Patient Education: Hormonal Methods of Birth Control (Beyond The Basics) - UpToDate

Patient education: Hormonal methods of birth control (Beyond the Basics) - UpToDate 16/07/23 16.
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Patient education: Hormonal methods of birth control

(Beyond the Basics)
author: Andrew M Kaunitz, MD
section editor: Courtney A Schreiber, MD, MPH
deputy editors: Kristen Eckler, MD, FACOG, Kathryn A Martin, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jun 2023.

This topic last updated: Nov 28, 2022.
Please read the Disclaimer at the end of this page.
INTRODUCTION
There are a number of methods available to help prevent pregnancy. Deciding which method
is right for you involves considering a number of issues, including convenience, cost, potential
side effects, and your future pregnancy plans. (See "Patient education: Birth control; which
method is right for me? (Beyond the Basics)".)
Hormonal methods of birth control (contraception) contain either estrogen and progestin or
progestin only; they are a safe and reliable way to prevent pregnancy for most people.
Hormonal methods include an implant, an intrauterine device (IUD), injections, pills, vaginal
rings, and skin patches.
This document discusses the various hormonal methods of birth control that are available.
Nonhormonal methods, which include the copper IUD, barrier methods (such as condoms),
and the cervical cap, diaphragm, and sponge, are discussed separately. (See "Patient
education: Long-acting methods of birth control (Beyond the Basics)", section on 'Intrauterine
device' and "Patient education: Barrier and pericoital methods of birth control (Beyond the
Basics)".)
CHOOSING A BIRTH CONTROL METHOD
It can be difficult to decide which birth control method is best due to the variety of options
available. The best method is one that will be used consistently and does not cause
bothersome side effects. Other factors to consider include:
● Efficacy (how well it works to prevent pregnancy)

● Convenience
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Patient education: Hormonal methods of birth control (Beyond the Basics) - UpToDate 16/07/23 16.21
● How long the drug or device can be used

● Whether and how it affects your monthly period
● Type and frequency of side effects
● Affordability
● Privacy concerns
● Whether or not it also protects against sexually transmitted diseases
● How quickly your fertility will return if you stop taking it
You should also think about whether you are comfortable remembering to take a pill every
day, whether you want to involve your partner(s) in the decision, and whether and when you
might want to get pregnant in the future. No birth control is perfect; you must balance the
advantages and disadvantages of the different options and decide which method is best for
you.
BIRTH CONTROL IMPLANT
The implant (brand name: Nexplanon) is a small rod that contains the hormone progestin. It is
inserted under the skin into the upper inner arm by a health care provider ( figure 1). It is
effective for at least three years but can be removed earlier if you decide you want to get
pregnant or simply prefer not to continue use of the implant. Insertion and removal can be
done in an office or clinic.
The implant is one of the most effective methods of birth control. It provides at least three
years of protection from pregnancy as progestin is slowly absorbed into the surrounding
tissues. Depending on when during the menstrual cycle the implant is placed, backup birth
control (for instance condoms) may be recommended for one week following placement.
Irregular bleeding is the most bothersome side effect. Fertility returns rapidly after the rod is
removed.
Side effects — The most common side effects of the implant are irregular/unpredictable
bleeding.
IUD WITH PROGESTIN
There are several intrauterine devices (IUDs) that contain a hormone called levonorgestrel (a
type of progestin). Two types of the levonorgestrel IUDs (brand names: Mirena, Liletta) can be
left in place for up to eight years. The other options (brand names: Kyleena, Skyla) are
somewhat smaller and can be left in place for up to five years (Kyleena) or three years (Skyla).
All of the levonorgestrel IUDs are highly effective in preventing pregnancy.
Side effects — Although irregular bleeding is common initially after progestin IUD placement,
bleeding tends to diminish over time. With ongoing use, people using Mirena or Liletta often
experience little or no bleeding. Those who use Kyleena or Skyla are more likely to continue
having monthly periods.
A complete discussion of the implant and IUDs is available separately. (See "Patient education:
Long-acting methods of birth control (Beyond the Basics)".)
INJECTABLE BIRTH CONTROL
The only injectable contraceptive currently available in the United States is depot
medroxyprogesterone acetate or DMPA (brand name: Depo-Provera). DMPA is injected deep
into a muscle, such as in the buttock or upper arm, or injected subcutaneously (under the
skin). With either type of injection, this contraceptive is given once every three months.
DMPA prevents ovulation and thickens the cervical mucus, making the cervix impenetrable to
sperm. If you get your first dose of DMPA during the first seven days of your menstrual
period, it prevents pregnancy immediately. If you get your first dose after the seventh day of
your period, you should use a second form of birth control (eg, condoms) for seven days.
DMPA is very effective, with a failure (pregnancy) rate of less than 1 percent when repeat
injections are given on time.
Side effects — The most common side effects of DMPA are irregular or prolonged bleeding
and spotting, particularly during the first few months of use. Up to 50 percent of people
completely stop having menstrual periods (doctors call this "amenorrhea") after one year of
DMPA use. Monthly periods generally return within six months of the last DMPA injection,
although, in some cases, it may take longer for periods to return. Some people gain weight
while they are getting DMPA injections.
In people who get the DMPA shot, there is no increased risk of cardiovascular complications
or cancer. Use of DMPA is associated with decreased bone mineral density; however, this
effect is mostly or completely reversed after stopping the injections. Studies have not shown
an increased risk of bone fractures in people who have used DMPA in the past.
Because DMPA is long-acting, it may not be ideal if you want to get pregnant shortly after
stopping the medication. Although most people are able to conceive within 10 months,
fertility may not return for up to 18 months after the last injection.
Benefits compared with birth control pills — There are a number of people who prefer DMPA
to the pill, including those who:
● Have difficulty remembering to take a pill every day

