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Contraception Part 2 -- Hormonal Birth Control
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Today's article focuses on contraception using hormonal means. We will talk about the types, how you use them, and the side effects they have.

  Combined Oral Contraceptives (COCs) Pill

So, what are the benefits of using a COMBINED oral contraceptive?

The first is that it works as a contraceptive. With perfect use, the chance of pregnancy is less than 0.3 percent over the course of the year. With typical use (how most people use it), the chance of pregnancy is 3-8 percent over a year.

There are also lots of other benefits from using a combined oral contraceptive. They
1. Decrease the chance of ovarian and endometrial cancer.
2. Can treat endometriosis (this is only if you have endoemetriosis, of course).
3. Potentially help treat ovarian cysts.
4. Decrease your chance of getting osteoporosis.

Combined oral contraceptives are also used to treat the following:
1. Painful or heavy menstruation
2. Menstrual irregularities
3. Menstrual migraines
4. Acne
5. Perimenopausal symptoms (as you are approaching menopause)

There are some side effects, though. These side effects include
1. Potentially a small increase in weight
2. Mood changes (this is really self reported; when studies have been done, there have been no difference when compared to placebo)
3. Headache
4. Breast tenderness
5. Nausea
6. Breakthrough bleeding or spotting

Most of these symptoms go away after three months, though.

Then, there are more serious side effects. The more serious side effects include:
1. Increased chance of an aterial thrombosis (a blood clot in an artery)
2. An increase chance of breast cancer (1.3x the risk, but this stops once you stop using birth control for 10 years.)
3. An increased chance of a venous thromboembolism (a blood clot in a vein)

It is important to look at the magnitude of these risks, though. The risk of a healthy person getting a clot in their veins is about 5 in 100,000. The risk of a person on birth control getting a blood clot is 15 in 100,000. Meanwhile, the risk of a pregnant woman getting a blood clot is 60 in 100,000. So, although it increases the chance, it is still a very low chance of a clot happening.

Now, there are different types of combined oral contraceptives that you can get. You can get 21 day packs, or 28 days packs. There is no difference between the two. In a 28 day pack, there just happens to be 7 pills that are placebo pills (or sugar pills) to help you to remember. In a 21 day pack, you take the 21 active pills, and then you take 7 days off before you start the next pack. The 28 day pack just helps you keep track of those 7 days.
With birth control, you want the hormone levels to stay the same. So, it is best to take your pills at the same time every day. It is also important not to forget a dose; if you do forget, it increases your chance of getting pregnant.

Here are the current guidelines on what to do if you miss a pill.
If you miss 1 pill or more in the first week, take one tablet as soon as your remember. You should then continue with the pack as normal. In this case, you should use a backup method for the next 7 days. If you had unprotected sex in the past 5 days, you should take an emergency contraceptive pill (ECP), such as Plan B.

If you miss LESS than 3 pills in weeks 2 or 3, take the tablet as soon as your remember. You should then continue with the pack as normal, but skip the placebo (sugar) pills. Start your next pack as soon as you finish this one.

If you miss MORE than 3 pills in weeks 2 or 3, take the tablet as soon as your remember and continue with the pack normally, but skip the placebo tablets (the sugar pills). You should start the next pack immediately. Also, you should use backup protection for the next 7 days. You should also use an emergency contraceptive pill if you have had unprotected sex before 7 active pills have been taken.

So, all of that information was for combined oral contraceptive pills. This is different than the information for Progesterone only pills.

  Progesterone Only Pill and the Depo-Injection

Now, we will talk about progesterone only pills. As mentioned earlier, these pills only contain progesterone. These are typically used for people who should not be taking estrogen. Estrogen is the reason you get clots, so if you have a family history of blood clots, you should not take a pill that contains estrogen. If you smoke it, also increases your chance of clots. Also, if you are over 35 and you smoke, you should not take a birth control pill that contains estrogen.

The chance of pregnancy while using progesterone only birth control is 0.5 percent over a year if used perfectly. Normal use results in about a 5-10 percent chance of pregnancy over a year. These pills are more sensitive, though, as you need to take them at the same time ever day. You only have a 3 hour window of taking them at the same time each day, whereas pills that contain estrogen have about a 12 hour window. With a progesterone only pill, you need to use backup protection for the first month of using it. There are no sugar pills with this type of birth control.

