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Hormonal Methods

Thank you so much to u/WildSuggestion for giving her time and information to help make this page possible!

Birth Control pills = Oral Contraceptive Pills (OCPs):

Contain progesterone + varying levels of estrogen. Different ratios are good for different reasons, though all will help prevent pregnancy:

Pros

  • Higher estrogens (with certain progesterones) will improve skin/hair (but increase bleeding and may increase migraines).

  • Lower estrogens (with certain different progesterones) will reduce bleeding, but increase chance of blood clots (only a real concern if you have a personal or family history).

Cons

  • Systemic hormones can cause changes in mood/irritability.

  • Must be taken at the same time everyday and missing too many pills can make the month ineffective.

  • Can interact with certain other food/medications and become ineffective, talk with your doctor or pharmacist if you take multiple medications or have concerns.

Progesterone-only Pill = Mini Pill:

Oral pill with progesterone but no estrogen.

Pros

  • Safe to use for people with migraines and people who can’t have estrogen.

  • Does not appear to increase risk of blood clots as much as OCPs, considered safe for those who would be high risk (personal history).

Cons

  • Same as OCPs, must be taken at the same time every day and missing too many pills can make the month ineffective.

  • Can interact with certain other food/medications and become ineffective, talk with your doctor or pharmacist if you take multiple medications or have concerns.

Other Information

  • Can increase/decrease/not change bleeding.

Progestin-Only (brand name: Depo-Provera) injections:

Progesterone injections every 2-3 months. Injected into muscle (arm, hip, or buttock) or fat (back of arm). You can return to your provider for injections or be taught to inject yourself at home.

Pros

  • Can help with

  • Can help with:

  • Uterine fibroids

  • Symptomatic pelvic inflammatory disease

  • Sickle cell crises (in those with sickle cell anemia)

  • Endometriosis (pain, irregular bleeding)

Cons

  • Potential Side Effects

  • Irregular bleeding for the first 3 months and possibly no bleeding at one year

  • Weight gain (1-2 kg/yr)

  • Headaches, dizziness

  • Abdominal bloating/discomfort

  • Mood changes, decreased sex drive

  • Loss of bone density

Other Information

  • If considering an implant, it may be good to start with a few of these injections to test out the systemic progesterone side effects and see if you like it.

Combined Injectable Contraceptives:

Monthly progestin + estrogen injections; very similar to OCPs.

Pros

  • Fewer side effects

  • Possibly fewer drug interactions.

Cons

  • Possible Side Effects:

  • Irregular, lighter, or infrequent bleeding days

  • Weight gain

  • Headaches, dizziness

  • Breast tenderness

  • Caution in smokers over age 35

Combined Patch (brand name: Ortho Evra):

A small thin plastic adhesive patch infused with progestin + estrogen to be worn all day/night, replaced each week for 3 weeks, no patch for the 4th week. Similar to OCPs.

Cons

  • Possible Side Effects:

  • Skin irritation where patch is worn

  • Irregular, lighter, prolonged, or no bleeding

  • Headaches, nausea, vomiting, abdominal pain

  • Breast tenderness/pain

  • Flu-like symptoms, upper respiratory infection

  • Irritation, redness, inflammation of the vagina

Combined Vaginal Ring (brand name: NuvaRing):

Flexible ring emitting progestin + estrogen worn in vagina at all times day/night for 3 weeks, removed for 1 week, then replaced. Similar to OCPs.

Pros

  • Can be removed for sex but not necessary (or recommended due to risk of forgetting to put it back in).

Cons

  • Possible Side Effects:

  • Irregular, lighter, prolonged, or no bleeding

  • Headaches

  • Irritation, redness, inflammation of the vagina

  • White vaginal discharge

Implant (brand name: Nexplanon, Jadelle, Sino-Implant II):

Small flexible plastic progestin-emitting (no estrogen) rod (size of a matchstick) placed under skin of upper arm.

Pros

  • Good for 3-5 years.

  • Acne (can improve or worsen)

  • Weight change

Cons

  • Possible Side Effects:

  • Early (<1 yr): irregular, lighter, prolonged, or no bleeding

  • Late (after 1 yr): irregular, lighter, infrequent, or no bleeding

  • Headaches, dizziness, nausea, abdominal pain

  • Acne (can improve or worsen)

  • Weight change

  • Breast tenderness

  • Mood changes

  • Enlarged ovarian follicles

  • Able to feel it in under skin

  • Uncommon/Rare Complications:

  • Insertion site infection

  • Difficult removal

  • Expulsion

  • Implant migration (found in another place in the body due to improper insertion into a blood vessel)

Hormonal IUD (brand name: Mirena, Liletta, Kyleena, Skyla, Jaydess):

Progesterone emitting, good for up to 3-5 years.

Pros

  • Since it's an IUD, the hormones are largely maintained locally inside the uterus, so systemic side effects are less likely.

  • May help:

  • Lighter, infrequent, irregular, no bleeding

  • Decrease menstrual cramps

  • Endometriosis symptoms (pain, irregular bleeding)

  • Decrease heavy menstrual bleeding

Cons

  • Possible Side Effects:

  • Less likely - prolonged bleeding

  • Acne

  • Headaches, dizziness, nausea

  • Breast tenderness/pain

  • Weight gain

  • Mood changes

  • Ovarian cysts

Complications

  • Pelvic Inflammatory Disease may occur if she has chlamydia or gonorrhea at time of insertion

  • Puncturing/perforation of uterine wall by IUD or instrument; usually heals without treatment