● Value the privacy with DMPA use
● Cannot use estrogen
● Also take seizure medications, which can be less effective with combination hormonal
contraceptives (see 'Anticonvulsants' below)
Additional benefits of DMPA include a decreased risk of uterine cancer and pelvic
inflammatory disease.
BIRTH CONTROL PILLS
Most oral contraceptives, commonly called "the pill," contain a combination of estrogen and
progestin. The combination pill reduces the risk of pregnancy by:
● Preventing ovulation
● Keeping the mucus in the cervix thick and impenetrable to sperm
● Keeping the lining of the uterus thin
The pill makes menstrual bleeding more regular, with fewer days of flow and overall lighter
flow. Other benefits of the pill include a reduction in:
● Menstrual cramps or pain

● Risk of ovarian cancer or cancer of the endometrium (uterine lining)
● Acne
● Iron-deficiency anemia (a low blood count due to low iron levels)
One potential downside of the pill is that, in order to maximize efficacy, you have to
remember to take it every day, ideally at the same time of day (see 'Efficacy' below). Some
people find this difficult or inconvenient.
Efficacy — When taken properly, birth control pills are a highly effective form of
contraception; however, skipping pills or forgetting to restart the pill after the week of your
period will increase risk of pregnancy (see 'When to expect bleeding' below). Approximately 9
out of every 100 people who take birth control pills for one year will have an unintended
pregnancy.
Missed pills are a common cause of pregnancy. In general, if you forget to take an active pill
(containing hormones), you should take it as soon as possible and take the next one at the
usual time it is due. If you miss more than two pills, use a backup method of birth control (eg,
condoms) for seven days.
Side effects — Possible side effects of the pill include:
● Nausea, breast tenderness, bloating, and mood changes – These typically improve
within two to three months without treatment (while continuing the pill).
● Irregular bleeding – Irregular bleeding, also called "breakthrough bleeding" or

