Birth control pills containing estrogen may not be a good fit for everyone. Oral estrogen increases the risk of dangerous blood clots, so women with a history or high risk of blood clots are advised not to take estrogen-progestin pills. Women who are in the early stages of breastfeeding also are not supposed to take oral estrogen medication.
That’s where progestin-only options most often come in. Progestin is a synthetic mimic for the body’s naturally produced hormone progesterone.
These options offer what some women see as a major advantage: They can regulate menses and lessen cramping and bleeding.
Progestin-only oral pills (POPs)
How well do they work? About 7% of typical users will get pregnant in a year.
The drug norethindrone (Camila, Errin, others) comes in packs where all the pills are active and contain the same amount of progestin. The drug drospirenone (Slynd) has 24 active pills and four inactive ones, meaning you may experience bleeding for those four days. With both of these options, you may experience irregular bleeding or spotting.
Norethindrone pills work in multiple ways to prevent pregnancy, including thickening the mucus that naturally comes from your cervix in order to make it less passable by sperm. They also thin your uterine lining to make it harder for a fertilized egg to implant into it. The progestin dose in these POPs is about a third of the amount in the estrogen-progestin pills. These POPs do not consistently stop ovulation, and 50% of women continue to ovulate.
Slynd mainly works by preventing ovulation.
These pills can cause unscheduled bleeding and worsen acne, but weight gain is not common. Additionally, norethindrone pills may not be for you if you’re not good with routine, as it’s very important to take the pills at the same time every day.
Injections
How well do they work? 6% of typical users will get pregnant in a year.
You can receive progestin through injections of medroxyprogesterone acetate (Depo-Provera) every three months. Depo-Provera typically suppresses ovulation, keeping your ovaries from releasing an egg. It also thickens cervical mucus to keep sperm from reaching the egg.
“That’s a good option. And it used to be very popular, but is losing its popularity to IUDs,” says Suneela Vegunta, M.D.
Injections do come with downsides. They can cause initial irregular bleeding, which many women find inconvenient. However, this may go away with time, and women may eventually experience no period at all. Injections might also cause loss of bone mineral density. Once the injections are stopped, in most women the bone density will largely return back to baseline.
You also have to go into the clinic for the regular injections every three months. There is a subcutaneous injection of the Depo-Provera known as Depo-SubQ Provera 104, and trained individuals can self-administer this at home. Additionally, after stopping Depo-Provera, it might take 10 months or more before ovulation begins again. You will not be able to get pregnant until your resume ovulating.
Other side effects include weight gain, which is more common in younger women. It’s one of the common reasons why women stop using this method.
However, injections can have benefits outside of pregnancy prevention, and because of this may be a good choice for patients with certain medical conditions such as seizure disorder or sickle cell anemia.
Contraceptive implants
How well do they work? Fewer than 1% of users will get pregnant in a year.
You can also receive progestin birth control through an arm implant, known by the brand name Nexplanon, which contains the drug etonogestrel. A small rod about the size of a matchstick is inserted underneath your skin. This is highly effective birth control for three years. It’s inserted during a minor procedure at your healthcare team’s office.
It delivers a low, steady dose of progestin to thicken cervical mucus and thin the lining of the uterus. A contraceptive implant can suppress ovulation as well.
Sometimes the rod can move in the arm, which does potentially make removal more difficult. Like the progestin injections, the implants can cause irregular bleeding, though this usually resolves within a few months. Some of the other downsides are more aesthetic, Dr. Vegunta says.
“A lot of women don’t like feeling that little bump in their arm,” Dr. Vegunta says. “And sometimes it can be visible, so we don’t want our birth control to be visible to other people.”
However, contraceptive implants are highly effective birth control; according to the Centers for Disease Control and Prevention, the failure rate of these implants is 0.1%.
Intrauterine devices (IUDs)
How well do they work? Fewer than 1% of users will get pregnant in a year.
Dr. Vegunta considers IUDs five-star birth control. Like implants, IUDs are over 99% effective at preventing unintended pregnancies. Though placement does require an appointment with a trained professional and office visits to check placement, IUDs are fairly low-hassle options for contraception.
There are two different types of IUDs: hormonal IUD options containing progestin and copper IUDs, which contain no hormones. Levels of progestin in the bodies of those with progestin IUDs are significantly less than what they are in those taking birth control pills, so possible side effects tend to be less with hormonal IUDs. The copper IUD does not limit bleeding; in fact, heavy bleeding is a possible side effect.
Rarely, IUDs come out and women can then get pregnant. It is also possible, though very unusual, for the IUD to poke a hole in the uterus.
“(It’s) highly effective birth control. And it’s reversible; that’s the beauty of it,” Dr. Vegunta says. “Let’s say that somebody has two children, and they say, ‘I’m not really sure whether I want to have another one, but I want to have the option to reconsider at a later time.’ This gives them that option.”
Learn more about the benefits, risks and procedures for IUDs here.
Learn more about what is available now and newer options being approved in this 5 part series on birth control:
Birth control pills and beyond: Exploring your contraception options – Part 1
Looking to maintain a regular cycle? Estrogen-progestin combination options – Part 2
Contraception when you need it – Part 4
Is your family complete? Permanent birth control – Part 5
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