Birth control pills, patch, or ring

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Very low-dose pills

Low-dose pills

Phasic pills

High-dose pills

Skin patch

Vaginal ring

Birth control pills

Very low-dose pills have 20 mcg of estrogen plus progestin.

Low-dose pills have 30 to 35 mcg of estrogen plus progestin.

Phasic pills have changing levels of estrogen and progestin.

High-dose pills have about 50 mcg of estrogen plus progestin.

For information on progestin-only pills, see progestin-only hormonal methods.

Some birth control packets have pills without hormones for certain days of the month. Other brands of birth control, such as LoEstrin, may add an iron supplement to the non-hormonal pills.

Birth control hormones in pills, skin patches, or vaginal rings give you a regular dose of estrogen and progestin. This controls your body's menstrual cycles and prevents pregnancy. It also helps relieve heavy menstrual bleeding, pain, and sometimes premenstrual mood problems and bloating.

In the perimenopausal years before menopause, hormone levels go up and down a lot. Using birth control hormones can help with hot flashes, sleep problems, and mood.^{1, 2}

Birth control pills

Birth control pills, also called oral contraceptives, come in packs. The most common type has 3 weeks of hormone pills. Some packs have sugar pills for the fourth week, and some do not. During that fourth non-hormone week, you have your menstrual period. After the fourth week (28 days), you start a new pack.

For Seasonique and Seasonale, you take 12 weeks of hormone pills followed by 1 week of low-estrogen or no-hormone pills. On this schedule, you have four periods a year. If your doctor prescribes an unlabeled use for other birth control pills, you can also have four periods a year. You take the active hormone pills continuously for 12 weeks, followed by 1 week of sugar pills. You then start a new pack of pills. If you have breakthrough bleeding during the 3 months, your doctor will prescribe extra estrogen.

Lybrel comes in 4-week packs of hormone pills, which you take every day of the year. On this schedule, you have no periods.

For more information, see how to take birth control pills.

Birth control skin patch

The birth control patch is a patch [about 1.75 in (4 cm) square] that sticks firmly on your skin. You can wear it on your lower abdomen, buttocks, or upper arm. Each patch releases estrogen and progestin through your skin for 7 days. Over a 4-week period, you use one patch each week for 3 weeks, and then no patch for 1 week. During this week, you have your menstrual period.

For more information, see how to use the patch.

Birth control vaginal ring (CVR)

The vaginal ring is small [about 2 in (5 cm) in diameter], flexible, and colorless. It releases a continuous low dose of hormones into the vagina to prevent pregnancy for that month.

You insert the vaginal ring yourself and leave it in place for 3 weeks. This gives you continuous birth control for the month. On the first day of the fourth week, you remove the ring and usually have a menstrual period. The exact position of the ring in the vagina is not critical for it to work.

For more information, see how to use a vaginal ring.

Birth control hormones are commonly used to:

• Prevent pregnancy. Birth control hormones prevent pregnancy in three ways. They stop the ovaries from releasing an egg each month (ovulation). They also thicken the mucus in the cervix. This makes it hard for sperm to travel into the uterus. And birth control hormones change the lining of the uterus, which makes it harder for a fertilized egg to attach to it.
• Control menstrual periods. Taking estrogen and progestin on a schedule keeps your menstrual periods on a schedule. You can schedule your periods to be every month, every few months, or not at all. This can relieve you of problems that flare with every menstrual cycle, like endometriosis or painful ovarian cysts.
• Lighten menstrual bleeding. Normally, the uterus builds up a new lining every month, which then sheds away. This shedding is your menstrual bleeding. Taking hormones keeps the lining from getting very thick, so bleeding is lighter.
• Help relieve menstrual pain. Birth control hormones lower your level of prostaglandins, which are one cause of menstrual pain.
• Help relieve perimenopausal problems. In the years leading up to menopause, a woman's hormone levels are unpredictable. Taking birth control hormones helps keep hormones even. This can help relieve hot flashes, sleep problems, and depression for many perimenopausal women.^{1, 2}
• Treat polycystic ovary syndrome (PCOS) problems. Birth control hormones can help control PCOS problems. The Yasmin birth control pill is used for PCOS hormone treatment.³ This pill has the progestin called drospirenone, which is an antiandrogen.⁴ It can improve PCOS acne problems, male-type hair growth, and male-pattern hair loss, which are caused by high androgen levels.
• Prevent some diseases. Taking birth control hormones lowers ovarian cancer risk.⁵ For women with a risk of endometrial cancer, taking progestin with estrogen helps lower that risk.⁶ The estrogen in the pill, patch, or ring also helps keep bones strong. This lowers your risk of osteoporosis later in life.¹