"spotting," is particularly common during the first few months of taking the pill. It
almost always resolves without any treatment within two to three months. Forgetting a
pill can also cause breakthrough bleeding.
Taking birth control pills does not cause weight gain.
Potential complications — When the pill was first introduced in the 1960s, the doses of both
hormones (estrogen and progestin) were quite high. Because of this, cardiovascular
complications occurred, such as high blood pressure, heart attacks, strokes, and blood clots in
the legs and lungs.
The pills prescribed today have much lower doses of progestin and estrogen, which has
decreased the risk of these complications. As a result, birth control pills are now considered a
reliable and safe option for most healthy, nonsmoking people. While there is a very small risk
of blood clots, this risk is actually lower than the risk during pregnancy or soon after giving
birth.
Experts have studied the possible association between taking the pill and the risk of breast
cancer. While these studies have had mixed results, there is some evidence that people who
take the pill do have a slightly higher risk of getting breast cancer later in life than those who
do not. However, if there is an increase in risk, it is very small, especially in younger people. It
is important to balance this against the benefits of the pill, which include not only pregnancy
prevention but a sizable reduction in the risk of ovarian and endometrial cancer. (See 'Birth
control pills' above.)
Who should not take the pill? — Because of an increased risk of complications, you should not
take the pill if you:
● Are 35 or older and smoke cigarettes (as this puts you at high risk for cardiovascular
complications such as blood clots or heart attack).
● Could be pregnant.
● Have had blood clots or a stroke in the past (as this increases your risk of blood clots
while taking the pill).
● Have a history of an "estrogen-dependent" tumor (eg, breast or uterine cancer).
● Have abnormal or unexplained menstrual bleeding (in which case the cause of the
bleeding should be investigated before starting the pill).
● Have active liver disease (the pill could worsen the liver disease).
● Have migraine headaches associated with certain visual or other neurologic symptoms
(eg, aura), which increases your risk of stroke.
If you are taking the pill, tell your health care provider right away if you experience abdominal
pain, chest pain, severe headaches, eye problems, or severe leg pain. These could be
symptoms of several serious conditions including heart attack, blood clot, stroke, and liver or
gallbladder disease.
Some people may take the pill under certain circumstances but need close monitoring. Talk
with your doctor or nurse if you:
● Have high blood pressure – You may experience a further increase in blood pressure
and should be monitored more frequently while on the pill.
● Take certain medication for seizures (epilepsy) – In this case, the pill may be slightly
less effective in preventing pregnancy because the seizure medicines change the way it
is metabolized. (See 'Anticonvulsants' below.)
● Have diabetes mellitus – People with diabetes and kidney disease or vascular
complications from diabetes should not use the pill.
Medication interactions — The pill may not work as well to prevent pregnancy if you also take
certain other medications.
Anticonvulsants — Some anticonvulsants, including phenytoin (sample brand names: Dilantin,

Phenytek), carbamazepine (sample brand names: Carbatrol, Tegretol), barbiturates,
primidone (brand name: Mysoline), topiramate (sample brand name: Topamax), and
oxcarbazepine (sample brand name: Trileptal), decrease the effectiveness of birth control pills
as well as patches, vaginal rings, and the implant. As a result, people who take these
anticonvulsants are advised to avoid hormonal birth control methods (with the exception of
depot medroxyprogesterone acetate or DMPA [brand name: Depo-Provera] and intrauterine
devices [IUDs] with progestin). (See 'Injectable birth control' above and 'IUD with progestin'
above.)
Other anticonvulsants do not appear to reduce contraceptive efficacy, including gabapentin

