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Birth Control
With Estrogen

The Pill, The Patch & The Vaginal Ring

What is a combined hormone birth control?

Oral contraceptive pills (“the pill”), the patch (OrthoEvra), and the vaginal ring (Nuva Ring) contain estrogen and progesterone hormones in different combinations and dosages. These are the same hormones that occur naturally in your body and are produced in the ovaries, resulting in ovulation.

How does this combination of hormones work in preventing pregnancy?

The combined hormone method of birth control works predominantly by preventing ovulation (blocking the release of an egg from the ovary). These hormones also have an effect on mucus in the cervix that interferes with the transport of sperm into the uterus and fallopian tubes. There are some occasions when neither of these actions prevent fertilization of the ovum (egg). Most of the time when this occurs, the fertilized egg is prevented from implanting in the uterus because the birth control hormones change the lining of the uterus so that it rejects the fertilized egg.

Who can use combined hormones?

The pill, the patch, and the vaginal ring are good birth control choices for healthy women who want a 99% effective birth control method. It is best for women who are in a monogamous (one partner) relationship, as it does not prevent the spread of sexually transmitted diseases, including HIV.

How can I use one of these forms of birth control?

The Pill: One birth control pill should be taken by mouth every day at the same time for it to be most effective. The hormone in the pills is released and absorbed into your bloodstream. Skipping pills can decrease their effectiveness. If you skip a pill you may need to double up the next day. The pill is one of the best methods of preventing pregnancy. Less than one woman in a hundred will become pregnant while taking the pill for one year.

Depending upon where in your cycle you start the pill, you may need to use a backup form of contraception (like a condom) until they are effective. You should always use condoms if you have a new partner or are concerned about the spread of sexually transmitted diseases. If you are using certain medications, you may need to use a backup method as well. Always let your health care provider know that you are taking birth control pills.

There are also pills that only contain progesterone. These are usually taken by women who cannot take estrogen or women who are breastfeeding. These pills depend on changes in the cervical mucus and in the endometrium to prevent fertilization.

The Patch (OrthoEvra): This is a thin, beige, flexible square that sticks to your skin. You use a patch for a week at a time. It is important to apply the patch on the same day each week. The hormones from the patch are absorbed through the skin and enter your bloodstream. It is OK to exercise, swim, and sit in a sauna with the patch in place. After three weeks of using the patch, you have one week without a patch when you get a period. You can apply the patch to your abdomen (tummy), buttock, upper body (except for the breast), or arm. Always let your health care provider know that you are using the patch.

The Vaginal Ring (Nuva Ring): is made of flexible, transparent plastic that contains estrogen and progesterone. The vaginal ring is placed inside the vagina and stays there for three weeks. The exact position of the ring is not critical. It only needs to feel comfortable. Hormones are released and absorbed into your bloodstream. Always let your health care provider know that you are using a vaginal ring.

Who should not use combined hormones for birth control?

You should not use the pill, the patch or the vaginal ring if:

  • You are older than 35 and are a smoker
  • You have a history of a certain type of migraine headaches
  • You have a history of blood clots
  • You have a history of heart disease or stroke
  • You have a history of high blood pressure or diabetes with vascular disease and older than 35
  • You have a history of lupus
  • You have a history of high blood triglycerides
  • You have active liver disease with abnormal liver function
  • You have a history of breast or liver cancer
  • You are pregnant
  • You weigh over 200 pounds, some of these methods have not been well tested – discuss with your doctor
  • You have abnormal vaginal bleeding without a medical diagnosis
  • You are taking certain medications like Rifampin, Griseofulvin, and certain anti seizure medications
  • You just had a baby and are nursing. Your health care provider may recommend a progesterone only pill and to start taking the pill 6 weeks after your delivery
What are the risks of using combined hormone birth control?

of using the pill, the patch or the vaginal ring should be discussed with your health care provider. Risks of these contraceptives include an increased chance of having a blood clot, stroke, heart attack, gallbladder disease, liver cancer, and high blood pressure. If you smoke the risk is greater. There may be less risks associated with the progesterone only pill.

Although serious problems from using combined hormone birth control are very rare you need to know what they are. Let you health care provider know if you are having any of the following problems:

  • Shortness of breath
  • Chest pain
  • Leg pain or swelling
  • New or worsening headaches
  • Fainting
  • Abdominal (belly) pains
  • Anything that worries you
What are the side effects of using combined hormone birth control?
The most common side effects are nausea and sometimes vomiting. These usually disappear in the first few days. Other side effects include breast tenderness, increased breast size, spotting between periods, missing periods, weight gain, and headaches. Most of these side effects disappear in 2-3 months. If you start gaining weight, it can often be controlled with diet and exercise. Some women have experienced some irritation at the site of the patch. There may be changes in cervical secretions and cervical erosions with the vaginal ring.

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