Birth Control Pills & Patch

The following page includes commonly asked questions and guidance about how to use your birth control medication.

What are the types of birth control available?

  1. Birth Control Pills

    1. Estrogen/Progesterone (COC)

      1. Theoretical Effectiveness in Preventing Pregnancy: 99.7%

      2. Real World Effectiveness in Preventing Pregnancy: 91%

      3. How to use: Take a pill daily for 21 or 24 pills, followed by 4 or 7 hormone-free pills (depending on the brand) that triggers a bleed

      4. Benefits: Decreases menstrual cramps, makes menstrual periods lighter, more regular and less painful, decreases acne

      5. Disadvantages: Have to remember to take a pill daily, not all women can use birth control pills containing estrogen due to stroke risk, slightly higher risk of blood clots, also has a risk of nausea, bloating and headaches

    2. Progesterone Only Pill

      1. Theoretical Effectiveness in Preventing Pregnancy: 99.7%

      2. Real World Effectiveness in Preventing Pregnancy: 91%

      3. How to use: Take a pill daily

      4. Benefits: Reduce blood loss and helps women with anemia

      5. Disadvantages: Have to remember to take a pill daily, have to take pill within the same 3 hours or high failure rate

    3. IUD (hormone) (inserted every 3-5 years)

      1. Theoretical Effectiveness in Preventing Pregnancy: 99.8%

      2. Real World Effectiveness in Preventing Pregnancy: 99.8%

      3. How to use: Inserted by a family doctor or OBGYN

      4. Benefits: may cause very light or no periods, comfortable - you and your partner should not feel the IUD

      5. Disadvantages: may have unscheduled bleeding or spotting, may trigger headaches in a small group of people, may cause weight gain

    4. IUD (copper) (Inserted every 3-5 years)

      1. Theoretical Effectiveness in Preventing Pregnancy: 99.4%

      2. Real World Effectiveness in Preventing Pregnancy: 99.2%

      3. How to use: Inserted by a family doctor or OBGYN

      4. Benefits: comfortable - you and your partner should not feel the IUD

      5. Disadvantages: may cause heavier periods

    5. Depo-Provera Injection (given every 11-13 weeks)

      1. Theoretical Effectiveness in Preventing Pregnancy: 99.8%

      2. Real World Effectiveness in Preventing Pregnancy: 94%

      3. How to use: Injected every 11-13 weeks by a health care provider

      4. Benefits: May cause very light or no periods

      5. Disadvantages: May have side effects such as weight gain

    6. Evra Patch (Skin Patch)

      1. Theoretical Effectiveness in Preventing Pregnancy: 99.7%

      2. Real World Effectiveness in Preventing Pregnancy: 91%

      3. How to use: Use the patch on the skin for a patch, then replace it weekly for a patch-free week. The 4th week is patch-free to allow for a bleed.

      4. Benefits: Decreases menstrual cramps; makes menstrual periods lighter, more regular and less painful; decreases acne

      5. Disadvantages: Slightly higher risk of blood clots - also has a risk of nausea, bloating and headaches

    7. Nuva Ring (Vaginal Ring)

      1. Theoretical Effectiveness in Preventing Pregnancy: 99.7%

      2. Real World Effectiveness in Preventing Pregnancy: 91%

      3. How to use: Ring is inserted into the vagina and left in place for 21 days; the ring is removed for 7 days to allow a bleed before another one is inserted

