The birth control pill is the most popular form of hormonal birth control in most countries. But there are other types, including some new forms, that allow you to have more options as you choose a contraceptive. In addition to the pill, you can also use the vaginal ring, skin patch, implant, intrauterine device (IUD), or birth control injection. The vaginal ring and the skin patch are the newest forms of hormonal birth control.
Each of these options will affect your hormone levels. Most of these forms will stop ovulation, which is when a mature egg leaves your ovaries. This prevents pregnancy.
How Has Hormonal Birth Control Changed?
Hormonal birth control options have come a long way. Experts continue to work on different forms so that they can be safer and cause less side effects. These include:
The birth control pill. The FDA approved the first birth control pill in 1960. It had 150 micrograms of artificial estrogen, which experts called mestranol. This pill tended to cause intense side effects like nausea, vomiting, and breast pain.
Since then, researchers have worked to create a better version of hormonal birth control that doesn’t come with such severe side effects. Today’s birth control pills usually have around 20-30 micrograms of estrogen alongside another hormone, progestin.
But modern birth control pills still can cause unwanted side effects. And if you use birth control with artificial estrogen, you’re more likely to develop harmful blood clots than those who don’t take it.
In 2021, the FDA approved another hormonal birth control pill called Estelle. This version contains estetrol, which is estrogen that occurs naturally in humans, and progestin drospirenone. During its clinical trials, experts found that it was 98% effective in pregnancy prevention. This is similar to other forms of the birth control pill.
But with Estelle, you may have less side effects than with other birth control pills. This is because it doesn’t contain ethinyl estradiol, which is the artificial estrogen that’s in most birth control pills. Instead, Estelle contains E4, a natural estrogen made during pregnancy that can be synthesized from a plant source and will only act on certain tissues in your uterus.
In early studies, experts found that hormones in Estelle don’t affect cell receptors in your breast tissue as much as hormones in other birth control pills do. This means that you’ll have less breast pain and tenderness. People who take Estelle have also said that they don’t have as much spotting in between periods.
Research has shown that this pill may even have a lower risk of blood clotting than other birth control pills, which heighten your risk.
The FDA has also approved versions of birth control pills that lower the risk of ovulation. If you ovulate, you’re more likely to get pregnant. Birth control pills usually contain 21 days of hormone pills and 7 days of sugar pills without hormones. But these different options allow for either 24 days of hormone pills and 4 days of sugar pills, or 84 days of hormone pills and 7 days of sugar pills.
With these options, you’ll still bleed normally, it just won’t happen for as long or as often, like in traditional birth control pills.
Vaginal rings. This form of hormonal birth control isn’t a pill. Instead, it’s a ring that you put in and take out yourself. Experts call this type of birth control a semi-long acting or mid-acting method. This is because you’ll leave it in for 3 weeks and take it out for 1 week. You won’t have to worry about a daily pill, but you also won’t have to commit to a long-term insert like an IUD.
The ring releases hormones and your vagina quickly soaks them up. This prevents ovulation. It may be a better choice for you if you don’t want to take a pill but also don’t want a doctor to have to insert something into your body.
NuvaRing, Annovera, and EluRyng are approved versions in the United States. But experts continue to look into new vaginal ring options.
Transdermal (through your skin) options. These forms of hormonal birth control include patches, gels, and skin spray.
Ortho Evra and Twirla are birth control patches that release hormones. You can use these patches for 3 weeks and then take them off for 1 week to bleed. Studies show that many people like the patch and find it easy to use.
Experts continue to look into different patch options. One that’s under study stopped ovulation in all of the people who were in the study. Another patch that experts continue to look at only uses progestin. This might be useful for people who can’t take estrogen or those who breastfeed.
Researchers continue to look at other options to put on your skin. They’ve studied:
- A gel that may be able to effectively stop ovulation
- A fast-drying spray that can deliver hormones to stop ovulation
- A gel that you can use “on-demand,” which would be especially useful for people who only have occasional sex and don’t need consistent birth control
IUDs. Mirena, one type of hormonal IUD, is highly effective. It can also treat heavy bleeding during periods.
Other similar options are in clinical trials. These would lessen bleeding even further. So far, these options seem to work for 3 years and they don’t have many side effects.
Implants. Implanon and Nexplanon are hormonal birth control implants that the FDA has approved. They are about 99% effective over 3 years.
There are other options in development that may be better for people who breastfeed. Experts want to make sure that the breastfeeding baby receives no hormones from this type of birth control. But studies showed that these versions may be less effective for people who don’t breastfeed.
Injectables. These options only contain progestin. The two most common options in the U.S. are norethisterone enanthate (NET-EN) and DMPA or Depo-Provera. But experts have found that DMPA without estrogen might lead to lower bone mineral density in young women. Because of this, experts suggested that people only use DMPA in lower doses and for only 2 years.
A study compared DMPA and NET-EN and saw no difference in how well they prevent pregnancy. But researchers noticed that people who took DMPA were more at risk for a loss of their period.
Experts continue to look into injections that last longer as well as ones that you can use to inject yourself, without help from a trained professional.
Photo Credit: Mindful Media / Getty Images
Institute for Quality and Efficiency in Health Care: “Contraception: Hormonal Contraceptives.”
UpToDate: “Patient education: Hormonal methods of birth control (Beyond the Basics).”
Nature: “Better Birth Control.”
NHS: “Can I get pregnant just after my period has finished?”
Contraception: “Contraception Technology: Past, Present, and Future.”