The Assumption Everyone Gets Wrong About Birth Control

The surprising reason so many teens are on it — and it’s not what you think

---

Birth control. The name is deceiving, and most people assume they know why teens take it. When people hear a teen is on it, their first thought is usually judgment; sometimes even disgust. But here’s the thing: most teens on birth control aren’t taking it for the reason you think. In fact, many use it to manage painful periods, irregular cycles, or acne, not to prevent pregnancy. 

According to Rachel Kramer, MD, studies have shown that 18 percent, or 1 in 5, of girls ages 13-18 are on the birth control pill. Well over half of them are taking it because of period-related problems, not pregnancy prevention. Another survey, conducted by the National Center for Health Statistics, interviewed 7,356 women ages 15 to 44. While this study included middle-aged women as well, the teenage results are what stood out. 70%-91% of the interviewed teenage girls reported painful periods, and 25% mentioned menstrual irregularities. Out of all the women surveyed, teens were more likely to use birth control for non-contraceptive reasons. 82% of them use the pill for period or hormonal issues, not to prevent pregnancy. 

While I have mentioned the birth control pill multiple times, that isn’t the only way for birth control to be administered. This article will explain why the majority of teenagers take birth control, how it works, and why the stigma needs to stop.

Why Teens Really Are on Birth Control

While many assume teens take birth control to avoid pregnancy, most actually start it for health reasons. Being a teenage girl isn’t just hard socially. During the teenage years, hormones are constantly surging. For some girls, hormonal changes can be as simple as a flickering candle. For others, they erupt like fireworks going off. Estrogen and progesterone are hormones that help regulate the menstrual cycle and influence things like acne, while prostaglandins are the hormone-like chemicals that control uterine contractions and cause cramps. All of these different things are completely normal. However, some teens experience more than just a small breeze of these. 

Painful cramps, or dysmenorrhea, are one of the most common reasons for a teenage girl to need a little extra help when that time comes around. Prostaglandins are the main culprit for these painful cramps. When there is too much of this substance, it can get out of control, leading the uterus to tighten beyond what is needed. This extra tightening is what many girls experience, especially during their teenage years, as their cycles and hormone patterns are still settling. Birth control pills release a controlled amount of estrogen and/or progestin, which suppresses ovulation and stabilizes the uterine lining, ultimately reducing prostaglandin production and easing cramps. Fewer prostaglandins means fewer cramps. This can make those teenagers who cannot get out of bed because of the storm that is going on inside their lower abdomen, able to function again and live their lives. 

Another reason many teenagers tend to go on birth control is because of acne. Teenage girls tend to be very insecure about themselves, and this method can help calm down any hormone-caused acne that may be bothering them. In addition to suppressing ovulation, combination birth control pills (estrogen and progestin) help reduce the effects of androgens, like testosterone, which can cause acne. Androgens start up the production of sebum, which is an oily substance that can clog pores and lead to acne. When estrogen is released from the pills, it increases the production of SHBG, which binds the androgens, making them less active.

 The final main reason that many teenage girls decide to take birth control is to regulate their cycles. Sure, during the teenage years, many girls don’t have regular cycles until a few years after menarche (first period). However, it can be stressful to have these irregular cycles for some teens. Imagine not knowing when you were going to start your period. Your app says you’re not supposed to start until next week; however, you're at the mall with your friends, and boom, there it is. Being unprepared for these moments is never fun, but for some girls, that's reality. If it gets a few years after a girl gets her first period and her cycles still are not regulating out, then birth control is a really good option to take away the stress of uncertainty. 

There are many reasons why a girl might be on birth control that have nothing to do with pregnancy prevention. 

With so many health reasons to consider birth control, teens have multiple methods to choose from, each offering a way to take control of their hormones and periods.

Exploring the Different Forms of Birth Control

Not all birth control comes in a pill. From patches to rings to implants, there are lots of ways teens can use them to take control of their hormones and periods. 

The most common and least invasive form of birth control is the pill. There are two types of the hormonal birth control pill. The combined oral contraceptives (COC) contain both estrogen and progestin. Progestin is designed to mimic the natural hormone, progesterone. The combination pill helps regulate periods, reduce painful and heavy periods, and reduce PMS and endometriosis symptoms. Breakthrough bleeding (spotting not related to menstruation), headaches, nausea, and breast tenderness are often the side effects that come with the combination pill throughout the first couple of months. The other type of oral birth control is the progestin-only pills (POPs), also known as the “mini pill”. POPs are a really good option for those seeking to take birth control but not wanting to include estrogen in the mix. These pills can help with painful and heavy periods as well as endometriosis, without the use of estrogen. While POPs may lead to lighter, shorter periods, irregular bleeding is also possible. Spotting between periods, acne, mood swings, and even weight gain are all possible side effects of the mini pill that need to be considered. Both the POP and COC pills should be taken every day at around the same time for the best results. 

Another form that is commonly used by teens is the birth control patch. These skin colored patches latch onto the skin like a Band-Aid and are often placed either on the upper arm, lower back, lower abdominal area, or upper back near the shoulder blades. They release hormones into the bloodstream that can help reduce menstrual flow, making periods lighter. These hormones also help regulate cycles and reduce period length, sometimes even to no period at all. Having no period at all without a form of hormonal therapy, where it is controlled medically, is not safe. However, since these hormones are being carefully disrupted by the medicine that was prescribed, not having a period is super common and safe. These patches must be switched out according to a schedule. Weeks 1, 2, and 3, the patches have to be replaced once a week. In the fourth week, you do not put a new patch on after you take off the old one. This is considered a “patch-free” week.  During this week, you may have your period, or you may not have a period at all. Both are completely normal with the patch. All medication has its side effects, even the patch. Nausea, irregular bleeding, sore breasts, headaches (especially in the first few weeks), and mood changes are all potential side effects. 

Hormonal implants, like Nexplanon, are another way to get hormones into the body. This implant is a small, straw-like rod that goes into your inner upper arm. It releases a steady amount of progestin into the bloodstream. Unlike the pill and patch, a healthcare provider has to place the implant into your arm. This procedure is very quick and is done in the office. It also only requires a small amount of lidocaine in the arm to numb the surrounding tissue. Many patients say that it may be uncomfortable, but not painful. This implant stays in the arm for 3 years, then a healthcare provider removes the implant and replaces it with a new one. The implant isn’t known for its side effects; however, you may experience nausea, headaches, sore breasts, and irregular bleeding, like the other birth control options. 

An Intrauterine Device, or IUD, is another form of birth control; however, it is not as common for teenagers as the other options are. While IUDs can be prescribed to teens, insertion can be painful, so some doctors may recommend them more often to women who have delivered babies vaginally. An IUD is a type of birth control that is placed inside the uterus via the vaginal canal. The device is a T-shaped plastic frame, and it produces a type of progestin into the body. The time frame of this form of birth control depends on the brand of IUD used. The longest-lasting ones are called the Mirena and Liletta IUDs. Both of these last up to 8 years! However, you do not have to keep it for those 8 years. At any point you wish to remove it, a doctor or nurse will gladly do so. Spotting, cramping, and irregular periods are some common side effects that may appear within the first 3-6 months, but these symptoms typically go away once your body gets used to it. 

While there are several other birth control methods, the ones listed above are the most common for teenagers (except the IUD). They all release hormones into the body that can help regulate periods, tame heavy bleeding and cramping, and even stop periods in a healthy way.

Ending the Stigma

As you now know, most teens use birth control to manage cramps, irregular cycles, and acne, not because they are trying to prevent pregnancy. Taking care of your body and hormones is smart, responsible, and nothing to be ashamed of. Still, society tends to shame or judge teens based on the assumption of why the pills are being taken without understanding that there can be more than just one reason. This assumption needs to end. Many girls are scared or embarrassed to bring up the thought of birth control because of what they have been taught, leading to more suffering for those who would really benefit from it. It’s time to stop making assumptions and start supporting each other. Let's ditch the stigma. Whether it’s for acne, cramps, or regulating cycles, birth control is a tool for health, not shame.