Birth Control Pills Explained

Why are there so many types of birth control pills and what are the differences? What are other benefits of birth control pills besides contraception? And one of the biggest questions: why are there so many brands for the same pill? Find out!

What birth control pill is best for me?

You need a prescription for oral contraceptives so getting the pill that's best for you requires communication between you and your physician. How do you talk to your doctor about oral contraceptives?

Guide to Choosing Birth Control Pills

Make a list about you! 

Focus on what you already know about your body. Write a quick list detailing your medical history including medications, hereditary risk, and how your body reacts to different environments, food and days in your cycle. Sex hormones whether from medication or your own body affect skin, GI, body mass, libido, mood, appetite and more. Share this list along your concerns, your lifestyle and expectations for birth control with your doctor.

Match your choice with your lifestyle

Women who are physically active - especially women who participate in sports 1 - tend to favor birth control pills that make periods lighter or less frequent. All birth control pills are expected to lighten periods, but if having your periods only four times a year seems like a dream, then ask about extended cycle choices.

Extended birth control pills, also called continuous cycle, make a woman have her period every 90 days instead of every 30. That's 4x per year, and the bleeding is usually lighter with less severe symptoms. 

What hormones are in birth control pills?

Natural estrogen and progesterone are crucial to reproduction. Lab-made weaker versions of them prevent pregnancy rather than support it. Pills either contain just synthetic progesterone called a progestin or a combination of a progestin and synthetic estrogen.

There are several synthetic estrogens used in medication but only two are used in birth pills. The most common is ethinyl estradiol. Estradiol valerate, sold as brands Dienogest, Natazia and Qlaira is an expensive birth control pill not available as a generic. It is also prescribed to treat endometriosis. 

There are four progestins used in birth control pills

  • Norethindrone
  • Levonorgestrel
  • Norgestimate
  • Drospirenone

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If you meet the criteria that restrict you from taking an estrogen, then you are limited to a progestin-only pill (POP). Your only choice from here is to select a brand or choose the generic, which has the same active ingredient as the brand, and costs much less. .35 mg of the progestin norethindrone is the only POP (also called the mini pill) available in the US. However, there are over one dozen brand progestin-only birth control pills:

  • Camila
  • Errin
  • Heather
  • Jolivette
  • Micronor
  • Nor-Q.D.
  • Norethindrone
  • Ovrette
  • Lyza
  • Sharobel
  • Deblitane
  • Jencycla

What are side effects of POP pills?

  • Spotting or breakthrough bleeding can last for a few days until your body gets used to the medicine, or for as long as you are taking it
  • Not having a period is also common
  • Acne, mood swings, nausea, dizziness, bloating, weight gain, headache, and/or hair thinning are rare

Most of the time side effects are mild. If you have bleeding that lasts longer than usual and/or severe pain in your belly, call your healthcare provider right away. Most women have no periods while taking POPs. If you are sexually active and have no periods, tell your provider and have a pregnancy test now and then.

How do I know if I should take a POP pill?

Some but not all of the reasons your physician may prescribe a POP are if you:

  • Have experienced unpleasant side effects from estrogen
  • Have a history of certain types of cancers such as breast cancer
  • Are at risk for heart disease
  • Have high blood pressure
  • Have a history of blood clots
  • Have migraines with aura
  • Are breastfeeding or intend to breastfeed

What is a combination birth control pill?

No oral contraceptive contains estrogen alone. Any birth control pill that contains estrogen will also contain progestin. They are classified as Combination Oral Contraceptives (COC), also known as "the pill." There are enough COC varieties to fill a notebook.

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There more COC pill types than you might imagine, but the options make a difference. If one COC gives you unwanted side effects you can try another type. Typically, the balance between the estrogen and progestin in the combination pill contribute to side effects with each woman possibly responding uniquely. 

Dividing combo pills into groups helps understand them. Progestins are classified as first to fourth generation progestins based on when they were first available. They each have different characteristics. Keep in mind that newer isn't necessarily better.

  • First generation: Norethindrone, norethindrone acetate, and ethynodiol
  • Second generation: Desogestrel and norgestrel
  • Third generation: Norgestrel and norgestimate
  • Fourth generation: Drospirenone

Most COC pills offer additional benefits like regulating cycles that are too long or sporadic, reducing heavy bleeding, preventing ovarian cancer and endometriosis.  When the added benefits are significant enough, the pills may be prescribed off-label.

How do birth control pills work?

For all the differences in birth control pills, there are really only two ways that they work. Combo pills work mainly by preventing ovulation. POP pills are more effective at preventing fertilization of the egg or the ability of the egg to attach to the uterine lining. 

What are low-dose birth control pills?

