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Birth control - hormonal methods

 

Definition

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.

Alternative Names

Contraception - hormonal methods; Hormonal birth control methods; Birth control pills; Contraceptive pills; BCP; OCP

Information

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.

THREE-MONTH PILL

  • 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.

PROGESTIN IMPLANTS

  • 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.

HORMONE INJECTIONS

  • 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.

SKIN PATCH

  • 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.

VAGINAL RING

  • 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.
References

Lopez LM, Grimes DA, Gallo MF, Schulz KF. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2008;(1):CD003552.

Spencer AL, Bonnema R, McNamara MC. Helping women choose appropriate hormonal contraception: update on risks, benefits, and indications. Am J Med. 2009;122:497-506.

Amy JJ, Tripathi V. Contraception for women: an evidence based overview. BMJ. 2009;339:b2895.doi:10.1136/bmj.b2895.

Mørch LS, Løkkegaard E, Andreasen AH, Krüger-Kjaer L, Lidegaard O. Hormone therapy and ovarian cancer. JAMA. 2009;302:298-305.


Review Date: 3/30/2010
Reviewed By: 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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