15 per month, and delivery is free.
Best for unlimited doctor messaging
Currently available in 19 states, Twentyeight Health asks customers to fill out a questionnaire before having a quick consultation with one of their doctors via messaging or audio call.
Unlike some services on this list, the consultation with Twentyeight Health is free.
Once you’ve filled your prescription, you also get access to unlimited messaging with your doctor for any questions about your birth control.
The company offers birth control pills, patches, rings, and shots. With birth control pills, you can order up to a 12-month supply if you want to get your birth control for the entire year.
Many reviewers note that response time from doctors is quick, and that they’re very knowledgeable and caring. Others mention the budget-friendly pricing and smooth process from questionnaire to receiving their pills.
A couple of reviewers say their pills were sent to the wrong address.
Price: Twentyeight Health takes insurance (including Medicaid in some states). For some, their pills are $0 or the cost of their copay. Without insurance, prices start at $16 per month.
Best for giving back
If you’re looking for simplicity, PRJKT RUBY will check the box. Similar to Hers, they offer a limited range of generic birth control pills — 12 different options, to be exact. The company also offers a generic emergency contraception option.
PRJKT RUBY uses a video consultation as part of their prescription process, which is great for people who don’t know which pill they want or feel more comfortable talking to someone face-to-face before starting a new medication.
But what makes PRJKT RUBY really special is their charitable commitment. For each month of oral contraceptives purchased through PRJKT RUBY, a donation of 25 cents is made to support access to contraception in the developing world via the non-profit Population Services International.
Reviews for PRJKT RUBY are mainly positive, with people describing the process as totally seamless. On the down side, some reviewers say they had trouble navigating the website.
Price: $20 per month, with a minimum 3-month supply order.
Best for out-of-pocket payment
LemonAid offers way more than just birth control prescription services. They can help if you need to talk to a doctor about a wide range of health issues, including asthma, high blood pressure, and migraine.
For their birth control pill service, fill out a questionnaire, and one of their doctors or nurse practitioners will get back to you within a day. Depending on where you live, you might have to do a phone or video consultation.
The service’s pricing is very transparent. You can see exactly how much you’ll pay for a name brand pill versus the generic version. The platform allows you to browse options before making a final decision and filling your prescription.
In reviews, people say the service is so simple, it almost seems too good to be true. Most negative reviews revolve around not being able to switch from a generic pill option to a brand name without doing a separate doctor visit.
Price: LemonAid starts at $15 per month for a 3-month supply. If you have insurance and want to use it, LemonAid can send your prescription to a local pharmacy.