POPs vs COCs? What You Need to Know



It may be surprising to learn that the pill has been around since the 1960s. This combination oral birth control method was approved by the Food and Drug Administration in June 1960. That was five years before the Supreme Court’s decision in Griswold v. Connecticut made contraception legal even for married couples.

The pill and its use have come a long way since then. If you decide to use oral contraception, you’ve made your first choice. From there, you have a multitude of decisions to make about brands. But among those brands, you need to choose either a combination pill (COC) or a progestin-only pill (POP). So, you’ll need to know a little about the pros and cons of each.

Figuring out which type of pill to use can be overwhelming. But knowing the basics should help you narrow the scope of your search and make it easier to navigate. Here’s what you need to know about POPs and COCs.

Affordability and Ease of Use

The pill is one of the most affordable methods of birth control out there. Even if you don’t have health insurance, or your plan won’t cover birth control, an out-of-pocket payment isn’t unreasonable.

Even better, both pill types are easy to access. You can pay a nominal annual consultation fee to skip the doctor’s office and work with an online provider. Once you do, you can have your birth control prescription delivered to your home for as little as $15 a month. If birth control is covered under insurance, you’ll most likely pay nothing.

You will need to remember to take the pill daily, and here’s where there’s a difference between POPs and COCs. For ultimate efficacy, you must take the progestin-only pill at the same time every day. Although combination pills also need to be taken daily, you don’t have to be quite so precise.

The time restriction makes COCs a little more forgiving. But access and affordability are pluses in both columns.

Estrogen and Progestin

One of the great debates about POPs and COCs relates to estrogen. POPs don’t contain estrogen, only progestin, which is a synthetic version of the naturally occurring hormone progesterone. COCs, on the other hand, employ both estrogen and progestin in their formulation. However, there are combination pills with lower amounts of estrogen than others.

Smoking or vaping is generally contraindicated for estrogen birth control due to increased risk of stroke and heart attack. Estrogen is also not recommended for those who are breastfeeding or have had or are at higher risk for certain health issues. These include blood clots, heart problems, migraines, breast cancer, high blood pressure, and severe diabetes or liver disease.

Progestin-only pills have fewer potential dangers. They aren’t recommended for those with lupus or those who have had breast cancer. A certain brand, Slynd, should be avoided by certain people. These include those with adrenal insufficiency, kidney or liver disease, or a history of breast, cervical, endometrial, ovarian, or uterine cancer.

Although the potential side effects are serious, they are rare. The pill in either form is primarily a safe and effective form of birth control.

Potential Side Effects

Potential side effects of POPs and COCs include headache, nausea, spotting, and breast tenderness. Moreover, the hormones in either type of pill will change the menstrual cycle you’re accustomed to. But if you suffer from irregular periods, either should solve that problem.

POPs can also cause irregular periods. They may also cause unusual hair growth, hair loss, and acne. These biological issues are hormonal. So, adding progestin to your body’s naturally occurring progesterone may affect them.

Estrogen may cause bloating, depression, and increased risk of blood clots and stroke. But COCs have some benefits as well, including lighter periods with less pain and reduced outbreaks of hormonal acne. In fact, certain formulations of the combination pill are prescribed to treat conditions like acne and premenstrual dysphoric disorder (PMDD). COCs may also reduce endometriosis and help prevent uterine fibroids and cancer.

Some people experience no side effects with the pill. For others, they may experience them only for the first two or three months they begin taking them. They may be worth a try.

Pregnancy Protection

Both POPs and COCs work by thickening cervical mucus and thinning the lining of the uterus, which keeps sperm from fertilizing eggs. But POPs are slightly less effective because they’re less consistent than COCs with preventing ovulation. That’s what holds those eggs at bay in the first place.

Progestin-only pills provide full protection within two days of starting them. Because they are taken daily with no break in the routine, you will have few or no periods. Back-up contraception is recommended when starting COCs for seven days. You take placebos one week every month, during which you may have a period.

Perhaps the major drawback to POPs is that requirement that you take the pill within a three-hour window every day. If you miss the window, you should use back-up birth control for two consecutive days. This can be a problem if you aren’t good at remembering when to take them.

POPs and COCs both provide excellent pregnancy protection, so long as you take them as prescribed. If you can establish a routine, doing so may not be an issue at all.

Choose What’s Best for You

There are so many variables among formulations used by different brands of birth control pills. It’s wise to do a little research and jot down potential health issues before contacting a provider. You should also consider those helpful side effects you might want, like improving your hormonal acne.

Birth control pills have come a long way in the last 60-plus years. When considering your POPs and COCs these days, you’ll need to mind your Ps and Qs and choose what’s best for you.