Birth control - hormonal methods
Birth control methods that use hormones contain man-made (synthetic) forms of estrogen and progesterone (progestin), hormones that are made in a woman's ovaries.
Contraception - hormonal methods; Hormonal birth control methods; Birth control pills; Contraceptive pills; BCP; OCP
Birth control methods that use hormones will have both an estrogen and a progestin, or just a progestin.
- Both hormones prevent a woman's ovary from releasing an egg during her menstrual cycle (called ovulation). They do this by changing the levels of the natural hormones the body makes.
- Progestins help prevent sperm from entering the uterus by making the mucus around a woman's cervix thick and sticky.
Once a woman stops using most hormonal birth control methods, fertility will return within 3 - 6 months. Some women may regain fertility as soon as the first cycle after the method is stopped.
BIRTH CONTROL PILLS (ESTROGEN AND PROGESTIN)
- Also called oral contraceptives or just the "pill," this method combines the hormones estrogen and progestin to prevent ovulation.
- A health care provider must prescribe birth control pills.
- This method is highly effective if the woman remembers to take her pills without missing a day.
- Women who have unpleasant side effects on one type of pill are usually able to adjust to a different type.
- About 2 to 3 pregnancies occur a year out of 100 women who never miss a pill.
- Birth control pills may decrease a woman's risk for ovarian cancer.
- Birth control pills may cause many side effects, including dizziness, irregular menstrual cycles, nausea, mood changes, worsening of migraines, breast tenderness, and weight gain.
- In rare cases, birth control pills can lead to high blood pressure, blood clots, heart attack, and stroke. The risk is highest for women who smoke or have a history of high blood pressure, clotting disorders, or unhealthy cholesterol levels.
- For all women who take birth control pills, a check-up at least once a year is essential. Women should also have their blood pressure checked 3 months after they begin to take the pill.
BIRTH CONTROL PILLS (PROGESTIN ONLY)
- The "mini-pill" is a type of birth control pill that contains only progestin, no estrogen.
- Progestin-only pills are always sold in 28-day packs, and all of the pills are active.
- These pills are an alternative for women who are sensitive to estrogen or who cannot take estrogen for other reasons.
- The effectiveness of progestin-only oral contraceptives is slightly less than that of the combination type. About 3 pregnancies occur a year in 100 women using this method.
- Risks include irregular bleeding, weight gain, and breast tenderness.
- Because these pills do not contain estrogen, they may be a safer choice for women over age 35, smokers, and those who have other risk factors that prevent them from taking estrogen.
- An estrogen and progestin pill called Seasonale may be taken for 3 straight months, followed by 1 week of inactive pills.
- A woman gets her period about four times a year, during the 13th week of her cycle.
- Seasonale is available by prescription.
- Fewer than 2 out of 100 women per year get pregnant using this method.
- The risks are similar to those of other birth control pills. Some women may have more spotting between periods.
- The pills must be taken daily, preferably at the same time of day.
- Implanon is a small rod that is implanted surgically beneath the skin, usually on the upper arm.
- It takes about a minute to insert the rod, which is done using a local numbing medicine in a doctor's office. Removal usually only takes a few minutes longer.
- The rod releases a small amount of the hormone progestin into the bloodstream.
- The rod remains in place for 3 years, although it can be removed at any time.
- Less than 1 pregnancy occurs a year out of 100 women using this type of contraception.
- Women often experience irregular spotting or bleeding with this method.
- Projestin injections, such as Depo-Provera, are given into the muscles of the upper arm or buttocks.
- This shot prevents ovulation.
- A single shot works for up to 90 days.
- Less than 1 pregnancy occurs a year in 100 women using this method.
- Sometimes the effect of this medication lasts longer than 90 days. If you are planning to become pregnant in the near future, you might consider a different method.
- The skin patch (Ortho Evra) is placed on your shoulder, buttocks, or another convenient location. It continually releases progestin and estrogen. Like other hormone methods, a prescription is required.
- The patch provides weekly protection. A new patch is applied each week for 3 weeks, followed by 1 week without a patch.
- About 1 pregnancy occurs a year out of 100 women using this method.
- Estrogen levels are higher with the patch than with birth control pills. In theory, higher estrogen levels may increase your risk of blood clots.
- The vaginal ring (NuvaRing) is a flexible ring about 2 inches wide that is placed into the vagina. It releases the hormones progestin and estrogen.
- A prescription is required.
- The woman inserts it herself. It stays in the vagina for 3 weeks. At the end of the third week, the woman takes the ring out for 1 week. The ring should not be removed until the end of the 3 weeks.
- About 1 pregnancy occurs a year out of 100 women using this method.
- Side effects (nausea and breast tenderness) are less severe than those caused by birth control pills or patches.
- Risks include vaginal discharge and vaginitis, as well as those similar to the combined birth control pill.
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Mørch LS, Løkkegaard E, Andreasen AH, Krüger-Kjaer L, Lidegaard O. Hormone therapy and ovarian cancer. JAMA. 2009;302:298-305.
Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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