Birth control pills, the birth control patch, and the vaginal birth control ring are combined hormonal birth control methods. They contain two hormones: estrogen and progestin.
Combined hormonal birth control methods release estrogen and progestin into the whole body. These hormones prevent pregnancy mainly by stopping ovulation (the release of an egg from one of the ovaries). They also cause other changes in the body that help prevent pregnancy. The mucus in the cervix thickens, making it hard for sperm to enter the uterus. The lining of the uterus also thins.
With typical use—meaning that the method may not always be used consistently or correctly—9 women out of 100 (9%) will become pregnant during the first year of using these methods. With perfect use—meaning that the method is used consistently and correctly each time—fewer than 1 woman out of 100 will become pregnant during the first year.
Combined hormonal methods have several benefits in addition to protecting against pregnancy:
Combined hormonal methods are safe for most women, but they are associated with a small increased risk of deep vein thrombosis (DVT), heart attack, and stroke. The risk is higher in some women, including women older than 35 years who smoke more than 15 cigarettes a day or women who have multiple risk factors for cardiovascular disease, such as high cholesterol, high blood pressure, and diabetes; a history of stroke, heart attack, or DVT; or a history of migraine headaches with aura.
You should not use combined hormonal methods during the first 3 weeks after delivery because the risk of DVT is higher in the weeks after childbirth. If you have additional risk factors for DVT, you should wait to use combined hormonal methods until after the first 4–6 weeks following delivery.
The risk of DVT also may be slightly higher in women taking pills containing a progestin called drospirenone and in women using the patch. However, the risk of DVT is higher during pregnancy and in the weeks after childbirth than when taking drospirenone-containing pills or using the patch.
If you are breastfeeding, estrogen may affect your milk supply. It is recommended that you wait until the fifth week after delivery to start using these methods, when breastfeeding has been well established.
In the United States, birth control pills are available by prescription only.
Possible side effects include the following:
Breakthrough bleeding usually is a temporary side effect as the body adjusts to a change in hormone levels. It may last longer than a few months with continuous-dose pills.
The vaginal ring is a flexible, plastic ring that is placed in the upper vagina. It releases estrogen and progestin that are absorbed through the vaginal tissues into the body.
A health care professional must prescribe the vaginal ring, but you insert it yourself.
You fold the ring and insert it into the vagina. It stays there for 21 days. You then remove it and wait 7 days before inserting a new ring. During the week the ring is not used, you will have your period. To use the ring as a continuous-dose form of birth control, insert a new ring every 21 days with no ring-free week in between.
Possible side effects include the following:
The contraceptive skin patch is a small (1.75 square inch) adhesive patch that is worn on the skin to prevent pregnancy. The patch releases estrogen and progestin, which are absorbed through the skin into the body.
A health care professional must prescribe the patch, but you do not need to visit a health care professional to apply or remove the patch. The patch is less effective in women who weigh more than 198 pounds.
The patch can be worn on the buttocks, chest (except the breasts), upper back or arm, or abdomen. You wear a patch for a week at a time for a total of 3 weeks in a row. During the fourth week, a patch is not worn, and you will have your period. After week 4, a new patch is applied and the cycle is repeated. You apply the patch on the same day of the week even if you still are bleeding. To use the patch as a continuous-dose form of birth control, apply a new patch every week on the same day without skipping a week.
Most side effects are minor and often go away after a few months of use. Possible side effects include the following:
Aura: A sensation or feeling, such as flashing lights, a particular smell, dizziness, or seeing spots, experienced just before the onset of certain disorders like migraine attacks or epileptic seizures.
Breakthrough Bleeding: Vaginal bleeding at a time other than the menstrual period.
Cardiovascular Disease: Disease of the heart and blood vessels.
Cervix: The lower, narrow end of the uterus at the top of the vagina.
Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.
Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.
Estrogen: A female hormone produced in the ovaries.
Fibroids: Benign growths that form in the muscle of the uterus.
Hormones: Substances made in the body by cells or organs that control the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.
Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and produce hormones.
Ovulation: The release of an egg from one of the ovaries.
Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.
Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.
FAQ185. Copyright March 2018 by the American College of Obstetricians and Gynecologists
Complete Healthcare for Women - Obstetrics and Gynecology
(509) 392-6700
Richard Lorenzo, D.O.
Kortney Jones ARNP