Premenstrual syndrome (PMD) relief. The Yasmin and YAZ birth control pills have a progestin that reduces water retention (bloating) during the menstrual cycle. This type of pill may help reduce severe mood and physical symptoms that some women get before they start their monthly periods.⁷ These symptoms are called premenstrual dysphoric disorder (PMDD). YAZ has been approved by the U.S. Food and Drug Administration (FDA) for treating PMDD symptoms. (These two pills have the same amount of progestin, called drospirenone. YAZ is very low-estrogen, and Yasmin is low-estrogen.)

Estrogen-progestin pills, skin patches, or vaginal rings are good choices for women who:

• Need short- or long-term birth control that can be stopped at any time.
• Prefer a form of birth control that does not interfere with sexual spontaneity.
• Have heavy, painful, or irregular menstrual periods.
• Have endometriosis or ovarian cysts.
• Have a family history of ovarian cancer. Estrogen-progestin pills start lowering the risk of ovarian cancer after 1 year of use. This benefit seems to last for years after a woman stops taking the pill.⁵

Do not use birth control hormones containing estrogen if you have any of the following conditions:

• Uncontrolled high blood pressure (hypertension)
• Liver disease
• History of blood clots
• History of stroke
• History of migraine headaches with aura
• Diabetes with complications
• History of breast cancer (estrogen stimulates certain types of breast cancer)
• Breast-feeding in the 6 months after childbirth
• Long-term bed rest after a major surgery

If you are older than age 35, do not use birth control pills if you:

• Take medicine for high blood pressure.
• Smoke.
• Have diabetes.
• Have high cholesterol.

Estrogen-progestin pills, skin patches, or vaginal rings are effective methods of birth control when they are used exactly as directed. Since some women do not use their birth control as directed, pregnancy does happen in a certain number of women. This has been shown by studies of actual users.

• Among pill users, 8 women out of 100 become pregnant each year.⁸ Of women who take their pills every day, only 3 out of 1,000 become pregnant each year.⁸ When the method fails, it is usually because of skipping a daily pill or two.
• Among skin patch and contraceptive vaginal ring users, 8 women out of 100 are expected to become pregnant each year. With perfect use, only 3 out of 1,000 become pregnant each year.⁸

The pill and the patch may not work as well if you are overweight. Talk with your doctor about the type of birth control that will work best for you.

Low-dose pills are as highly effective as higher-dose pills when you take them as directed. But your risk of pregnancy is higher after missing low-dose pills than after missing higher-dose pills.⁵

For more information about how well estrogen-progestin birth control works for helping other medical problems, see the topics Dysfunctional Uterine Bleeding, Menopause and Perimenopause, Polycystic Ovary Syndrome (PCOS), Uterine Fibroids, Functional Ovarian Cysts, Premenstrual Syndrome, Endometriosis, Chronic Female Pelvic Pain, and von Willebrand's disease.

Estrogen-progestin pills, skin patches, and vaginal rings have similar possible side effects. The pill causes hormone levels to peak and drop each day. Each weekly patch takes 3 days after application to reach a steady hormone level. The ring releases a steady dose every day throughout the day. This may explain why the ring is less likely to cause headaches and nausea than the pill or patch.

Common side effects of estrogen-progestin methods

The most common side effects are changes in menstrual periods, including:

• Very light or skipped periods. If you take monthly cycles of birth control hormones for a long time, your periods might stop. This effect can last until several months after you stop taking hormones.
• Bleeding between periods (spotting). This usually decreases after a woman uses a hormonal method for 3 to 4 months.

The contraceptive skin patch may cause skin irritation at the site.

The contraceptive vaginal ring may cause:

• Vaginal discharge.
• Irritation and inflammation of the vagina (vaginitis).

Less common side effects of estrogen-progestin methods

Less common side effects include:

• Nausea and vomiting, especially during the first month of use. This side effect usually goes away after the first few months of use.
• Frequent or more severe headaches. Migraine headaches may get worse.
• Weight gain.
• Breast tenderness for the first few months.
• Depression or mood changes.
• Darkening of the skin on the upper lip, under the eyes, or on the forehead (chloasma). This may slowly fade after you stop using hormonal methods, but in some cases it is permanent.
• Change in interest in sex (can be more or less).

