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Combination Hormonal Birth Control

Hormonal birth control options that contain a combination of estrogen and progestin include:

Birth Control Pills

Most oral contraceptives, also referred to as "the pill," contain a combination of female hormones, estrogen and progestin.

Several non-contraceptive benefits of the pill include a reduction in:

  • Menstrual cramps or pain (dysmenorrhea)
  • Acne
  • Iron-deficiency anemia (a low blood count due to low iron levels)
  • Ovarian cancer
  • Uterine cancer

Other non-contraceptive benefits are treatment of:

  • PMS (in many women)
  • Perimenopausal problems

Side Effects

Possible side effects of the pill may include:

  • Nausea, breast tenderness, bloating, and mood changes, which typically improve within two to three months without treatment.
  • Breakthrough bleeding or spotting. This is particularly common during the first few months of taking oral contraceptives and almost always resolves itself without any treatment within two to three months. Missed or late pills can also cause breakthrough bleeding.

If you experience continuing side effects from taking birth control pills, talk with your Women First Care Team. The pill comes in many brands and formulations, and your Care Team can help you find the pill that’s best for you.

When taking the pill, you should notify your Women First Care Team for severe symptoms such as shortness of breath, chest pain, or severe leg pain.

Medication Interactions

The effectiveness of the pill may be reduced if you take certain medications.

Anticonvulsants: Some anticonvulsants, including phenytoin (Dilantin®), carbamazepine (Tegretol®), barbiturates, primidone (Mysoline®), topiramate (Topamax®) and oxcarbazepine (Trileptal®) can decrease the effectiveness of hormonal birth control methods (pill, patch, ring). These medications should be discussed with your doctor. Depo-medroxyprogesterone acetate [Depo-Provera®]) is NOT affected by any of these medications, and it actually reduces seizures in patients who have them, making it a good choice for women with seizures.

Other anticonvulsants DO NOT appear to reduce contraceptive efficacy, including gabapentin (Neurontin®), lamotrigine (Lamictal®), levetiracetam (Keppra®), and tiagabine (Gabitril®). However, there is some concern that oral contraceptives may reduce the effectiveness of lamotrigine, potentially increasing the risk of seizures.

Antibiotics: Rifampin, which is sometimes used to treat tuberculosis, can decrease the efficacy of hormonal birth control.

Other antibiotics (e.g., penicillin, cephalexin) DO NOT affect the efficacy of hormonal birth control methods.

St. John's Wort: St. John's wort, an herbal supplement sometimes taken to treat depression, may reduce the effectiveness of birth control pills.

Starting the Pill

When to expect a period: When the pill is taken on a 28-day cycle with 21 days of hormone pills followed by 7 days of placebo pills ("sugar pills"), your period usually occurs during the fourth week of the pill pack, i.e., the “placebo week.” However, some women have irregular breakthrough bleeding or spotting in the first few months. It is not necessary to take the placebo pills, but some women find it easier to remember to start their next pill pack if they have taken the placebos.

Shorter pill-free interval: Several pill formulations are available with 24 days of hormone pills (rather than 21) and only four days of placebo pills. This approach is designed to shorten and lighten periods, and minimize pill failures and side effects.

Continuous dosing: Some women prefer to take birth control pills continuously, which allows you to have fewer days of menstrual bleeding per year. This regimen is a particularly good treatment if you experience painful periods or endometriosis, as well as if you want to avoid a monthly bleed.

Some pills are designed and packaged for extended continuous dosing to have a period only every 3 months. Taking an oral contraceptive for an extended time results in fewer periods per year, although you may experience breakthrough bleeding when starting this regimen. Breakthrough bleeding is inconvenient, but does not indicate an increased risk of pill failure (unless you’ve forgotten to take any pills).

Traditional birth control pill packs can also be used in continuous dosing. In this regimen, you take the first three weeks of a pill pack (all the active pills), then immediately start a new pack (without a break); the last week of (placebo) pills is not used. This can be continued for as long as desired. This works best when all the active pills are the same pills (mono phasic not triphasic).

Birth Control Patch

Birth control patches contain estrogen and progestin—similar to oral contraceptives—and are a week of pills in patch form. The patch is as effective as oral contraceptives and may be preferred since it does not require daily dosing. The failure rate of the patch may be higher for women who weigh more than 198 pounds.

Xulane® is the only patch contraceptive available in the United States. Effectiveness is similar to that of oral contraceptive pills.

The patch is worn for one week on the upper arm, shoulder, upper back, abdomen, or hip. After one week, the old patch is removed and a new patch is applied.

This is a great option for women who like birth control pills but don’t like daily responsibility. Risks and side effects are similar to those of oral contraceptives. Learn more about the patch here.

Vaginal Ring

Nuvaring® is a soft flexible vaginal ring that contains estrogen and progestin, which is slowly absorbed through the vaginal tissues. The ring is changed monthly, and its position inside the vagina is not important.

Most women cannot feel the ring, and it is easy to insert and remove. If the ring is left out for more than 3 hours, a backup method of birth control (e.g., condom) should be used for the next 7 days.

This is a great option for women who like birth control pills but don’t like daily responsibility. Risks and side effects are similar to those of oral contraceptives. This is essentially a monthly pack of pills in vaginal ring form.

Learn more about Nuvaring here.

If you are using a hormonal method of birth control (pill, patch, vaginal ring), be sure to take the next dose (or apply a new patch or insert a new ring) on schedule, even if you have not had your menstrual period. Being late getting back on your pill pack or patch or ring is one of the most common causes of contraception failure. If you are late starting the next pack of pills, patch, or vaginal ring, be sure to use an additional method of birth control. Contact your Women First Care Team for additional information.

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