(sample brand names: Gralise, Neurontin), lamotrigine (sample brand names: Lamictal,
Subvenite), levetiracetam (sample brand names: Keppra, Roweepra), tiagabine (brand name:
Gabitril), and valproic acid (brand name: Depakote). However, there is some concern that oral
contraceptives may reduce the effectiveness of lamotrigine, potentially increasing the risk of
seizures.
If you take any anti-seizure medications, it is important to talk with your health care provider
about possible interactions before starting the pill or another hormonal birth control method.
Antibiotics — Rifampin, which is sometimes used to treat tuberculosis, can decrease the
efficacy of hormonal birth control. As a result, people who take rifampin are advised to avoid
most hormonal birth control methods, with the exception of DMPA (brand name: Depo-
Provera) and IUDs with progestin (see 'Injectable birth control' above and 'IUD with progestin'
above). Alternative options include a copper IUD, condoms, or a diaphragm, or tubal ligation
(permanent birth control). (See "Patient education: Long-acting methods of birth control
(Beyond the Basics)" and "Patient education: Barrier and pericoital methods of birth control
(Beyond the Basics)" and "Patient education: Permanent birth control for women (Beyond the
Basics)".)
Contrary to popular belief, other (more commonly used) antibiotics do not affect the efficacy
of hormonal birth control methods. Backup contraception is not needed when you take these
antibiotics.
St. John's Wort — St. John's wort, an herbal supplement sometimes taken to treat depression,
may reduce the effectiveness of birth control pills, and possibly the patch and ring. (See
"Patient education: Depression treatment options for adults (Beyond the Basics)".)
Starting the pill — Ideally, you should start taking the pill on the first day of your period. This
provides protection from pregnancy beginning immediately.
As long as you are sure you are not pregnant (which can be confirmed with a urine pregnancy
test), it is also an option to start the pill as soon as your doctor prescribes it, regardless of
where you are in your menstrual cycle. This is called the "quick start" method. If you do this,
you will need to use a backup form of birth control (eg, condoms) for the first seven days after
the quick start.
Many people start taking the pill on the first Sunday after their period starts (because most
pill packs are arranged for a Sunday start). If you do this, you will also need to use some form
of backup contraception (eg, condoms) for the first seven days after the Sunday start.
When to expect bleeding — Traditionally, the pill is taken on a 28-day cycle that includes 21
days of hormone pills followed by 7 days of placebo pills ("no hormone pills") that do not
contain hormones. Newer formulations have a longer duration of hormone pills (eg, 24 days)
and fewer days of placebo pills (eg, 4 days). It is not necessary to take the placebo pills as they
do not contain any active ingredients, but many people find it easier to stay on schedule when
they continue to take a daily pill throughout the entire 28-day cycle.
Bleeding should occur during the fourth week of the pill pack (ie, the week that you are taking
placebo pills or no pills). However, some people have irregular breakthrough bleeding or
spotting in the first few months. (See 'Side effects' above.)
Continuous dosing — Some people prefer to take hormone-containing birth control pills
continuously, without the week of no pills or placebo pills. This allows you to control whether
and when you have a monthly period. This regimen may be a good option if you have painful
periods, endometriosis (a condition that causes pelvic pain), or bothersome premenstrual
symptoms, including mood changes.
Traditional birth control pill packs can be dosed continuously to get rid of monthly bleeding.
To do this, you take the first three weeks of a pill pack, then immediately start a new pack the
next day (without taking a break or taking the placebo pills). This can be continued for as long
as desired. A pill called Seasonale was specifically designed for continuous dosing. You take
an active pill every day for 12 weeks, followed by seven days of placebo pills. With this
regimen, you only experience bleeding once every three months. Seasonique it is similar; it
contains 84 days of active pills and 7 days of low-dose estrogen pills. The addition of low-dose
estrogen pills is intended to reduce breakthrough bleeding and possibly other symptoms,
such as mood changes and headaches. Both are available as generic medications that work in
the same way.
Over time, using continuous-dosing regimens results in fewer bleeding episodes per year (or
no bleeding at all); however, many people experience unpredictable breakthrough bleeding
when starting a continuous-dosing regimen. Breakthrough bleeding is inconvenient but does
not mean that the pills are less effective (assuming you are taking them at the same time
each day and not skipping any active pills).
Progestin-only pills — Some pills contain only progestin (sometimes called the "mini pill");
these may be an option for people who cannot or should not take estrogen. This includes
those who are breastfeeding or who have worsened migraines or high blood pressure with
combination contraceptive pills. Progestin-only pills appear to be as effective as combination
pills when taken at the same time every day, but they have a slightly higher failure rate if you
are more than three hours late in taking them. A backup method of birth control should be
used for seven days if you forget a pill or are more than three hours late in taking it.
Breakthrough bleeding or spotting is common with both types of progestin-only pills.
Progestin-only pills are available in 28-day packs. Two types of progestin-only pills are
available in the United States. For one type (containing norethindrone), all 28 pills contain the
hormone (ie, there is no "placebo week"). For the second type (containing drospirenone), each
pack includes 24 hormone pills and 4 placebo pills. The drospirenone pill may be more
effective than the norethindrone pill. A disadvantage of the drospirenone pill is that no
generic is available, which may make it more expensive.
VAGINAL RINGS