      4. Benefits: Decreases menstrual cramps; makes menstrual periods lighter, more regular and less painful; decreases acne

      5. Disadvantages: Slightly higher risk of blood clots - also has a risk of nausea, bloating and headaches

    8. Nexplanon (Arm implant)

      1. Theoretical Effectiveness in Preventing Pregnancy: 99.95%

      2. Real World Effectiveness in Preventing Pregnancy: 99.95%

      3. How to use: Implant is inserted in the inner upper arm, and is inserted for up to 3 years.

      4. Benefits: May cause very light or no periods

      5. Disadvantages: Requires a surgical procedure

    9. Male Condom

      1. Theoretical Effectiveness in Preventing Pregnancy: 98%

      2. Real World Effectiveness in Preventing Pregnancy: 82%

      3. How to use: New condom is used with each episode of intercourse

      4. Benefits: Protects against STIs

      5. Disadvantages: Some people have latex allergies

    10. Female Condom

      1. Theoretical Effectiveness in Preventing Pregnancy: 94%

      2. Real World Effectiveness in Preventing Pregnancy: 88%

      3. How to use: New condom is used with each episode of intercourse

      4. Benefits: Protects against STIs

      5. Disadvantages: Some people have latex allergies

    11. Male Vasectomy

      1. Theoretical Effectiveness in Preventing Pregnancy: 99.9%

      2. Real World Effectiveness in Preventing Pregnancy: 99.5%

      3. How to use: Surgery completed by a urologist or family doctor

      4. Benefits: No further prevention is required to protect against pregnancy

      5. Disadvantages: Requires surgery which is typically permanent (rarely reversed successfully)

    12. Female Tubal Ligation (i.e. “Tubes Tied”)

      1. Theoretical Effectiveness in Preventing Pregnancy: 99.5%

      2. Real World Effectiveness in Preventing Pregnancy: 99.5%

      3. How to use: Surgery completed by an OBGYN.

      4. Benefits: No further prevention is required to protect against pregnancy

      5. Disadvantages: Requires surgery which is typically permanent (rarely reversed successfully)

    13. Withdrawal Method (“Pull Out”)

      1. Theoretical Effectiveness in Preventing Pregnancy: 96%

      2. Real World Effectiveness in Preventing Pregnancy: 78%

      3. How to use: Male withdraws before ejaculation (high failure rate)

      4. Benefits: No cost

      5. Disadvantages: Not very effective, may decrease sexual pleasure for both partners

What is birth control used for?

  • Preventing pregnancy - the most common reason for birth control is to prevent pregnancy. Birth control pills work in many ways, but the most important way is to send a signal to your brain not to release an egg.

  • Menstrual Pain - Birth control pills can be used for managing menstrual and mid-cycle pain. In some women with a diagnosis of endometriosis or chronic pelvic pain, birth control pills can be used continuously (i.e. skipping the hormone pills) and is often a better way to control pain symptoms than having a monthly bleed.

  • Acne and Hair Growth - Birth control pills help with suppressing male hormones that are responsible for acne and hair growth in women (i.e. facial hair growth). In some conditions like PCOS (polycystic ovarian syndrome), birth control is an effective way to improve acne, regulate cycles and prevent unnecessary hair growth.

What hormones are in birth control?

Nearly all birth control pills contain two hormones - estrogen and progesterone - two hormones your body naturally produces. These pills are called Combined Oral Contraceptives (COCs). One type of birth control, called Micronor, is a progesterone-only pill.

What are Combined Oral Contraceptives (COCs)?

Combined oral contraceptives (COCs) are birth control pills that contain both estrogen and progesterone. All birth control pills contain generally the same estrogen (ethinyl estradiol) but have different progesterones (i.e. cyproterone, desogestrel, drospirenone, levonorgestrel, norethindrone). The strength of the estrogen, and the type of progesterone vary between pills.

Is Micronor or the Mini Pill a COC?

Micronor, or the ‘mini pill’ is not a combined hormonal contraceptive as it has only one hormone, progesterone. It does not contain any estrogen.

What are the risks with estrogen?

Estrogen carries a number of risks for individuals with specific medical conditions. If you do not have a listed medical condition below, birth control pills are generally very safe.

Hormonal contraception containing estrogen carries a slightly higher risk of developing blood clots in your legs, arms, lungs or brain. This risk is approximately 3x what it is for someone not on hormonal contraception, but the total or absolute risk is very low (3-15 women in 10,000 will get a blood clot after 1 year on birth control). This risk is greatest in the 1st year of contraception and declines over time. The risk is less than for someone who is pregnant.

