Know Your Birth Control Methods Part 2: Hormonal Contraception

A variety of factors will likely determine the right kind of birth control for you. Recently we spoke with Dr. Donald Brown, an OB/GYN at INTEGRIS, about the many different types of birth control available to help you choose the best option.

Today’s blog provides an in-depth discussion on hormonal contraception. Don’t forget to read our other blog posts on barrier methods of birth control and permanent contraceptive methods.

Hormonal contraception

Hormonal contraceptives contain either estrogen and progestin hormones or progestin-only hormones. The hormonal method inhibits a woman’s natural cyclical hormones and prevents pregnancy.

In some forms, it stops the body from ovulating and alters the cervical mucus to make it more difficult for sperm to travel through the cervix to an egg. The lining of the womb can also be altered to prevent a fertilized egg from implantation.

Hormonal contraceptives are often prescribed to women with significant acne, unwanted hair growth or heavy bleeding. They can make menstrual cycles lighter, shorter and more regular while decreasing the discomfort of cramps. Additionally, they can serve as treatments for fibroids and endometriosis.

Combination hormonal oral contraceptives

An oral contraceptive, or “the pill,” is taken once daily to prevent pregnancy. It is best to take the pill at the same time each day. With precise use, oral contraceptives are 99.99 percent effective in preventing pregnancy.

The pill is typically prescribed for those seeking control over their menstrual cycle or relief from ovarian cysts, painful periods or heavy cycles.

The pill does not protect against STIs. To prevent both pregnancy and STIs, multiple forms of birth control, such as the pill and a condom, should be used. Additional birth control methods should also be used when taking the pill in combination with antibiotics or yeast medications, as they can metabolize the contraceptive, rendering it ineffective.

There are four types of combined hormonal pills.

• 21-day pills, taken daily for 21 days, with a seven-day period
• 28-day pills, taken daily for 28 days with the first 21 pills containing both hormones, and the remaining pills (taken during your seven-day period) containing no hormones, estrogen-only hormones or iron
• 90-day pills, taken daily for 84 days with a seven-day period while taking estrogen-only or inactive pills every three months
• 365-day pills, taken daily for one year

Oral contraceptives are not recommended for women with an increased risk or history of cardiovascular disease as the combined hormones can create a risk for deep vein thrombosis (DVT), heart attack or stroke.

Additional side effects include nausea, headache, breast tenderness and breakthrough bleeding. 

Progestin-only oral contraceptives

Progestin-only oral contraceptives, also known as “mini-pills,” are birth control pills taken daily to prevent pregnancy. They have the same effectiveness as combination hormonal pills.

Progestin-only pills cause the mucus in the cervix to thicken, making it difficult for sperm to enter the uterus. They can also stop ovulation (although this is only effective in 60 percent of cases) and thin the lining of the uterus to prevent egg implantation.

Unlike combination pills, the progestin-only pill is not associated with an increased risk of cardiovascular disease or DVT, making it a is a safer option for women with cardiovascular disease or diabetes.

Side effects include unpredictable bleeding, spotting, heavy bleeding, nausea, diarrhea, headaches and breast tenderness. Women with lupus or a history of breast cancer should not take progestin-only pills.

Patch

The contraceptive skin patch is a small, self-adhesive patch that is worn on the skin. It releases estrogen and progestin which are absorbed into the body to prevent pregnancy. The patch is prescribed by a health care professional and worn on the upper back, chest (except the breasts), buttocks, upper arm or abdomen.

The patch should be worn one week at a time for three consecutive weeks. On week four, you will not wear a patch and will have your period. The following week, you will apply a new patch and repeat the cycle. For a continuous dose of birth control, the patch can be applied weekly without the break in the fourth week.

The patch should be applied on the same day every week despite your menstrual flow. 

Side effects can include breast tenderness, skin irritation, headaches and breakthrough bleeding.

Vaginal ring

A vaginal ring is a flexible, plastic ring that is placed in the upper region of the vagina where it releases estrogen and progestin to be absorbed through the vaginal tissues. The ring comes in one standard size and is prescribed by a health care professional.

Once it is prescribed, you will insert it yourself. “I tell patients to insert it using an empty tampon dispenser,” says Dr. Brown.

Once the ring is inserted, it will stay in the vagina for 21 days. At that point, you will remove it and wait seven days before inserting a new ring. During this time, you will have your menstrual cycle.

Another option is to insert a new ring every 21 days, without the ring-free week, to maintain a continuous dose of birth control.

Side effects can include headaches, nausea, vaginal discharge or irritation, breast tenderness and breakthrough bleeding.

In addition, “A vaginal ring may not work if you have elevated vaginal secretion. This birth control option is best for those with drier vaginas,” says Dr. Brown.

Depo-Provera shot

The Depo-Provera shot is an injection of the depot medroxyprogesterone (DMPA) hormone, a manufactured version of progesterone. The shot is prescribed by a physician and administered in your arm or buttocks every 12 weeks. The shot is 99 percent effective in preventing pregnancy but does not protect against STIs.

Each injection works for 12-14 weeks, but you must get new shots regularly within the first five days of your menstrual cycle to receive full protection.

“The Depo-Provera shot has the most side effects compared to the other birth control options,” says Dr. Brown. Side effects can include headaches, irregular or nonexistent menstrual periods, depression, dizziness, weight gain, acne, hair growth or loss and loss of bone mineral density.

If you are planning to become pregnant soon, Depo-Provera is not the optimal birth control method. It is possible to conceive within three to four months of your last shot, but many women take up to two years to become pregnant after they stop receiving the shot.

The Depo-Provera shot is not recommended for women with a history of liver disease, breast cancer, osteoporosis, blood clots or unexplained vaginal bleeding.

IUD

Intrauterine devices (IUDs) are one of two long-acting reversible contraception (LARC) methods. They are small, T-shaped plastic devices that are inserted into the uterus by a health care professional.

There are two types of IUDs: hormonal, which are approved for a maximum of three to five years of use, and copper, approved for up to 10 years of use. Hormonal IUDs thicken cervical mucus and stop ovulation to prevent pregnancy. Copper IUDs take a different approach and prevent the sperm from fertilizing the egg. Copper IUDs can also be used as a form of emergency birth control if inserted within five days of unprotected sex.

“IUDs are a good choice for women who have only one sexual partner, already have kids or are not planning to have kids for several years,” Dr. Brown says. “It is my number one birth control choice for women with children who are not planning to get pregnant in the near future.”

The IUD is over 99 percent effective against pregnancy and provides long-term protection without the inconvenience of barrier methods or monthly device insertions. Side effects can include back pain, irregular periods or spotting, uterus wall perforation, uterine infection and ectopic pregnancy. IUDs do not protect against STIs and can be expensive to remove prior to their prescribed removal date.

Single-rod contraceptive implant

The single-rod contraceptive implant is the other LARC method. It is inserted into the upper left arm to release a form of progesterone called etonogestrel. The rod is small enough to not be visible under the skin. Each implant is effective for up to three years.

“Although it is a more expensive option, the implant is a good choice for women who don’t want the responsibility of taking the pill, but can’t have an IUD,” Dr. Brown says. It is also a good option for women who are planning to become pregnant sooner, as you can conceive quickly after implant removal.

Side effects can include pain after insertion, bruising, swelling, irritation, redness, infection of the insertion site, scarring, depression, weight gain, nausea, abdominal pain, breast pain, headache, back pain, vaginitis, irregular menstrual bleeding or dizziness.