|very low-dose pills
||Alesse, Loestrin 1/20, Mircette
||Lo/Ovral, Seasonale, Yasmin
||Ortho-Novum 7/7/7, Ortho Tri-Cyclen Lo, Triphasil
||Demulen 1/50, Ortho-Novum 1/50, Ovral
This is not a complete list of all brand-name birth control
|20 mcg estrogen, plus progestin
||Ortho Evra patch
|15 mcg estrogen, plus progestin
Very low-dose pills have 20 mcg of estrogen plus
Low-dose pills have 30 to 35 mcg estrogen plus
Phasic pills have changing levels of estrogen and
High-dose pills have about 50 mcg of estrogen plus
How It Works
Birth control pills, also called oral
contraceptives, control the body's
progesterone levels (progestin is a synthetic form of
the body's progesterone).
Even though estrogen and progestin have
a role in
uterine fibroid growth, birth control pills do not
affect the size of fibroids. birth control
improve heavy menstrual bleeding, which can be
caused by uterine fibroids.
Birth control pills:
- Prevent the ovaries from releasing an egg every
month (ovulation). This prevents pregnancy.
Minimize the growth of the uterine lining, called the
endometrium. This reduces or stops
dysfunctional uterine bleeding (thick endometrial
growth leads to heavy bleeding).
- Can stop
menstrual periods if taken for a long period of time.
This effect can last until several months after you stop taking them.
If you prefer to use a birth control patch or vaginal ring,
see how to use the contraceptive skin patch or
how to use the vaginal hormonal contraceptive ring.
Why It Is Used
Birth control pills are commonly
prescribed to lighten heavy menstrual bleeding with or without uterine
fibroids. This is because birth control pills can help correct menstrual
problems, and they are a low-risk treatment for most women.
Generally, birth control hormonal pills, skin patches, or vaginal rings are
good choices for women who have one or more of the following concerns:
- Need short- or long-term birth control that can
be stopped at any time
- Prefer a form of birth control that does not
interfere with sexual spontaneity
- Have heavy, painful, or irregular
- Have a family history of
ovarian cancer. Combination pills reduce the risk of ovarian cancer after 1
year of use. This benefit seems to last for years after stopping the
How Well It Works
Birth control pill use reduces
heavy, prolonged, and painful menstrual bleeding. Because the pills prevent
pregnancy, they are not a choice for women who are trying to become
Birth control pill use does
not affect the size of uterine fibroids.3
Birth control pills have been studied
for many years and are considered very safe.
Common side effects
The most common side effects
are changes in menstrual periods, including:
- Very light or
- Bleeding between periods
(spotting), which usually decreases after using a hormonal method for 3 to 4
The contraceptive skin patch may
cause skin irritation at the site.
The contraceptive vaginal ring may cause:
Less common side effects
Less common side effects
of combination hormonal methods include:
Nausea and vomiting, especially during the
first month of use. (Try taking your pill with your evening meal or at bedtime
and then sleeping through the high-hormone hours that can cause nausea. Or take
your pill with breakfast, if nausea bothers you at night.) This side effect is
least likely with the vaginal ring. Nausea usually goes away after the first
few months of use. If not, a lower dose of estrogen may help.4
- Frequent or more severe headaches.
Migraine headaches may get worse. This side effect is
least likely with the vaginal ring.
- Breast tenderness for the first
Uncommon side effects
Side effects that are
sometimes reported with hormonal birth control use include:4
Weight gain. (Although some women report
weight gain with birth control pill use, studies suggest that generally,
long-term weight gain is not a common side effect.5)
- 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
- Decreased interest in sex.
Rare but serious side effects of combination hormonal methods
The risk of a serious side effect increases with age and
with smoking. Rare, but more serious, side effects include:
- High blood pressure.
- Blood clots in a vein (deep vein thrombosis) or lung (pulmonary embolism).
- Possible increased risk of cervical cancer. (See
Does the Pill cause cancer?)
The following symptoms, called ACHES, are rare but serious. Report any of these to your
health professional immediately.6
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.
may be a sign of blood clots in the lungs (pulmonary embolism),
heart attack, or heart disease. Smoking increases this
Headaches that are severe may be a
migraine, or high blood pressure. Smoking increases
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
pain or sudden swelling of one leg may be a sign of leg blood clots
(thrombophlebitis) or deep vein thrombosis (DVT).
Report any serious side effect to your health
professional for immediate follow-up.
Report bothersome side
effects to your health professional at your next regularly scheduled
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
What To Think About
Combination hormonal pills, skin
patches, and vaginal rings have similar possible side effects because they all
contain a combination of estrogen and progestin. 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 than the pill
or patch to cause headaches and nausea.4
Birth control hormones may not relieve your uterine fibroid symptoms.
They do not shrink fibroids.3 They may, however,
improve heavy menstrual bleeding.
- The patch delivers more estrogen than
low-dose birth control pills do. Some research has found that women using the
patch are more likely to get dangerous blood clots in the legs and lungs. The
risk may be higher if you smoke or have certain health problems. The U.S. Food
and Drug Administration (FDA) suggests that you 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.
Do not use birth control
hormones if you:
- Are older than 35 and smoke, have
diabetes, or have an increased risk of heart
- Have a personal history of
breast cancer. Estrogen stimulates certain types of
Birth control hormones are not generally recommended if you
have any of the following conditions:
- Uncontrolled high blood
- Liver disease
- A history of blood clots in a
vein (deep vein thrombosis) or lung (pulmonary embolism)
- A history
- Migraine headaches with aura
For women older than 35, low-dose birth control pills are
recommended. If you have no risk factors, such as a history of heart problems
or diabetes, you may use birth control pills until you reach
menopause. This is when you have had no menstrual
periods for 1 year. Birth control pills are not recommended for use after
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Abramowicz M (2004). Choice of contraceptives.
Treatment Guidelines From The Medical Letter, 2(24):
Speroff L, Fritz MA (2005). Oral contraception. In
Clinical Gynecologic Endocrinology and Infertility, 7th
ed., pp. 861-942. Philadelphia: Lippincott Williams and Wilkins.
Haney AF (2008). Leiomyomata. In RS Gibbs
et al., eds., Danforth's Obstetrics and Gynecology, 10th
ed., pp. 916-931. Philadelphia: Lippincott Williams and
Hatcher RA, et al. (2004). Combined (estrogen and
progestin) contraceptives. In A Pocket Guide to Managing Contraception, pp. 97-119. Tiger, GA: Bridging the Gap
Kaunitz AM (2001). Oral contraceptive use in
perimenopause. American Journal of Obstetrics and Gynecology, 185(2, Suppl): S32-S37.
Hatcher RA, et al. (2004). A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation.