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Birth Control Pills, Patch, or Ring

Birth Control Pills, Patch, or Ring

Examples

Very low-dose pills

Generic Name Brand Name
desogestrel and ethinyl estradiol Mircette
drospirenone and ethinyl estradiol YAZ
levonorgestrel and ethinyl estradiol Lybrel
norethindrone and ethinyl estradiol LoEstrin

Low-dose pills

Generic Name Brand Name
drospirenone and ethinyl estradiol Yasmin
levonorgestrel and ethinyl estradiol Seasonale, Seasonique
norgestrel and ethinyl estradiol Lo/Ovral

Phasic pills

Generic Name Brand Name
levonorgestrel and ethinyl estradiol Trivora
norethindrone and ethinyl estradiol Ortho-Novum 7/7/7
norgestimate and ethinyl estradiol Ortho Tri-Cyclen Lo
dienogest and estradiol valerate Natazia

High-dose pills

Generic Name Brand Name
ethynodiol and ethinyl estradiol Zovia
norethindrone and mestranol Norinyl

Note:

This is not a complete list of all brand-name birth control pills available.

Skin patch

Generic Name Brand Name
ethinyl estradiol and norelgestromin Ortho Evra patch

Vaginal ring

Generic Name Brand Name
ethinyl estradiol and etonogestrel NuvaRing

Birth control pills

Very low-dose and low-dose pills generally have less estrogen than other pills.

Phasic pills have changing levels of estrogen and 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 nonhormonal pills.

How It Works

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 may help relieve some of the symptoms women have in the years before menopause.

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 pills without hormones (sugar pills) for the fourth week, and some do not. During that fourth no-hormone week, you have your menstrual period. After the fourth week (28 days), you start a new pack.

For some kinds of pills, such as 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.

Another kind of pill, such as 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. (4.5 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.

Why It Is Used

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 may help relieve some of the symptoms women have in the years before menopause (perimenopause).
  • Treat polycystic ovary syndrome (PCOS) problems. Birth control hormones may help control PCOS problems. Certain pills may improve acne problems, excess hair growth, and male-pattern hair loss related to PCOS.
  • Prevent some diseases. Taking birth control hormones lowers ovarian cancer risk.1 For women with a risk of endometrial cancer, taking progestin with estrogen helps lower that risk.2
  • Relieve PMS-related problems. Certain birth control pills, such as Yasmin and Yaz, have a type of progestin hormone that reduces water retention (bloating) during the menstrual cycle. This type of pill may also help relieve symptoms of premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome.

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

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.

How Well It Works

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.3 Of women who take their pills every day, only 3 out of 1,000 become pregnant each year.3 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.4

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.1

Side Effects

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 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.

Some types of progestin used in certain birth control pills may cause a greater risk of blood clots than other types of progestin in birth control pills. Talk to your doctor about your risk of blood clots when deciding which pill is best for you.

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.)

What To Think About

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. When you start using hormonal birth control, be sure to tell your doctor about all medicines and supplements you are taking.
  • If you want to be able to start a planned pregnancy soon after you stop long-term use of birth control hormones, hormone shots (such as 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.

References

Citations

  1. Abramowicz M (2010). Choice of contraceptives. Treatment Guidelines From the Medical Letter, 8(100): 89–96.
  2. Fraser IS, Kovacs GT (2003). The efficacy of non-contraceptive uses of hormonal contraceptives. Medical Journal of Australia, 178(12): 621–623.
  3. Nelson A (2007). Combined oral contraceptives. In RA Hatcher et al., eds., Contraceptive Technology, 19th ed., pp. 193–270. New York: Ardent Media.
  4. Trussell J (2007). Choosing a contraceptive: Efficacy, safety, and personal considerations. In RA Hatcher et al., eds., Contraceptive Technology, 19th ed., pp. 19–47. New York: Ardent Media.

Credits

By Healthwise Staff
Sarah Marshall, MD - Family Medicine
Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
Last Revised May 3, 2012

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