Your life is different, and so are your health risks.

Barbara Brody
September 10, 2018

Whether you're 15 or 50, one rule remains the same: If you haven't hit menopause and you don't want a baby, then you need some kind of birth control.

But that doesn't mean you should stick with the same method for all of your fertile years. In fact, it's often wiser to make some changes along the way. The best pick for you today might no longer be a winner in a few years, and if you haven't thought about your contraception in a while, it could be time for an update. So what's the ideal option for you right now?

To make your selection, you and your doctor should discuss a number of factors, including your age. Age is important both because of certain health issues and risk factors as well as because your lifestyle habits tend to change, Mary Jane Minkin, MD, clinical professor of obstetrics and gynecology at Yale University School of Medicine, tells Health. Here's a guide to getting smarter about birth control in your 20s, 30s, and 40s.

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In your 20s...

The Pill is a popular pick at this age, and it might be ideal for you—or maybe not. Many 20somethings live a hectic lifestyle, notes Dr. Minkin. "Can you remember to take a pill every day? That's the major question," she says. "If you look at the scientific literature, you'll see that the average number of forgotten pills can be as high as 4 per month!" Each missed pill further reduces the efficacy of this method, so skipping several is pretty risky if you're trying to avoid getting pregnant.

Fortunately, the Pill isn't your only option. "I have a patient, a very smart girl who's a college student, who just can't remember to take the Pill, so every 3 months she comes in for a Depo-Provera shot instead," says Dr. Minkin. (Depo-Provera relies on the hormone progestin to thicken cervical mucus so sperm can't get to an egg.) 

For other young and busy women, NuvaRing might work well. This hormonal method requires you to insert a ring and remove it after 3 weeks, which might be less of a hassle than taking an oral med every day. The catch: "You have to be comfortable touching your vagina," says Dr. Minkin. If the idea of inserting a ring makes you squeamish, it isn't for you. (The FDA just approved a vaginal ring called Annovera that can be used for a full year, but it likely won't hit pharmacy shelves until 2019 or 2020.)

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Also worth remembering: If you have multiple partners, you need to use a condom every time to protect against sexually transmitted infections (STIs), even if you're using hormonal contraception. "I've had so many young women tell me, 'But I've had the HPV vaccine!' That's great—I'm delighted—but there are many other [STIs] out there that it doesn't protect against," says Dr. Minkin.

In your 30s...

If you're happy with the method you were using in your 20s, you might be able to stay with it, but there are some important caveats. "If you're over the age of 35 and you're a smoker, you shouldn't be taking birth control pills," says Minkin. Ditto for rings and patches, because the hormones will raise your risk of a heart attack, stroke, or blood clot. These risks exist for non-smokers and younger smokers, too, but are much lower.

Whether you're a smoker or not, one method you may want to consider in your 30s is an IUD. Although you can get an IUD at any age, they're most popular in the U.S. among women who've finished having children or who don't plan to get pregnant again for a while. Once you've given birth, your cervix has been stretched out, so insertion tends to be less painful than if you haven't had a baby—though most women (including those who've never had kids) can just take an OTC painkiller before the procedure and feel fine, says Dr. Minkin.

The two most commonly used IUDs are the Mirena (which releases a small amount of progestin and can stay in for at least 5 years) and ParaGard (which is made of copper and can stay in for at least 10 years). Dr. Minkin says IUDs have become increasingly popular, and she's seen a surge of interest in her practice since President Trump got elected. "Contraceptive coverage is up in the air, along with funding for Planned Parenthood," she explains. "IUDs are covered for now and can stay in for 5 to 10 years."

And again, if you have more than one partner, a condom—with or without another form of contraception—is a must.

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In your 40s...

You've probably heard that your fertility takes a nosedive in this decade, and that's generally true. But there are also plenty of "surprise" pregnancies among women in this age group. "I have personally delivered babies for three women who were 47 years old and not trying to get pregnant!" says Dr. Minkin. You're not in the clear until you've gone a full year without a period.

If you're dealing with symptoms of perimenopause like hot flashes, night sweats, and irregular periods and you aren't a smoker, then low-dose birth control pills might be a good bet. "I use them a lot for women in their early- to mid-40s, because it helps control their symptoms," says Dr. Minkin.

Concerned about your breast cancer risk, which starts to rise in your 40s? Some research has suggested that hormonal birth control might further raise the chances of the disease, though Dr. Minkin isn't too concerned. (She says any increase appears to be minimal.) Still, if you're worried—perhaps because you also have a family history of breast cancer or other risk factors—then consider the copper IUD. "If your periods are regular and you just want reliable contraception, ParaGard is fabulous and there are no hormones," says Dr. Minkin.

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The contraceptive sponge, which is back on the market, might also be a good pick for some women in this age group. "I don't want a teenager using it exclusively, but if you're 48 years old and you've gone 9 months without a period, the chances of you getting pregnant are pretty darn small," says Dr. Minkin. "So if you want to stop the method you were using before for whatever reason and use the sponge now, that's fine."

Of course, if you have multiple partners—maybe you're starting to date again after a long hiatus—you still need to use condoms, because you can get an STI at any age.

No matter how old you are, Dr. Minkin says finding a birth control method that fits your personal needs is really what's key. "I want to make sure that patients are using something they're comfortable with and that's compatible with their lifestyle," she says.