A low-dose birth control pill contains around 30 mcg (.03 milligrams) of estrogen and an ultra-low-dose birth control pill may contain as little as 20 micrograms (.02 milligrams) of estrogen. These differences do not apply to POP pills because they do not contain estrogen. 

Older generation combination birth control pills used to contain as much as 50 micrograms (mcg) of estrogen. As research advanced it was discovered that lower doses of estrogen were still effective and could reduce the chances of adverse reactions from estrogen. Today, a standard dose birth control pill may have between 35 and 40 mcg of estrogen. 

Popular low-dose birth control pills:

  • Norgestimate/ethinyl estradiol, sold under the brand names Ortho tri-Cyclen Lo, Tri-Lo Marzia, Tri-lo Estarylla, Trinessa Lo and Tri-lo Sprintec.
  • Drospirenone/ethinyl estradiol, sold under the brand names Yasmin, Ocella, Zarah, and Syeda.

Popular ultra-low-dose birth control pills:

  • Drospirenone eth estra, sold under the brand names Yaz, Gianvi, Vestura, Nikki and Loryna
  • Ethinyl estradiol and levonorgestrel, sold under the brand names Alesse, Aviane, Lutera, Vienva, and Falmina  
  • Norethindrone Eth-Estra Fe 1/20, sold under the brand names Microgestin Fe 1/20, Tarina Fe 1/20, Blisovi Fe 1/20, Larin Fe 1/20, Junel Fe 1/20, Gildess Fe 1/20, and Loestrin Fe 1/20

Can birth control pills treat acne?

  • Sprintec is one of the top-selling birth control pills and also FDA-approved to treat acne in adults. Sprintec is also sold under the brand names Mono-Linyah, Estarylla, Femynor, Mononessa, Previfem, and TriNessa. Its active ingredients are norgestimate and ethinyl estradiol.
  • Yaz is also FDA-approved to treat acne in adults and children as young as 14 and premenstrual dysphoric disorder (PMDD)

What does "fe" in birth control pills stand for?

Birth control pills that contain iron have "fe" in their name. The iron is not an active ingredient, which means it doesn't impact the birth control's effectiveness. If an oral contraceptive contains iron it is in the last reminder pills and may only be as high as 75 mg.

Iron may reduce the heaviness of periods and lessen the amount of bleeding. Some women become slightly anemic during their period, so the iron can help offset low iron levels. While 75 mg of iron is higher than the RDA, it is less than 150-200 mg, the recommended dose to treat iron deficiency.

What are off-label uses for birth control pills?

One in five prescriptions is written "off-label." Some off-label uses for birth control pills are to regulate heavy or painful menstrual cycles, treat endometriosis and menstrual migraines. Since everyone is unique, off-label uses don't work 100% of the time. When a drug class such as hormonal birth control pills is frequently prescribed for off-label use, that means that the benefits to a large number of people are backed up with studies. 

Birth control pills may be used to treat, manage or help prevent:

  • Acne in adults and children age 15 and older
  • Endometriosis
  • Menstrual migraines
  • Excess uterine bleeding
  • Irregular periods
  • Pain during menstruation (dysmenorrhea)
  • Risk of ovarian, uterine and colon cancer
  • Risk of developing ovarian cysts

Which birth control pills give you shorter periods?

Combination birth control pills come in different mixtures of active and inactive pills, depending on how frequently you want to have periods:

  • Conventional: Usually contain 21 active pills and seven inactive pills, or 24 active pills and four inactive pills. Bleeding occurs every month when you take the inactive pills.
  • Continuous dosing or extended cycle: Typically contain 84 active pills and seven active or inactive pills. Bleeding generally occurs only four times a year during the time when you take the inactive pills. Formulations containing only active pills — eliminating bleeding — also are available. Generic LoSeasonique is an ultra-low-dose extended- birth control pill. It contains 91 active pills. Reminder pills also help keep you in the habit of taking a pill every day.

Take control of unwanted side effects

  • Birth control pills can also be used to balance your hormones, although that is not the most popular off-label use for them. Hormone Replacement Therapy (HRT) is the main protocol to balance hormones. 
  • Although Sprintec and Yaz are both FDA-approved to treat acne, an unwanted side effect some women experience is acne outbreaks. Learn how to control acne caused by hormonal imbalance.
  • Don't let your birth control pill ambush your sex life. Female sexual enhancement products can treat FSD and low libido caused by birth control stress, menopause and more.

Reference

1 Schaumberg, M. A., (2018). Use of Oral Contraceptives to Manipulate Menstruation in Young, Physically Active Women, International Journal of Sports Physiology and Performance13(1), 82-87. Retrieved Aug 27, 2019, from https://journals.humankinetics.com/view/journals/ijspp/13/1/article-p82.xml

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