These are flexible plastic rings ( figure 2) that contain estrogen and a progestin. The ring is
inserted into the vagina, and the hormones are slowly absorbed into the body. This prevents
pregnancy, similar to the pill. You keep the ring in your vagina for three weeks then leave it
out for one week, during which you will experience bleeding. The following week, you insert a
new ring or reinsert the previous one (one type of ring is reusable for approximately one year,
while the other type needs to be discarded and replaced each month). As long as the ring
remains in the vagina and is not uncomfortable, the ring's position inside the vagina is not
important.
You can start using the vaginal ring anytime during your menstrual cycle. If you start it more
than seven days after the first day of your last period, or if you are not sure when your last
period started, you should use a backup method of contraception (eg, condoms) for the first
seven days of inserting the ring.
Most people cannot feel the ring while it is in place, and in most cases, it is easy to insert and
remove. It may be removed for a short time if desired, as discussed below, but should be left
in during intercourse. Your partner most likely will not be able to feel the ring. You should use
your fingers to check before and after sex to confirm the ring is in place. If the ring is left out
for more than a few hours, you may be able to put it back in, or you may need to discard it,
depending on which type of ring you use and where you are in your menstrual cycle. Because
the instructions can vary, it is important to read the information that comes with your ring.
If you use the ring that gets replaced each month (brand names: NuvaRing, EluRyng):
● During the first two weeks of your cycle, you can reinsert the ring and continue with the
usual schedule. The ring should be rinsed in cool or warm (but not hot) water, without
soap or detergent, before it is reinserted.
● During the third week, you can insert a new ring and begin a new cycle immediately, in
which case you will not get a period. If the ring was previously in place for at least seven
days in a row, you can also choose to leave the ring out for up to one week (during which
you have your period) and then insert a new one.
● Regardless of where you are in your cycle, if the ring is left out for more than three
hours, you should use a backup method of birth control (eg, condoms) for the next
seven days. Any backup method other than the female condom or diaphragm can be
used.
If you use the reusable ring that gets reinserted each month (brand name: Annovera), the
instructions are the same regardless of where you are in your menstrual cycle:
● If the ring is out for two hours or less, you can reinsert it. Before doing so, wash the ring
with mild soap, rinse with water, and gently dry.
● If the ring is out for more than two hours, either continuously or cumulatively (eg, if you
take it out two separate times that add up to more than two hours), you should also
clean and insert the ring. However, you also must use a backup form of birth control
(eg, condoms) for the next seven days.
As with the pill, in addition to being an effective method of preventing pregnancy, the vaginal
ring also has other potential benefits. These include a reduction in menstrual cramps, iron-
deficiency anemia, and the risk of certain cancers. (See 'Birth control pills' above.)
Risks and side effects are also similar to those of oral contraceptives. (See 'Side effects' above
and 'Potential complications' above.)
BIRTH CONTROL SKIN PATCHES
Birth control skin patches (sample brand names: Xulane, Twirla) contain estrogen and
progestin, similar to oral contraceptives. Both patches are similar to the pill in terms of
efficacy in preventing pregnancy. Some people prefer patches because they do not require
remembering to take a pill each day; on the other hand, some people do not like having a
visible patch on their skin. Neither patch type should be used by people with a body mass
index (BMI) of 30 kg/m2 or higher.
The patch is worn for one week on the shoulder, upper back, abdomen, or buttock
( figure 3); one type (brand name: Twirla) can also be worn on the upper arm. After one
week, you remove the old patch and apply a new one; this is done for three weeks. During the
fourth week, you do not apply a new patch; you will experience bleeding during this time.
The patch is ideally started on the first day of your period. This approach provides protection
from pregnancy immediately. If you prefer, you can also start using the patch on the day it is
prescribed, regardless of where you are in your menstrual cycle (called "quick start"). If you do
this, you will need to use a backup form of birth control (eg, condoms) for the first seven days.
As with the pill, in addition to being an effective method of preventing pregnancy, the patch
also likely has other potential benefits, although studies are limited. These include a reduction
in menstrual cramps, iron-deficiency anemia, and the risk of certain cancers. (See 'Birth
control pills' above.)
While efficacy is similar to the pill, the patch may deliver a higher overall dose of estrogen.
Some studies found that this was associated with an approximate doubling of the risk of
blood clots compared with use of oral contraceptives (the pill). However, other studies found
no increase in risk compared with people using the pill. Further study is needed to define this
risk.
PREGNANCY AFTER HORMONAL BIRTH CONTROL
The length of time it takes to become pregnant after use of a hormonal method of birth
control depends upon which method was used, as well as some individual factors.
Most people return to their normal level of fertility within a cycle or two. For some, it may take
several months before their cycle (including when they ovulate) becomes regular and they can
get pregnant. This is more likely for people whose periods were irregular before starting birth
control. However, hormonal birth control does not increase the risk of infertility. In general:
● People who use the pill, skin patch, or vaginal ring usually start ovulating regularly again
within one to three months of stopping birth control.
● With injectable depot medroxyprogesterone acetate (DMPA; brand name: Depo-

