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What’s the difference between natural and hormonal birth control? Experts explain

Natural birth control works for those with regular periods who are diligent about tracking their cycles. Experts pros and cons of the birth control methods.
Natural birth control involves careful tracking of one's menstrual cycle and taking basal temperature every morning. For those with regular cycles and attention to detail, it can work.
Natural birth control involves careful tracking of one's menstrual cycle and taking basal temperature every morning. For those with regular cycles and attention to detail, it can work.Mohammed Haneefa Nizamudeen / Getty Images/iStockphoto

On TikTok, loads of people share videos talking about natural contraception and the dangers of birth control. It seems overwhelming to understand what natural birth control is, if there’s a problem with hormonal birth control and what the options are for people who do not want to get pregnant.

“It boils down to this idea that birth control is not natural,” Dr. Jennifer Lincoln, an OB-GYN and author of “Let’s Talk about Down There: An OB-GYN Answers all Your Burning Questions … Without Making You feel Embarrassed for Asking,” told TODAY. “Every few weeks or months, there’s some influencer who goes, ‘Oh my goodness, did you know our birth control isn’t natural?’ And what they’re really often saying is that it’s severing the brain/body connection.”


But that's an oversimplification of what birth control is and can do. Here, experts discuss the various forms of birth control and the pros and cons of each — and encourage people to speak with their doctors instead of relying on TikTok opinions.

“Birth control is probably one of the most well-researched medications that we have. It’s not something we just developed yesterday,” Lincoln said. “The forms we currently know were developed in the 1960s and, since then, have been really changed and the dosages are a lot lower. But these are a class of medications that are extremely well-studied.”

Hormonal birth control: The pill, the patch, the ring and the shot

The birth control pill — often called simply “the pill” — is probably what many think of when considering birth control. Doctors prescribe one of two types, a combination pill or a progesterone only pill.

“There are your traditional regular birth control pills, which are called combined oral contraception. Combined, meaning the pill has both estrogen and progestin in it,” Dr. Staci Tanouye, an OB-GYN in Florida, told TODAY. “There’s progesterone-only pills, which are just progestin, no estrogen.”

A person’s health history often indicates what pill works best for them. People with certain conditions, such as high blood pressure, a history of blood clots or who are those breastfeeding cannot take pills with estrogen, according to the American College of Obstetricians and Gynecologists.

Both types of pills prevent pregnancy by stopping ovulation. While the pill prevents pregnancy if used correctly, it also has some other beneficial side effects, including reducing the length or eliminating periods — and the combined pill can reduce acne, Tanouye said. The pill also helps treat symptoms of conditions, such as polycystic ovarian syndrome (PCOS), endometriosis and premenstrual dysphoric disorder (PMDD), she said.

“We have to remember that 50% of people on hormonal birth control of some sort are on it for non-contraception purposes, such as painful periods, heavy periods, long periods, regulation of timing of periods,” Tanouye explained. “Combined oral contraceptives can also help improve skin because of the way it can decrease testosterone in the body.”

People sometimes feel wary about using birth control because it has been associated with an increased risk of breast cancer, Lincoln said. It does represent a slight increase in the occurrence of breast cancer in some, she said, but it can also protect people from other cancers.

“Birth control can actually be protective against cancer. The one that’s the most striking is the risk of ovarian cancer. Your risk decreases about 20% with every five years of use and the longer you use it, that protection is even higher,” Lincoln said. “You also see your risk of cancer of the uterus decrease by about half, colorectal cancer decreased about 20%. These are medications that we actually use to prevent cancer for some people who are at higher risk.”

Some people use a patch or ring as birth control instead of taking a pill, but they work the same as taking a pill. The delivery method just differs.

The most common complaint about birth control is that it causes weight gain, but the experts said research finds that’s not true.

“The largest most recent studies show either zero — or even negative one or two pounds — and I always remind people that’s the average,” Tanouye said. “There’s going to be a small percentage of people that will notice (weight gain) because of how their body reacts to whatever hormone that we’re giving them. So, it’s not that weight gain never happens. It can but it’s a lot less frequent than people think.”

The shot, Depo-Provera, is an injection of progestin that offers long lasting birth control as well. Of all the birth control methods, it can cause a delay in fertility for a few months, Tanouye said, but it is temporary.

IUDs

Like the pill, IUDs can be hormonal or non-hormonal. The non-hormonal IUD is a copper coil that’s inserted into uterus and makes it “inhospitable to sperm.”

“The sperm are not modal in that sort of environment within the uterus because of the reaction of what the copper does to it,” Tanouye said. “The sperm should not be able to move up to the tube and ever meet an egg.”

People using copper IUDs still experience their periods as usual because there are no hormones introduced into the body. Some people report heavier bleeding or more cramps, but it depends on the person, Lincoln said.

“It can increase the flow of your periods or make them more crampy,” she said. “So not everybody loves them.”

Still, it has many benefits.

“It’s over 99% effective. It’s a fantastic form of birth control. It has no hormones, completely reversible, good for over a decade,” Lincoln said. “For those people who do really want to have a good reliable form of birth control with no hormones, it is a great option.”

The hormonal IUDs have progestin on them and while they prevent pregnancy, they’re also used to treat heavy bleeding and pain.

“The progestin that’s in it can significantly decrease the amount of bleeding people have with their periods,” Tanouye said.

The progestin IUD works by transforming the cervical mucous so that the sperm can’t reach the egg.

“It thickens up cervical mucous so sperm either can’t get up the cervix, it changes the uterine environment a little bit so sperm aren’t as mobile and so they can’t get up to meet the egg,” Tanouye said.

The progestin on the IUD mostly stays in the uterus but the body does absorb a small amount.

“A lot of people won’t get the same hormonal side effects because the effective dose of progestin in your whole body is significantly lower than in a pill,” Tanouye said.

Natural birth control

This form of birth control involves tracking menstrual cycles and basal temperature, which is one’s at-rest body temperature, to know when they’re ovulating so they don’t have sex during that time and, in theory, prevent pregnancy.

“You have to make sure you’re having regular periods and you’re able to check your temperature before you get out of bed,” Lincoln said. “It’s ideal if you can track your cycles for a few months before you use it as birth control to understand when you are ovulating.”

According to the Mayo Clinic, ovulation causes body temperature to rise slightly. Natural birth control doesn’t work well for people who have irregular menstrual cycles and can be tricky to follow.

“It is effective for someone who is very diligent about tracking and very much aware of their symptoms and has nice regular periods. It can be effective if you are very on top of it and committed to doing that and tracking every single day,” Tanouye said. “It’s not as effective as other methods.”

For people who do not have regular cycles or aren’t mindful about tracking, it’s not great at preventing pregnancy. Also, people need to feel confident they’ll be OK to skip having sex.

“You need to be able to abstain from sex,” Lincoln said. “If you don’t have an understanding partner, it might be difficult and you’ve got to understand that if you don’t use it as directed the failure rates are not insignificant.”