What are the benefits of COCs?

Aside from pregnancy prevention, regulating menstrual cycles and reducing flow associated with menstrual cycles, COCs have a number of other benefits. These include but are not limited to:

  • Reduce undesirable hair growth

  • Improvement in acne

  • Reduce lifetime risk of endometrial cancer

  • Reduce lifetime risk of ovarian cancer

  • Reduce lifetime risk of colorectal cancer

  • Reduce the formation of new ovarian cysts

  • Help with symptoms of pre-menstrual dysphoric disorder

  • Help with endometriosis pain

Do COC’s have long-term effects on my fertility?

  • No. Return to your age-specific fertility occurs typically no later than 90 days after stopping birth control. The pregnancy rate for women who stop using birth control matches those who have never been on birth control after they have stopped birth control. Remember, your fertility rate drops significantly after age 35, so talk with a health care provider about managing your fertility after or before this age.

Who should not be on COC birth control?

People with the following medical conditions should not be on COCs (i.e. pills with estrogen):

  • Have a history of breast cancer

  • < 42 days postpartum (i.e. first 42 days after having a baby)

  • Liver cirrhosis

  • History of Deep Vein Thrombosis or Pulmonary Embolus (blood clots in veins or lungs)

  • Recent surgery requiring you to be bed-bound

  • Diabetes for more than 20 years

  • Diabetes for less than 20 years with kidney, eye or nerve damage

  • Symptomatic gallstones

  • Migraines with auras (aura = neurological symptoms like vision changes, muscle weakness, numbness, etc)

  • Some people who have had bariatric surgery

  • High blood pressure or are on high blood pressure pills

  • Heart Disease (i.e. have plaque in your arteries, or had stunting or a cardiac bypass)

  • Have a predisposition to blood clots (AT Deficiency, Protein C or S deficiency, Factor V Leiden, Prothrombin mutation)

  • Hepatocellular adenoma

  • Liver Cancer

  • Have multiple risk factors for heart disease (i.e. high cholesterol, smoking, older age)

  • Multiple Sclerosis specifically with reduced mobility

  • Cardiomyopathy

  • Smoking and over 35

  • Some people who had had a solid organ transplant

  • Have had superficial venous thrombosis

  • Lupus

  • Heart valve disease

  • Some antibiotics (rifampin)

  • Take seizures medications (lamotrigine, phenytoin, carbamazepine, topiramate, oxcarbazepine)

  • On some antivirals used for PrEP (foamprenavir)

Who should be on a progesterone-only pill?

  • Women who cannot take COCs should be on a progestin-only pill.

  • Women who don’t want estrogen exposure

Who should not be on a progesterone-only pill?

  • History of breast cancer

  • Liver Cirrhosis

  • Some types of bariatric surgery

  • Hepatocellular Adenoma

  • Liver Cancer

  • Heart disease

  • Prior stroke or mini-stroke (TIA)

  • Lupus

  • Some antibiotics (rifampin)

  • Take seizures medications (lamotrigine, phenytoin, carbamazepine, topiramate, oxcarbazepine)

Does birth control increase my risk of cancer?

  • Birth control has actually been demonstrated to reduce the risk of ovarian and endometrial cancer. It does not cause breast cancer, but we do not use birth control in women with a breast cancer history because estrogen can ‘feed’ some types of breast cancer. Taking oral contraceptives does not increase your chance of breast cancer whatsoever. There is a small increase for cervical cancer, which declines after you stop birth control.

What are the different types of birth control pills?

Most birth control pills are mono-phasic - that means a single dose of estrogen and progesterone in all the hormone pills in the package. Nearly all birth control pills prescribed by doctors are mono-phasic pills.

Some pills are multi-phasic - that means the hormone strength in each package changes from one week to the next. Most of the time, it is the progesterone dose that is changed (i.e. Linessa, Tri-Cyclin, Tri-Cyclin Lo) but in other cases it is the estrogen pill (i.e. Triquilar). Multi-phasic pills were originally developed to reduce hormonal side effects including irregular bleeding, but to date, there is no evidence that they are different than monophonic pills.