Provera), return of fertility can be delayed. Approximately half of people who want to be
pregnant are pregnant within 10 months of stopping DMPA. However, some people will
not get their periods back for up to 18 months. (See 'Injectable birth control' above.)
● People who get an implant (eg, Nexplanon) or an intrauterine device (IUD) usually begin
to ovulate again within one month after the device is removed.
EMERGENCY CONTRACEPTION
If you have unprotected sex or a problem with your birth control (for example, you miss a pill,
your skin patch falls off, or your vaginal ring falls out), you can use emergency contraception
to reduce your risk of pregnancy. There are two forms of emergency contraception, the
copper intrauterine device (IUD) and pills. Emergency contraception should be taken as soon
as possible after sex, ideally within 120 hours (five days). More information about this is
available separately. (See "Patient education: Emergency contraception (Beyond the Basics)".)
WHERE TO GET MORE INFORMATION
Your health care provider is the best source of information for questions and concerns related
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to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related
topics for patients, as well as selected articles written for health care professionals, are also
available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a
patient might have about a given condition. These articles are best for patients who want a
general overview and who prefer short, easy-to-read materials.
Patient education: Hormonal birth control (The Basics)

Patient education: Choosing birth control (The Basics)
Patient education: Barrier methods of birth control (The Basics)
Patient education: Endometriosis (The Basics)
Patient education: Ovarian cysts (The Basics)
Patient education: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder
(PMDD) (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more
sophisticated, and more detailed. These articles are best for patients who want in-depth
information and are comfortable with some medical jargon.
Patient education: Long-acting methods of birth control (Beyond the Basics)

Patient education: Barrier and pericoital methods of birth control (Beyond the Basics)
Patient education: Birth control; which method is right for me? (Beyond the Basics)
Patient education: Depression treatment options for adults (Beyond the Basics)
Patient education: Emergency contraception (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and
other health professionals up-to-date on the latest medical findings. These articles are
thorough, long, and complex, and they contain multiple references to the research on which
they are based. Professional level articles are best for people who are comfortable with a lot
of medical terminology and who want to read the same materials their doctors are reading.
Intrauterine contraception: Candidates and device selection

Contraception: Issues specific to adolescents
Depot medroxyprogesterone acetate (DMPA): Formulations, patient selection and drug
administration
Emergency contraception
Internal (formerly female) condoms
Fertility awareness-based methods of pregnancy prevention
Hormonal contraception for suppression of menstruation
Pericoital (on demand) contraception: Diaphragm, cervical cap, spermicides, and sponge
External (formerly male) condoms
Contraception: Counseling and selection

Combined estrogen-progestin oral contraceptives: Patient selection, counseling, and use
Contraception: Progestin-only pills (POPs)
Combined estrogen-progestin contraception: Side effects and health concerns
The following organizations also provide reliable health information.
● National Library of Medicine
(https://medlineplus.gov/healthtopics.html)
● National Institute of Child Health and Human Development (NICHD)
Toll-free (800) 370-2943

www.nichd.nih.gov/
● National Women's Health Resource Center (NWHRC)
Toll-free: (877) 986-9472

www.healthywomen.org/
● Planned Parenthood Federation of America
Phone: (212) 541-7800

