Hormonal Contraception

Combined Hormonal Contraception (CHC)

The pill, patch, and ring are commonly known as combined hormonal contraceptives.   They provide small amounts of estrogen and progestin that are designed to stop ovulation, therefore preventing pregnancy.  The pill can also alter cervical mucus, making it more resistant to sperm.

Important Information

  • Hormonal contraception (pill, patch, ring, implant and IUD) DO NOT protect you from STD’s (sexually transmitted infections).  Use a condom for best protection.
  • Campus Health Services does not require a pap smear or full physical exam to give you birth control.  You do need an appointment to start these methods. 
  • There are many brands of combined hormonal contraception on the market.  Your health care provider will help you decide on the best one for you.  Costs can vary, and many insurance plans will cover most of the cost.

Benefits of CHC

  • Prevention of pregnancy
  • Lighter menstrual flow
  • Less cramping with periods
  • Regulate menstrual periods and hormones
  • Reduce the chance of ovarian cysts (usually not serious, but can be painful)
  • CHC can be prescribed for women with certain gynecological concerns even if they do not need contraception
  • Improvement of acne
  • Reduced risk of ovarian and uterine cancers.

Side Effects

  • Irregular bleeding, mid-cycle spotting
  • Nausea
  • Breast tenderness
  • Mood changes
  • Weight changes
  • Fatigue
  • Mild headaches
  • Generally, side effects are mild and temporary.  Most will resolve within 1-3 cycles of pill use.  If they persist or are truly bothersome, please talk with your health care provider about changing brands.

Risks

While birth control pills have been safely prescribed and used for over 50 years, some risks remain.  The most critical of those risks can be summed up as ACHES.

A - Abdominal pain (severe, sudden onset)
C - Chest pain, shortness of breath, coughing up blood
H - Headache (severe, unrelenting), numbness, or weakness in arms or legs
E - Eye problems: sudden vision changes, blurring, flashing lights
S - Severe leg pain in calf or thigh

If you experience ANY of these signs while taking CHC, stop taking the pills and seek health care assistance immediately.

The Fine Print

Severe complications related to CHC use often stem from abnormal blood clotting.  Estrogen may cause the body to change the way it forms blood clots.  Additional risk factors include:

  • Smoking:  Do not smoke if you take CHC, especially if you are over age 35.
  • Family history of clotting disorders:  You may need to be tested for these disorders if your family has a history of serious blood clots.
  • Migraine headaches with aura:  There is an increased risk of stroke in women with severe migraines.
  • Obesity:  Being significantly overweight may increase the chance of abnormal blood clotting.
  • High Blood Pressure:  This needs to be treated before you can take CHC.
  • Diabetes:  Uncontrolled diabetes may present additional risks.
  • High cholesterol:  Hormones can affect cholesterol which can also affect blood clotting.
  • Current or past breast cancer or other hormone related cancers.
  • Unexplained or undiagnosed abnormal vaginal bleeding.

Drug Interactions

Some medications can interact with CHC, or make the CHC less effective.  Tell your health care provider if you are taking any of the following types of medications:

  • Seizure medications
  • Antifungal medications
  • Antibiotics (not all)
  • St. John’s Wort
  • Steroids
  • Anti-anxiety drugs
  • Blood Pressure Medication

What kind of pill should I take?

This is a decision for you and your provider.   Pills can have minute differences that can affect your mood, cycle, and overall well-being.  If one brand isn’t right, there is probably another!  It sometimes takes some experimenting to find the right one. 

The Great Ketchup Story 

All CHC pills (patch and ring, too) contain both estrogen and a progestin. Birth control pills, patches, and rings are like ketchup. When you go to the grocery store, you may find as many as 10 different brands of ketchup on the shelf.  But all of them are made from three things:  tomatoes, secret spices, and water.  You can think of birth control in similar terms:

Tomatoes:  the estrogen component is the same in all pills/patches/rings

Secret Spices:  the progestin (progesterone-like component) will vary from brand to brand

Water: the quantity of the hormones in the pill

Just like ketchup, birth control comes in a variety of recipes for a variety of individuals.  If you think of it in these simple terms, it’s easier to understand!  Work with your health care provider to find the best one for you.

How to Take Birth Control Pills

Pills come in 21 and 28 day packages, although the 28 day packs are most popular.  The 21-day pack has all active pills, while the 28-day pack contains 21 active pills and 7 reminder or placebo pills (and is the most common packaging).

  • With the 21-day pack, you will take 1 pill a day for 21 days, and pills for 7 days, during which you will have your period.  Then start the next pack.
  • With the 28-day pack, you will take 1 active pill for 21 days, followed by the 7 reminder pills (during which you will have your period).  Then start the next pack.
When do I start?

