6 Effective Hormonal Birth Control Methods And How They Work

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Hormones as chemical messengers help in different functions of the body. Estrogen and progesterone are the primary hormones of pregnancy and are utilized in combination in the different hormonal birth control methods. Since these regulate women’s menstrual and fertility cycles, doctors may prescribe synthetic forms of the hormones as birth control. However, such pregnancy preventive techniques cannot protect from sexually transmitted disease (STD) (1).

Read on to know about the efficacy of hormonal birth control, the different types, and who can use it.

How Does Hormonal Birth Control Prevent Pregnancy?

Hormonal birth control works by (2) (3)

  • Preventing ovulation (it does not allow the ovaries to release eggs)
  • Changing the lining of the uterus to prevent pregnancy from developing
  • Thickening the cervical mucus so that sperms cannot travel to the uterus or the fallopian tubes to fertilize the egg

Pregnancy can be prevented when there are no eggs or no sperm to fertilize the released eggs.

How Well Does Hormonal Birth Control Work?

When used correctly, hormonal birth control can be the most effective birth control for some women. When used as prescribed, only about three in 1000 women get pregnant in the first year of use. However, if you do not use the birth control pills as advised or skip a dose, you are at risk of unintended pregnancy (2).

What Are The Contraindications For Hormonal Birth Control?

While most women can safely use hormonal birth control methods, the following conditions are contraindications for using them (2).

  • Being older than 35 years and suffering from migraine headaches or smoking more than 15 cigarettes per day
  • Suffering from migraine headaches accompanied by an aura (seeing lights or feeling unusual sensations on your skin)
  • Having a history of blood clots in the legs or lungs
  • Suffering from high blood pressure
  • Suffering from diabetes for more than 20 years
  • Having high triglycerides
  • Suffering from heart diseases
  • Having continued complications from an organ transplant
  • Suffering from a liver problem
  • Having a history of jaundice while using birth control pills
  • Suffering from gallbladder problems
  • Having a history of breast cancer.

What Are The Different Hormonal Methods Of Birth Control?

The following are various methods of hormonal birth control (1) (2) (4).

1. Oral contraceptives

Oral contraceptives are medicines taken by mouth to avoid unwanted pregnancies. They can be of two types (5):

1. Combination pills

  • Contain synthetic estrogen and progestin
  • Commonly used type of contraceptive
  • Also known as “pills”
  • Should be taken daily but not necessarily at the same time.
  • Inhibit ovulation
  • According to the Centers for Disease Control and Prevention (CDC), the typical use failure rate of the pill is 7% (1) 

2. Progestin-only pills

  • Contain only progestin and are a good option for those who cannot take estrogen
  • Also known as mini pills
  • Should be taken at the same time each day
  • May interfere with ovulation and sperm functions
  • Make some changes in the uterine lining and may also cause breakthrough bleeding
  • According to the CDC, the typical use failure rate of the mini pill is 7% (1)

Side Effects Of Contraceptive Pills

  • Unexpected bleeding
  • Stomach discomfort, bloating, and vomiting
  • Breast tenderness
  • Blood clots in lungs or legs
  • Headache
  • Depression
  • Dark patches on the skin (melasma)
  • Increased susceptibility to cervical cancer
  • Weight gain

2. Birth control implant

  • A small, thin, plastic rod that is inserted in the skin of a woman’s upper arm
  • Slow-release hormonal contraceptive
  • Contains progestin that is released in small amounts and lasts for about three years
  • According to the CDC, the typical use failure rate of implants is 0.1% (1)
  • Could get pregnant as soon as the implant is removed
  • Read more about birth control implants here.

Side effects

  • No periods
  • Unexpected bleeding
  • Weight gain
  • Headaches

3. Birth control shot

  • Involves an injection of progestin in the arm or buttocks once every three months
  • May take up to 18 months to get pregnant after you stop taking shots.
  • According to the CDC, the typical use failure rate of the shot is 4% (1).

