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?
Birth Control Pills
Estrogen/Progesterone (COC)
Theoretical Effectiveness in Preventing Pregnancy: 99.7%
Real World Effectiveness in Preventing Pregnancy: 91%
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
Benefits: Decreases menstrual cramps, makes menstrual periods lighter, more regular and less painful, decreases acne
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
Progesterone Only Pill
Theoretical Effectiveness in Preventing Pregnancy: 99.7%
Real World Effectiveness in Preventing Pregnancy: 91%
How to use: Take a pill daily
Benefits: Reduce blood loss and helps women with anemia
Disadvantages: Have to remember to take a pill daily, have to take pill within the same 3 hours or high failure rate
IUD (hormone) (inserted every 3-5 years)
Theoretical Effectiveness in Preventing Pregnancy: 99.8%
Real World Effectiveness in Preventing Pregnancy: 99.8%
How to use: Inserted by a family doctor or OBGYN
Benefits: may cause very light or no periods, comfortable - you and your partner should not feel the IUD
Disadvantages: may have unscheduled bleeding or spotting, may trigger headaches in a small group of people, may cause weight gain
IUD (copper) (Inserted every 3-5 years)
Theoretical Effectiveness in Preventing Pregnancy: 99.4%
Real World Effectiveness in Preventing Pregnancy: 99.2%
How to use: Inserted by a family doctor or OBGYN
Benefits: comfortable - you and your partner should not feel the IUD
Disadvantages: may cause heavier periods
Depo-Provera Injection (given every 11-13 weeks)
Theoretical Effectiveness in Preventing Pregnancy: 99.8%
Real World Effectiveness in Preventing Pregnancy: 94%
How to use: Injected every 11-13 weeks by a health care provider
Benefits: May cause very light or no periods
Disadvantages: May have side effects such as weight gain
Evra Patch (Skin Patch)
Theoretical Effectiveness in Preventing Pregnancy: 99.7%
Real World Effectiveness in Preventing Pregnancy: 91%
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.
Benefits: Decreases menstrual cramps; makes menstrual periods lighter, more regular and less painful; decreases acne
Disadvantages: Slightly higher risk of blood clots - also has a risk of nausea, bloating and headaches
Nuva Ring (Vaginal Ring)
Theoretical Effectiveness in Preventing Pregnancy: 99.7%
Real World Effectiveness in Preventing Pregnancy: 91%
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
Benefits: Decreases menstrual cramps; makes menstrual periods lighter, more regular and less painful; decreases acne
Disadvantages: Slightly higher risk of blood clots - also has a risk of nausea, bloating and headaches
Nexplanon (Arm implant)
Theoretical Effectiveness in Preventing Pregnancy: 99.95%
Real World Effectiveness in Preventing Pregnancy: 99.95%
How to use: Implant is inserted in the inner upper arm, and is inserted for up to 3 years.
Benefits: May cause very light or no periods
Disadvantages: Requires a surgical procedure
Male Condom
Theoretical Effectiveness in Preventing Pregnancy: 98%
Real World Effectiveness in Preventing Pregnancy: 82%
How to use: New condom is used with each episode of intercourse
Benefits: Protects against STIs
Disadvantages: Some people have latex allergies
Female Condom
Theoretical Effectiveness in Preventing Pregnancy: 94%
Real World Effectiveness in Preventing Pregnancy: 88%
How to use: New condom is used with each episode of intercourse
Benefits: Protects against STIs
Disadvantages: Some people have latex allergies
Male Vasectomy
Theoretical Effectiveness in Preventing Pregnancy: 99.9%
Real World Effectiveness in Preventing Pregnancy: 99.5%
How to use: Surgery completed by a urologist or family doctor
Benefits: No further prevention is required to protect against pregnancy
Disadvantages: Requires surgery which is typically permanent (rarely reversed successfully)
Female Tubal Ligation (i.e. “Tubes Tied”)
Theoretical Effectiveness in Preventing Pregnancy: 99.5%
Real World Effectiveness in Preventing Pregnancy: 99.5%
How to use: Surgery completed by an OBGYN.
Benefits: No further prevention is required to protect against pregnancy
Disadvantages: Requires surgery which is typically permanent (rarely reversed successfully)
Withdrawal Method (“Pull Out”)
Theoretical Effectiveness in Preventing Pregnancy: 96%
Real World Effectiveness in Preventing Pregnancy: 78%
How to use: Male withdraws before ejaculation (high failure rate)
Benefits: No cost
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?
1st day of your menstrual cycle | Start the package on the 1st day of your cycle. Back-up birth control (i.e. condoms) is not required. |
After miscarriage or abortion | Start within 7 days, and use backup birth control for 7 days (i.e. condoms) to reduce pregnancy risk. |
Start the day the prescription is given | Start the pills right away. If it has been more than 5 days since the 1st day of your last menstrual cycle, use a back-up birth control (i.e. condoms) for the 1st 7 days on the pills.
Complete a pregnancy test 2 weeks into the pill package. |
Start on Sunday | Start the pills on the 1st Sunday after your period begins. Doing so avoids bleeding on weekends. If it has been more than 5 days since the 1st day of your last menstrual cycle, use a back-up birth control (i.e. condoms) for the 1st 7 days on the pills.
Complete a pregnancy test 2 weeks into the pill package. |
What should I do if I miss pills?
Miss One Pill | If you miss a pill anywhere in your cycle, please take a pill right away and continue taking your other pills daily. If you notice you missed a pill the day after skipping one, take 2 pills on that day. |
Miss Two Pills | If you miss two or more pills, take one of the missed pills when you remember (this might mean taking 2 pills on the day you remember). For example, if you missed 3 pills, you would take 1 extra pill on the day you remember, and would resume your regular pattern of one pill daily. You would not need to take the 2 other missed pills. |
Miss Two Pills in 1st Week | If you missed 2 pills in the 1st week of your package, AND you had unprotected sex, we recommend you discuss emergency contraception with your pharmacist. |
Miss Two Pills in 3rd Week | If you miss 2 or more pills in the 3rd week of your package (day 15-21), skip the sugar pill week and start a new package. |
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
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