There are three ways to begin pills:

First Day Start: 

  • Take the first active pill in the package on the first day of your menstrual period.  Most pill packs will come with adhesive labels so you can label the days of the week and the corresponding pills. 
  • Take one pill at day at about the same time of the day until the pack is finished. 
  • If you are taking the 21-day pack, stop the pills for 7 days and then start the new pack.
  • If you are taking a 28-day pack, you will take a pill every day.
  • When one pack is empty, start the new one the next day.  You will always start a new pack of pills on the same day of the week.

Sunday Start: 

  • Take the first active pill on the first Sunday after your period begins.  If your period starts on a Sunday, take it that day. 
  • Take one pill at day at about the same time of the day until the pack is finished. 
  • If you are taking the 21-day pack, stop the pills for 7 days and then start the new pack.
  • If you are taking a 28-day pack, you will take a pill every day. 
  • When one pack is empty, start the new one the next day.  You will always start a new pack of pills on the same day of the week.

Same Day Start:

  • You can start the pills on the same day you receive your first prescription, as long as you are NOT already pregnant (ask for a test if you are unsure!).
  • Take one pill every day as noted above.
  • You must use condoms or another form of birth control for the first 7 days, at which time the pill will be effective.
  • You may have irregular vaginal bleeding in the first pack of pills, but this should resolve in the second cycle.

What happens if I miss a pill (or two or three)?

  • If you miss one pill, take it as soon as you remember it, even if it means taking 2 pills in one day.
  • If you miss two pills in a row, take 2 pills per day until you catch up to the correct day. 
  • If you miss 3 pills in a row, you can still double up until you are back on track. 
  • Missing 2 or more pills puts you at high risk for pregnancy or starting your period early. 
  • Be sure to use another method of birth control for the remainder of the cycle. 

Acyclic Birth Control Pills (Continuous Use)

  • Many women do not want to have a period every month.
  • Several formulations of pills can be taken daily, without a monthly break, to suppress menstruation.
  • You can choose to have a period every 3 months, or not at all.
  • It is not harmful to stop your periods!
  • As your provider if you would like to try this method.

What else do I need to know?

NuvaRing® The Ring

NuvaRing is a soft , flexible ring that is approximately 2 inches in diameter.  It contains both estrogen and progestin like a birth control pill but the medication is absorbed through the vaginal walls.  It is inserted into the vagina and left in place for three weeks, then removed for one week when you will have your period.  When in the proper place, you cannot feel it and because of the vaginal muscles, it stays in place.  

The risks and benefits are similar to that of the pill.  Some women may not be comfortable inserting or removing it.

What else do I need to know?                                

Single Ingredient Birth Control

Progestin-Only

Some women cannot tolerate or should not take estrogen.  In those cases, progestin only contraceptives can be used.

Women who cannot take estrogen include those with:

  • A personal or family history of blood clotting disorders
  • High blood pressure that is not controlled
  • Personal history of stroke
  • Migraine headaches with neurological symptoms or aura
  • Previous medical side effect to estrogen
  • Active liver disease
  • Breast feeding women
  • Other personal preferences

Progestin only contraceptives work by:

  • Preventing ovulation (release of the egg from the ovary)
  • Thickening the cervical mucus, making it more difficult for sperm to enter the uterus
  • Thinning out the uterine lining, to help the egg from implanting in the uterus

Risks and benefits are similar to the pill, but progestin only contraceptives can also cause

  • Irregular bleeding, especially in the first several months
  • Appetite or weight changes
  • Mood changes including depression
  • Bone density changes especially in younger women
  • Longer return to fertility when method is stopped

Types of Progestin-only Contraception

Depo Provera “The Shot”

Depo Provera is given as an injection every 10-13 weeks (the average is 12) and is a continuous, highly effective method of birth control.  Women who are using DepoProvera should insure their diets include 1000-1200 mg of calcium daily to prevent bone loss.

What else do I need to know?   

Progestin-Only Pills “The Mini Pills”

The mini pill is a daily pill (no placebo pills) that contains a small amount of progestin.  It is most often used with women who are actively breastfeeding or should not use other forms of birth control.

What else do I need to know?  

The Mirena IUD

An intrauterine device (IUD) is a small plastic device that resides in the uterus.  It prevents the movement of sperm and fertilization.  Mirena contains small amounts of progestin that are released over a 5 year period and often reduces or eliminates the menstrual flow.  IUD’s are expensive but provide long term, reliable contraception. 

What else do I need to know?   

Implant (Implanon or Nexplanon)

The implant is a small rod that is inserted in the soft skin of the inner upper arm.  It releases small amounts of progestin for up to 3 years to prevent pregnancy.  CHS currently does not provide this method but can refer you to local providers for this method.

What else do I need to know?