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Hormonal Methods of Birth Control

The term "hormonal contraception or birth control" refers to birth control that contains estrogen and/or progestin. These ingredients are similar to those hormones produced naturally by the ovaries for the process of ovulation and the menstrual cycle.

All forms of hormonal contraception require a prescription from a health care provider. There are two categories of hormonal contraception:

IT IS IMPORTANT THAT A WOMAN DISCUSS HER MEDICAL HISTORY WITH HER HEALTHCARE PROVIDER BEFORE BEGINNING ANY HORMONAL CONTRACEPTIVE METHOD.

Hormonal contraception offers NO protection against HIV infection and other sexually transmitted infections (STIs). Condoms may be used along with a hormonal method to reduce the risk of transmission of STIs.

Combined hormonal contraceptives (CHC)

Combined hormonal contraception includes birth control pills, the birth control ring, and the birth control patch. Because these three methods all contain estrogen and progestin, there are similarities between them. Combined hormonal contraceptives have excellent effectiveness ratings in preventing pregnancy - between 97 and 99% - because they work in three ways:

  • Ovulation (release of an egg) does not occur.
  • Cervical mucus becomes thickened, making it more difficult for sperm to enter the uterus.
  • The uterine lining is thinner than normal, making it more difficult for a fertilized egg (if one were present) to implant in the uterus.

Fertility returns quickly after this method is discontinued, therefore when a woman stops using a CHC method, she must make plans to have another method of birth control immediately available unless a pregnancy is planned. Years of research reveal no connection between the use of CHC and birth defects.

CHC usually helps regulate menstrual periods, lessen cramps and decrease the amount of period flow. They are often prescribed to treat medical conditions such as ovarian cysts, severe cramps, irregular or absent periods, hormone imbalances, etc., even when a woman does not need the contraceptive effect.

Risks related to combined hormonal contraceptives

Abnormal blood clotting is the primary risk related to the use of combined hormonal contraceptives. In a small number of women the estrogen changes the way that the body forms blood clots. Blood clots may form in the legs, lungs, brain or other vital organs and cause serious health problems. Factors contributing to the risk include:

  • Smoking contributes to narrowing of the blood vessels and slows blood flow; blood clotting occurs more quickly if blood flow is not adequate. Therefore, women are encouraged to STOP SMOKING when they are using any CHC birth control method. The risk is greater when a woman smokes 15 cigarettes or more per day. The risk is greatest when a women reaches 35 years of age. (If you smoke and wish to quit, NDSU has a Tobacco Cessation Program that can help.)
  • Migraine headaches may cause a higher risk of stroke. This risk increases when women who have migraine headaches take estrogen, especially when they experience auras or symptoms such as flashing lights, visual disturbances, weakness affecting one side of the body, difficulty walking, etc., with their migraines. It is important to realize that for most women, the risk of taking CHCs are lower than the risks associated with pregnancy and childbirth.
  • Other contributing factors increasing the risk of blood clotting problems include being overweight, having diabetes, high cholesterol and high blood pressure.

If you experience any of the following symptoms, you should seek medical care immediately. Tell them that you are using hormonal contraception. Note that the first letter of each word spells out the word ACHES.

  • Abdominal pain (severe, sudden onset)
  • Chest pain, shortness of breath, coughing up blood
  • Headache (severe, unrelenting), numbness or weakness in arms or legs
  • Eye problems (sudden vision changes, blurred vision, flashing lights)
  • Severe leg pain in calf or thigh

Side effects related to combined hormonal contraceptives

Side effects are similar among all CHC methods. Most side effects are temporary and seldom serious. Most will occur within the first 1 to 3 months of use and should decrease or disappear quickly as your body adjusts to the medication. Most women will experience only a few of these side effects. If you experience any, or if they last more than three cycles, you should consult with your health care provider.

These are the most common side effects:

  • Spotting or break-through bleeding refers to bleeding that occurs while you are actively taking the birth control pill, or wearing a patch or a ring - in other words, at a time other than your regular period. The bleeding may be only light spotting, or may seem as heavy as a regular period. Contact your health care provider if you have cramps or fever along with the bleeding, or if you notice a change in your normal vaginal discharge prior to the onset of bleeding. If you are on the pill, be sure you are taking it at the same time every day. DO NOT discontinue the pill, patch or ring until you have talked to your health care provider; the bleeding will often subside within the first two months of use.
  • Nausea usually occurs when a woman first begins using a CHC method. It does not usually last more than a few days and rarely causes vomiting. Nausea may be reduced by eating small, frequent meals; if on the pill, trying taking it with food.
  • Breast tenderness may occur at any time in the menstrual cycle, but may be worst just prior to the period. A few women report an increase in breast size/fullness. Contact your provider if you notice a breast lump or notice changes in only one breast. Decreasing your caffeine intake may reduce tenderness.
  • Skin changes/acne may occur initially, but with continued use your complexion will often improve. Infrequently, areas of the skin may spontaneously darken. Contact your health care provider if this occurs.
  • Mood swings, irritability and depression may increase during the first few weeks of CHC use. If it persists or develops into depression it is important to talk with your health care provider.
  • Fatigue may occur in the first month of use but usually tapers off quickly.
  • Weight changes of usually only 3 to 4 pounds may occur, but with the new low dose hormonal methods available, it is less of a problem. Some women report changes in appetitie. Sometimes weight gain is related to fluid retention.
  • Headaches (1) that are more severe than in the past, or (2) that do not respond to over-the-counter remedies, or (3) that are occurring much more frequently. Contact your health care provider right away.

These are the common side effects, but there are more potential side effects that you as an individual may experience. Refer to the health information flyer that comes with each package of hormonal contraceptives for a complete listing. If any symptoms are severe or persist, contact the NDSU Student Health Service (701-231-7331), or your health care provider, or seek other medical service immediately. Click here for a map of all clinic and emergency room locations in Fargo.

If you experience persistent or very unpleasant side effects, we urge you to talk to your health care provider before you stop your birth control method. It may be possible to offer some suggestions that will help you adjust to the medication. If you stop your birth control method, you may be immediately at risk for pregnancy.

Progestin-only contraceptives

Methods include the progestin-only pill (POP) or "mini-pill" and and contraceptive injection. These products do not contain estrogen and therefore may be recommended to women who cannot take estrogen.

Progestin-only Pills (POP)

  • Progestin-only birth control pills must be taken at the same time every day. Varying the time by even a few hours greatly increases the risk of becoming pregnant.
  • Progestin-only pills work by thickening the cervical mucus, making it difficult for sperm to enter the uterus, and by supressing ovulation (although this is not consistent on a month-to-month basis).
  • Irregular periods will occur - this is related to ovulation. Periods will usually be light, but this too will vary on a month-to-month basis.
  • Progestin-only pills are usually prescribed only for those women who cannot or should not use a combined hormonal contraceptive.
  • With typical use, 5% of women using POP will become pregnant within the first year of use. The perfect use rate is 99.5% effectiveness.

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Last Updated: October 08 2007 3:22:58 pm
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