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When Enovid -- the first birth control pill -- was introduced in 1960, it was a revolution in contraception. For the first time, women could take control of their own reproductive cycles. According to Eve Espey, MD, Enovid ushered in "a whole new world for birth control." Espey is associate professor in the department of obstetrics and gynecology at the University of New Mexico. She tells WebMD it was the first time there was any kind of hormonal contraceptive "or any alternatives to condoms."
Nearly half a century later, and despite the introduction of IUDs, patches, injections, and the female condom, the pill remains the No. 1 form of contraception. It's used by an estimated 12 million women in the U.S. and 100 million women worldwide. According to Paula Hillard, MD, "When you say 'birth control,' most women think of birth control pills." A professor of obstetrics and gynecology at the Stanford University School of Medicine, Hillard says that birth control pills are still widely popular, especially among younger women.
Today's birth control pills contain a much lower dose of estrogen than their predecessors. That means they have fewer side effects. Nevertheless, they're still highly effective.
There are two basic types of birth control pills. Combination pills combine estrogen and progestin. The "minipill" contains progesterone only. There is also an emergency contraceptive pill, which is taken after unprotected sex.
Here is an overview of each type of pill and an explanation of how it works.
Birth Control Pill Type: Combination Pills
Combination birth control pills are the type most commonly associated with
the term "the pill." They contain a combination of the hormones estrogen
and progestin. Progestin is a synthetic form of the hormone progesterone.
Ovulation normally occurs when a spike in estrogen levels signals the ovaries to release an egg. Combination pills prevent ovulation by adjusting hormone levels to prevent this spike. They also thicken cervical mucus to prevent sperm from reaching the egg. In addition, they change the lining of the uterus to make it more difficult for a fertilized egg to implant.
Most combination pills use the same form of estrogen -- ethinyl estradiol -- but different types of progestins. For example, Mircette uses the progestin desogestrel. Yasmin uses drospirenone.
Most combination pills come in 21- or 28-day packs. With a 21-day pack, all of the pills are active. You don't take any pills for the last seven days of the cycle. It's up to you to remember when to start the next pill pack. With a 28-day pack, you take 21 active pills followed by seven inactive placebo pills.
There are three types of combination pills: monophasic, biphasic, and triphasic.
All of the 21 active pills contain the same level of
hormones.Brand names include:
Yaz (contains 24 active pills and four placebo pills) Biphasic:
The 21 active pills contain two different levels of estrogen and
progestin. Brand names include:
Ortho-Novum 10/11 Triphasic:
The 21 active pills contain three different doses of hormones.
The dose changes every seven days. Brand names include:
Ortho-Novum 7/7/7 Ortho Tri-Cyclen Tri-Levlen
Tri-Norinyl Triphasil In terms of safety and effectiveness, the three combination pill types are pretty much interchangeable. Many doctors, though, recommend monophasic pills because the hormone dose and color are more consistent. "I almost always prescribe monophasic pills," says Espey. "For me the biggest problem with biphasic [and triphasic] pills has nothing to do with content. It has to do with colors. If a woman misses a pill and you tell her to take another pill the next day, she can get confused about the color."
What are the pros of combination pills?
Combination pills offer a number of advantages and benefits:
They are 99% effective when taken every day. The typical failure rates,
Menstrual periods are lighter, more regular, and less painful. There are fewer premenstrual side effects, such as moodiness. There is lower risk of ovarian and uterine cancers, ovarian and breast
There is less acne.
The pills prevent ectopic pregnancy.
They ease the discomfort of endometriosis. What are the cons of combination pills?
Combination pills also have their downside:
Irregular bleeding, especially in the first two months of use
The pills might increase risks of high blood pressure, heart attack, stroke,
blood clots, liver tumors, or, in rare cases, gallstones.
They are not appropriate for women with a history of blood clots,
uncontrolled high blood pressure, migraine headaches with aura, heart disease, or liver disease.
Birth Control Pill Type: Minipill (Progestin-Only)
The "minipill" or progestin-only pill (POP) contains no estrogen. It's
designed for women who are breastfeeding. Estrogen reduces milk
production. They are also designed for women who have conditions that
prevent them from taking estrogen. For example, women with a history of
blood clots should not take estrogen.
