Hormonal Birth Control
Please review Menstrual Cycle 101 to best understand the following information.
There are two types of hormonal birth control:
Combination estrogen and progesterone
Progesterone only
Combination methods of hormonal birth control contain both estrogen and a progesterone. The hormones in combination birth control suppress FSH and LH production and therefore suppress ovulation, or the release of eggs from the ovary, thereby preventing pregnancy. You cannot get pregnant if you don't ovulate.
Progesterone only methods contain only some type of progesterone, and it acts by thinning the lining of the uterus, or endometrium. Thus thinned, the endometrium cannot allow a pregnancy to implant. This is believed be the mechanism of action of the Mirena, an intrauterine device which secretes a progesterone onto the lining of the uterus. This mechanism probably also plays a role in the other progesterone only birth control methods such as the injectable preparation call Depo-Provera, and the mini pill, which is progesterone only and frequently given to nursing mothers.
Combination birth control methods come in many forms:
Birth control pills (many brand names)
28 day packs = 21 days or 3 weeks of active pills + 7 of spacers
Birth control pills in three-month packages
(Seasonale brand name)
Birth-control patches (Ortho Evra brand name)
7 days x 3 = 21 days, then one week of none
The birth-control ring (Nuva Ring brand name)
Inserted in the vagina for three weeks at a time, then out for a week.
Route of delivery for combination hormonal birth control methods
Provided that you and your caregiver have concurred that hormonal contraception is right for you, you then need to consider the type and its route of delivery. This is largely a personal decision. The most important thing to consider is whether your chosen delivery method enables you to take the medication as it is prescribed. Are you good at remembering pills every day? Pills must be taken every day for 21 straight days, at the same time every day. After that there are 7 medication free days when the period comes.
Do you need a visual reminder on your skin ? Patches are worn for seven days at a time, then replaced two more times to make a total 21 days of medication once again. Seven patch free days follow in order for the period to come.
Would you like to only deal with something once a month? Rings are placed in the vagina for 21 days straight, then removed for seven.
Pills are most easily forgotten of all the combination contraception methods. Patients who know themselves to be forgetful sometimes choose patches, but others do not like having things on their skin so they choose the vaginal ring.
No matter the chosen method, I prefer to ask patients to keep some sort of calendar to remind them about taking the birth control. Nowadays there are many smartphone apps to help with this.
Progesterone only birth-control methods:
The mini pill (Camila, Nor Qday and other brand names) - taken daily
Depo-Provera - a shot, given about every 12 weeks
The Mirena IUD - which is inserted in the office and is good for five years
Nexplanon which is a device inserted subcutaneously which releases a progesterone only preparation and lasts for three years.
Health concerns with hormonal birth control
Most healthy women do well with a variety of different kinds of birth control. However personal health factors and preferences come into play when deciding what is best for any given woman. Birth control is prescribed in the setting of an office visit. This way, medical conditions or risk factors for complications with birth control can be identified in advance. For example, certain types of headaches worsen with estrogen containing birth control preparations. In other cases, there is a hereditary predisposition to abnormal clotting which must be taken into consideration. Some women may be at risk of bone loss or depression from progesterone only preparations. Additionally, there are myriad other factors that can come into play which can increase risk of complications, such as frequent pelvic infections, or smoking. Even without any known risk factors, a small number of women will develop complications with their birth control, and must be aware of those potential complications beforehand. Sometimes a given birth control method just doesn't feel right, and it can be changed based on personal preference. This is simply a trial and error process since each woman's biology is unique.
Health benefits of hormonal birth control
The first and most obvious health benefit of birth control is that it greatly lessens the complications associated with pregnancy. If the combination birth control method is chosen, i.e. one that includes both estrogen and progesterone, it suppresses ovulation. Interestingly, these types of birth control greatly reduce the risk of ovarian cancer later in life. Combination birth-control also reduces the risk of uterine cancer later in life. In women with heavy or irregular cycles, birth control can regulate them, diminish menstrual flow and reduce the risk of anemia. It can help preserve bone density, reduce PMS, painful periods, and skin breakouts. Hormonal birth control can add greatly to quality of life in selected patients.
Choosing a correct birth control method is a joint effort between you and your doctor, factoring in your unique health history, preferences, and needs.