Side effects

  • Unexpected bleeding
  • No periods
  • Weight gain
  • Headaches
  • Reduced bone density (the bone density may return to normal after you stop getting the injections)

4. Skin patch

  • A thin, sticky patch is worn on the lower abdomen, buttocks, or upper body (not on the breasts)
  • Gradually releases estrogen and progestin
  • Patch has to be removed and replaced once a week for three consecutive weeks
  • Not worn in the fourth week, when you will get your menstrual period
  • According to the CDC, the typical use failure rate of the patch is 7% (1)
  • Using a backup birth control method, such as a condom,is suggested during the first week of applying the patch

Side effects

  • Similar side effects to that of using a pill
  • Might not work effectively for overweight people
  • Some women may experience pain or itching under or around the patch

5. Vaginal ring

  • A small silicone ring is placed in the vagina
  • Releases estrogen and progesterone to prevent pregnancy
  • Left inside for three weeks and removed in the fourth week to get the periods
  • A fresh ring has to be inserted after the fourth week.
  • Some doctors recommend leaving the ring in for five weeks before replacing it with a new one.
  • Using a backup birth control method, such as a condom, is suggested in the first week after insertion.

Side effects

  • Similar side effects to that of contraceptive pills or skin patches
  • Increased vaginal wetness (6)

6. Intrauterine devices (IUD)

  • An IUD or IUS (intrauterine system) is a small, flexible T-shaped plastic device
  • Two types are available: copper IUDs and hormonal IUDs
  • Mirena, Skyla, Kyleena, and Liletta are four types of hormonal IUDs
  • Hormonal IUDs use progestin to thicken the cervical mucus and prevent the sperm from meeting the egg; they may also prevent ovulation
  • Copper IUDs prevent the sperm from reaching the egg and may prevent the egg from latching to the womb
  • Last for several years but are not permanent
  • Your healthcare provider can remove the IUD whenever you want to get pregnant
  • The Mirena and Liletta IUDs work for up to seven years, Kyleena up to five years, and Skyla up to three years (7)

Side effects (8)

  • Irregular periods or no periods when the hormonal IUD is inserted
  • Pain at the time of IUD insertion
  • Cramps or backache for a few days after hormonal IUD insertion

Frequently Asked Questions

1. How long can you take hormonal birth control?

It is advised not to take hormonal contraception for more than five years as it might increase the chances of cervical cancer (9).

2. What is the safest form of permanent birth control?

The process of tube ligation is considered to be the safest form of permanent birth control (10).

Your doctor can recommend the best hormonal birth control methods based on your needs, overall health, and medical records. You can talk to them about the safety, efficacy, accessibility, and prices of all available options and make an informed selection. However, for optimal performance, make sure to employ these procedures for the required amount of time and according to the doctor’s instructions. All of the procedures described above have a 93-99% effectiveness rate. However, consult your healthcare provider if you experience any unusual symptoms.

Key Pointers

  • Hormonal birth control prevents pregnancy by preventing ovulation, altering uterus lining, and thickening cervical mucus.
  • Most women can safely use hormonal birth control methods, except those with certain conditions, such as migraine, high BP, heart diseases, and liver issues.
  • Different hormonal birth control methods are hormonal contraceptives, birth control shots, implants, skin patches, vaginal rings, and IUD.
  • Each method has side effects that one should contemplate before making a choice.

References:

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Dr. Ritika Shah

Dr. Ritika Shah is a certified lactation counsellor from iNational Health Care Academy, Singapore and a dental surgeon with more than seven years of clinical experience across various cities in India. She did her graduation in Dentistry from KM Shah Dental College. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate... more

Dr. Mona Hardas

(MD)
Dr. Mona Hardas is a practicing Ob/Gyn from Flint, Michigan, with over 20 years of experience in private practice. She is also actively involved in teaching medical students and residents as an associate clinical professor from MSU College of Human Medicine.  Dr. Hardas is interested in minimally invasive gynecology procedures, including laparoscopic hysterectomy, myomectomy, removal of adnexal masses, etc. Having... more

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