Blocking one of the hormones needed for ovulation Thickening the cervical mucus to prevent sperm from getting to the egg Changing the lining of the uterus to make it more difficult for a fertilized
They come in 28-day packs, and all of the pills are active.
The minipill can be effective. But you do need to be meticulous about
taking it. "They are pretty unforgiving in terms of missed pills or pills taken
late," Hillard says. "They hardly last a full 24 hours, so you really need to
be just about perfect in taking your pills at the exact same time every day. Birth Control Pill Type: Minipill (Progestin-Only) continued.
Brand names include:
Ovrette What are the pros of minipills?
Here are the advantages and benefits associated with minipills:
They can be used by breastfeeding women. They can be used by women who can't take estrogen, such as those
who smoke and are over 35, and those who have high blood pressure or migraines with aura.
They reduce menstrual blood loss and cramps. They protect against ovarian and uterine cancers and pelvic
What are the cons of minipills?
Here are the problems associated with using minipills:
They are not quite as effective as the combination pill. They must be taken every day at the same time. They can cause irregular bleeding and missed periods. They won't regulate periods like the combination pills. Side effects can include abdominal pain or cramps, fatigue, hot flashes,
reduced sex drive, headache, nausea, dizziness, and difficulty sleeping.
Birth Control Pill Type: Extended-Cycle Pills/Continuous Use Pills
Extended-cycle pills are relatively new. They offer a choice for women who
have painful periods or who just don't like the inconvenience of having a
monthly period. Like the combination pills, they contain both estrogen and
progesterone. By having more days of active hormone in a row, though,
these pills eliminate many -- if not all -- periods.
The number of active pills you take and the number of times you get your period depend on the type of extended-cycle or continuous-use birth control pill you take:
Seasonale contains 81 days of active pills. That's followed by seven days
of inactive pills. That means you get a period about once every three months.
Seasonique contains 84 days of active pills. They're followed by seven
days of low-dose estrogen pills. The result is you have about four periods a year.
Lybrel contains only active pills. It's taken 365 days a year, which
It may seem unnatural to reduce or eliminate your period. But extended-dose pills are actually just as safe as traditional combination birth control pills. "When you give the combination of estrogen and progestin," Espey says, "it causes a thinning of the lining of the uterus, so you really don't need to have a period. If you're not building up the uterus every month, you don't need to shed it."
Seasonique What are the pros of extended-cycle pills?
There are several benefits and advantages in using extended-cycle pills:
You have fewer or no menstrual periods. Using the pills may be more effective than the traditional combination pill
cycles because the pills are easier for women to take.
The pills can help treat conditions that are exacerbated by periods, such
as endometriosis, menstrual headaches, painful periods, and premenstrual dysphoric disorder.
There are fewer menstrual symptoms. What are the cons of extended-cycle pills?
Just like with the other pills, there are downsides to extended-cycle pills:
There may be irregular or breakthrough bleeding.
The pills have the same side effects as combination pills. Birth Control Pill Type: Emergency Contraceptive Pills
The emergency contraceptive pill is meant to be used to prevent a
pregnancy after unprotected sex. The only FDA-approved emergency
contraceptive available in the U.S. is Plan B. Plan B is available over-the-
counter to women 18 and older.
The emergency contraceptive pill contains a form of progestin called levonorgestrel. It works by preventing ovulation. But it won't stop the fetus from developing if you're already pregnant. It's taken in two doses. You take the first dose as soon as possible after having unprotected sex. The second dose is taken either right afterward or 12 hours later. Plan B is effective for up to five days after having unprotected sex.
If you don't have Plan B on hand and you've had unprotected sex, it's also possible to take several of your regular birth control pills as a form of emergency contraception. This is known as the Yuzpe regimen. But ask your doctor about the exact dosing.
What are the pros of emergency contraceptive pills?
There are two main benefits associated with emergency contraceptive pills:
They decrease the risk of an unintended pregnancy by about 87%.
There is no risk of harm to the fetus if you do get pregnant. What are the cons of emergency contraceptive pills?
There are several disadvantages to emergency contraceptive pills:
Women under 18 cannot get these pills without a doctor's prescription. The pills must be taken within 120 hours -- five days -- of unprotected
Side effects include nausea, vomiting, dizziness, fatigue, breast
Birth Control Types Guide
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