https://www.plannedparenthood.org/
● Bedsider
(www.bedsider.org)
● The Hormone Foundation
(www.hormone.org/)
[1-5]
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Med 2003; 349:1443.
2. Baerwald AR, Olatunbosun OA, Pierson RA. Ovarian follicular development is initiated
during the hormone-free interval of oral contraceptive use. Contraception 2004; 70:371.
3. van Vliet HA, Grimes DA, Lopez LM, et al. Triphasic versus monophasic oral contraceptives
for contraception. Cochrane Database Syst Rev 2006; :CD003553.
4. Edelman AB, Gallo MF, Jensen JT, et al. Continuous or extended cycle vs. cyclic use of
combined oral contraceptives for contraception. Cochrane Database Syst Rev 2005;
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5. Gallo MF, Grimes DA, Schulz KF. Skin patch and vaginal ring versus combined oral
contraceptives for contraception. Cochrane Database Syst Rev 2003; :CD003552.
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Topic 8419 Version 34.0
Contributor Disclosures
Andrew M Kaunitz, MD Grant/Research/Clinical Trial Support: Bayer [Treatment of menopausal
symptoms]; Exeltis [Oral contraception]; Merck [Contraceptive implant]; Mithra [Treatment of menopausal
symptoms]; Mylan [Transdermal contraception]. Consultant/Advisory Boards: Myovant [Uterine fibroids,
use of GnRH antagonists]. All of the relevant financial relationships listed have been mitigated. Courtney A
Schreiber, MD, MPH Patent Holder: Penn, Saul [Medical management of nonviable pregnancy].
Grant/Research/Clinical Trial Support: Athenium Pharma [Early pregnancy loss]; Bayer [Contraception];
Medicines360 [Contraception]; VeraCept [Contraception]. Consultant/Advisory Boards: Danco
Pharmaceuticals [Early pregnancy loss]. Other Financial Interest: American Board of Obstetrics and
Gynecology [Member of Board of Directors, Chair of Division of Complex Family Planning]; Athenium
Pharmaceuticals [Royalties]. All of the relevant financial relationships listed have been mitigated. Kristen
Eckler, MD, FACOG No relevant financial relationship(s) with ineligible companies to disclose. Kathryn A
Martin, MD No relevant financial relationship(s) with ineligible companies to disclose.
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are
addressed by vetting through a multi-level review process, and through requirements for references to be
provided to support the content. Appropriately referenced content is required of all authors and must
conform to UpToDate standards of evidence.
Conflict of interest policy

Patient Education: Hormonal Methods of Birth Control (Beyond The Basics) - UpToDate

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Patient education: Hormonal methods of birth control (Beyond the Basics) - UpToDate 16/07/23 16.

Official reprint from UpToDate®

Patient education: Hormonal methods of birth control

Literature review current through: Jun 2023.

Please read the Disclaimer at the end of this page.

CHOOSING A BIRTH CONTROL METHOD

● Efficacy (how well it works to prevent pregnancy)

● How long the drug or device can be used

BIRTH CONTROL IMPLANT

IUD WITH PROGESTIN

INJECTABLE BIRTH CONTROL

● Have difficulty remembering to take a pill every day

BIRTH CONTROL PILLS

● Menstrual cramps or pain

Side effects — Possible side effects of the pill include:

● Irregular bleeding – Irregular bleeding, also called "breakthrough bleeding" or

Taking birth control pills does not cause weight gain.

the legs and lungs.

● Have a history of an "estrogen-dependent" tumor (eg, breast or uterine cancer).

Anticonvulsants — Some anticonvulsants, including phenytoin (sample brand names: Dilantin,

Other anticonvulsants do not appear to reduce contraceptive efficacy, including gabapentin

BIRTH CONTROL SKIN PATCHES

PREGNANCY AFTER HORMONAL BIRTH CONTROL

● With injectable depot medroxyprogesterone acetate (DMPA; brand name: Depo-

WHERE TO GET MORE INFORMATION

to your medical problem.

Patient education: Hormonal birth control (The Basics)

Patient education: Long-acting methods of birth control (Beyond the Basics)

Intrauterine contraception: Candidates and device selection

Contraception: Counseling and selection

The following organizations also provide reliable health information.

● National Library of Medicine

● National Institute of Child Health and Human Development (NICHD)

Toll-free (800) 370-2943

● National Women's Health Resource Center (NWHRC)

Toll-free: (877) 986-9472

● Planned Parenthood Federation of America

Phone: (212) 541-7800

● The Hormone Foundation

1. Petitti DB. Clinical practice. Combination estrogen-progestin oral contraceptives. N Engl J

This generalized information is a limited summary of diagnosis, treatment, and/or

Topic 8419 Version 34.0

Conflict of interest policy

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