There are some advantages to using a progesterone only birth control pill.
1. There is no increased risk of breast cancer
2. Amenorrhea (no menstrual bleeding) occurs in about 10 percent of people who use it

There are not all of the advantages of the combined oral contraceptive, though. There is no decrease in endometrial or ovarian cancer, for instance. There is also no benefit on ovarian cysts with just progesterone pills.

Progesterone only pills do have some side effects. These include:
1. Acne
2. Breast tenderness
3. Nausea
4. Weight gain (about 5 pounds in the first year)

There is also a progesterone only injection you can get; most people are familiar with its name, Depo-Provera. This is an injection of progesterone that lasts for about 14 weeks. You get an injection every 12 weeks, though. If you get the injection every 12 weeks, it has a 0.3 chance of pregnancy over a year. If you do not get an injection every 12 weeks, you have a 3-7 percent chance of pregnancy each year. The injection also has the chance of increasing your risk of osteoporosis slightly. It also takes a little while before you can become pregnant after using it, as well. It takes some people up to 9 months before they conceive a child after stopping it.

  Other Forms (patch, ring, IUD)

So, now that we have talked about the two types of oral contraceptives, I want to talk about the other types of birth control.

There is the patch. This is a patch that delivers both estrogen and progesterone through your skin. You wear one patch on your upper arm, buttocks, lower abdomen, or your upper torso for one week at a time. You then remove the patch, putting a new one on. You wear patches for 3 weeks, then stop for a week. The patch has the same effectiveness and side effects as the pill, but there is an even high risk of blood clots with the patch (around 30 in 100,000 people).

Here are the recommendations for what should happen if the patch falls off:
If the patch falls off for less than 24 hours, attempt to reapply it. You should use a backup method of birth control for 1 week.
If the patch falls off for MORE than 24 hours, reapply the patch as soon as you remember. You will now count this as day 1. You need to use a backup protection for one week if this occurs. Also, if you have had unprotected sex within the past 7 days, you should take an ECP. This recommendation also applies if you left the patch on for longer than 9 days.

There is the intravaginal contraceptive called the NuvaRing. This is a flexible plastic ring that is inserted into the vagina. It provides estrogen and progesterone that way. It has a similar effectiveness to the pill, as well. The side effect profile is also similar. It also can cause some inflammation of the vagina, a foreign body sensation, and some problems with sex. The NuvaRing is inserted into the vagina, where it is then left for three weeks. It is then removed for one week. A new ring is then inserted again for 3 weeks, after the one week break. This cycle keeps repeating. You can remove the ring for sex, but you do not want to ever have the ring out for more than 3 hours at a time.

Here are the recommendations on what to do if you remove the ring:
If the ring is out for less than 3 hours, rinse the ring with water and re-insert it.

If the ring is left out for more than 3 hours, rinse the ring with water and re-insert it. You will then skip the hormone free interval (that one week without the ring). Instead, you will just insert a new ring after the 3 weeks are up. You also need to use an ECP if you have had unprotected sex in the past 7 days.

If the ring is left in for 3-4 weeks, it is still effective. However, if you leave the ring in for longer than 4 weeks, you should check to see if you are pregnant before inserting a new ring.

Next come the intrauterine devices; these devices are inserted into your uterus. There are two types of intrauterine birth control: hormonal and non-hormonal.

The non-hormonal kind is a t-shaped plastic piece with copper wire. The copper has an effect on the inside of the uterus and the cervical mucus. Essentially, the copper causes the sperm to die when it enters the uterus. This type has a 1.25 percent chance of pregnancy each year. These devices can last for up to 10 years.

Then, there is the hormonal intrauterine device. These devices are commonly called IUDs, and the brand name is Mirena. This is a plastic-T shaped device. This device has hormones in it, which are released slowly. So, it works similarly to the combined oral contraceptive, but it is inside the uterus. These devices last for 5 years. It has a 0.2 percent chance of pregnancy each year. It has the same side effects as the pill, as well. There can be some pain, swelling, and discomfort when inserting these IUD's (this is true of both the copper and hormonal kind). They used to recommend IUD's to women who have previously had a child, but now they say anyone can get one. With the hormonal kind, 20 percent of women will end up having no period.

These are all of the hormonal types of birth control. If you have any questions, feel free to ask them in the comments.



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