Rare but serious side effects of estrogen-progestin methods

The following symptoms, called ACHES, are rare but serious and should be reported to your doctor immediately.

• Abdominal pain that is severe or persists may be a sign of blood clots (thrombophlebitis) in the pelvis, liver blood clots or tumors, or gallbladder disease.
• Chest pain may be a sign of blood clots in the lungs (pulmonary embolism), heart attack, or heart disease. Smoking increases this risk.
• Headaches that are severe may be a sign of stroke, migraine, or high blood pressure (hypertension). Smoking increases this risk.
• Eye problems, such as blurred vision or loss of vision, may be a sign of migraine, blood clots in the eye, or a change in the shape of the cornea.
• Severe leg pain or sudden swelling of one leg may be a sign of leg blood clots (thrombophlebitis) or deep vein thrombosis (DVT).

If you have kidney, liver, or adrenal gland disease, you cannot use YAZ or Yasmin. This is because the progestin in these pills can increase your potassium levels. This can be dangerous for people who have kidney, liver, or adrenal gland disease.

Patch warnings. The patch delivers more estrogen than the low-dose birth control pills do. The U.S. Food and Drug Administration (FDA) warns that women using the patch are slightly more likely to get dangerous blood clots in the legs and lungs than women using birth control pills. So talk to your doctor about your risks before using the patch.

Direct sunlight or high heat can increase, then lower, the amount of hormone released from a patch. This can give you a big dose at the time and leave less hormone for the patch to release later in the week. This increases your risk of pregnancy. Avoid direct sunlight on the hormone patch. Also avoid using a tanning bed, heating pad, electric blanket, hot tub, or sauna while you are using a hormone patch.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Cancer protection, cancer risk? Overall, if there is an increase in cancer risk from using estrogen-progestin birth control pills, it seems to be very small. Using estrogen-progestin birth control lowers the risk for uterine, ovarian, and colon cancers while slightly increasing the risk for cancers of the breast, cervix, and liver. Women who have a personal history of breast cancer should not take estrogen-progestin.

Other factors to consider include the following:

• Birth control hormones may not be as effective when combined with other medicines. Whenever you get a new prescription, be sure to tell your doctor or pharmacist that you are taking birth control hormones. The herbal medicine St. John's wort also makes birth control hormones less effective. When you start using hormonal birth control, be sure to tell your doctor about all medicines and supplements you are taking.⁹
• If you want to be able to start a planned pregnancy soon after you stop long-term use of birth control hormones, hormone shots (Depo-Provera) may not be a good choice. They can make it hard to get pregnant for several months after you stop them.
• If you are taking birth control hormones, take special precautions for backup birth control if you miss or skip pills.
• Birth control pills may not be as effective if you are vomiting or have diarrhea. Use another method of birth control for 7 days after vomiting or diarrhea, even if you have not missed any pills.
• The pill and the patch may not work as well if you are overweight. If you are overweight, ask your doctor about which birth control methods are right for you.

Be sure to use a backup birth control method during the first 7 days of starting hormonal birth control.

Emergency contraception is available if any birth control method fails and you are concerned about unprotected sex.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. Kaunitz AM (2001). Oral contraceptive use in perimenopause. American Journal of Obstetrics and Gynecology, 185(2, Suppl): S32–S37.

2. Rapkin AJ, et al. (2002). The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders. Current Psychiatry Reports, 4(6): 419–428.

3. Hatcher RA, et al. (2004). Combined (estrogen and progestin) contraceptives. In A Pocket Guide to Managing Contraception, pp. 97–119. Tiger, GA: Bridging the Gap Foundation.

4. Ehrmann DA (2005). Polycystic ovary syndrome. New England Journal of Medicine, 352(12): 1223–1236.

5. Abramowicz M (2004). Choice of contraceptives. Treatment Guidelines From The Medical Letter, 2(24): 55–62.

6. Fraser IS, Kovacs GT (2003). The efficacy of non-contraceptive uses of hormonal contraceptives. Medical Journal of Australia, 178(12): 621–623.

7. Yonkers KA, et al. (2005). Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstetrics and Gynecology, 106(3): 492–501.

8. Zieman M, et al. (2007). Managing Contraception for Your Pocket. Tiger, GA: Bridging the Gap Foundation.

9. Hatcher RA, Nelson A (2004). Combined hormonal contraceptive methods. In RA Hatcher et al., eds., Contraceptive Technology, 18th ed., pp. 391–460. New York: Ardent Media.