How many pills are hormone pills in a package?

Most pill packages come in a 28-day format. Typically, 21 of the pills are hormone pills, and 7 of the pills are placebo (sugar) pills. Many hormone pills now come in a 24/4 package (24 hormone pills, 4 ‘sugar’ pills). Pharmacies also offer pills in a 21-day formats (no sugar pills).

What is the benefit of a higher estrogen or a 21-day brand vs. A 24-day brand?

Higher estrogen doses and 21-day pill packages have lower rates of breakthrough or irregular bleeding. Not all women experience this side effect, so if you are not experiencing breakthrough bleeding, there is no need to change birth control brands.

How do I start birth control?

What should I do if I miss pills?

What happens if I wait before starting my next birth control package?

If you are on combined contraceptive pills and your packages contain placebo pills, delaying starting your package when your current package finishes increases your chance of pregnancy.

Do birth control pills increase my risk of blood clots?

Yes, combined oral contraceptives (estrogen-progesterone pills) increase your risk of blood clots by 3-4x compared to women who do not use hormonal birth control pills. The risk of blood clots is greatest in the 1st year of birth control. Pregnancy, by contrast, carries a higher risk of blood clots of approximately 4-5x. The rate is quite low, however.

When should I stop taking birth control?

Birth control pills are considered generally safe until the age of 50 in non-smoking women. Most health care providers will stop birth control at the age of 50.

What should I do if I have breast tenderness?

  • Take your pills at bedtime

  • Do a home pregnancy test

  • Talk with your doctor about changing your pill to one with a lower estrogen dose and progesterone

  • Talk with your doctor about trying a birth control pill with a progesterone called drospirenone

I don’t want a contraceptive which affects my hormones. Will a hormone IUD affect my whole body?

Hormonal IUDs (Mirena, Kyleena) do not have whole-body effects. For example, birth control pills exert a contraceptive effect by suppressing ovulation at the level of the brain. IUDs work by affecting the lining of the uterus and do not suppress ovulation at the level of the brain. Hormonal IUDs are a great choice for women who desire lighter or absent menstrual flow and want to avoid the systemic (‘whole body’) effects of hormonal birth control pills or depo-proverb injection.

Migraines and Combined Hormonal Contraceptives

What's the definition of a migraine?

It is a 'recurrent headache disorder manifesting in attacks lasting 4-72 hours.' And it requires:

  • At least 5 attacks

  • Has two of the following four characteristics

    • One-sided

    • Pulsatile quality

    • Moderate or Severe Pain

    • Worse with routine activity (climbing stairs)

  • During the headache, you have either/both:

    • Nausea and/or Vomiting

    • Light sensitivity and Sound Sensitivity

What is a migraine with aura?

You experience visual, sensory and/or speech/language symptoms.

Examples of aural symptoms include:

  1. Vision: vision loss (spot or shape), may involve a quarter, half or entire visual space

  2. Sensory: tingling, numbness or pain

  3. Motor: weakness in a muscle group (face, eyes, arms/legs)

  4. Language: difficulties finding words or articulating

To qualify as an aura, you have to have 2 of the following 4 characteristics

  • 1 aural symptom, spreading gradually over 5 minutes, or 2 or more symptoms in succession

  • Each aural symptom lasts 5-60 minutes

  • Headache starts within 60 minutes of an aura

  • At least one of the aural symptoms is on 1 side of your body

What is not an aura?

Blurring, floaters or flashes lasting a few seconds before or during a migraine do not meet our medical criteria for an aura.

Why are migraines with aura relevant to combined hormonal contraception (COC, estrogen-containing) birth control?

Women with migraines are at a 2-4 x increased risk of stroke on combined hormonal contraception. The risk is higher in women with aura, so current guidelines dictate that COCs should not be prescribed to women with migraine headaches of the aural subtype.

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