Hormonal Contraception: So Many Choices…
Women have different needs when it comes to birth control. Hormonal contraception has many forms to meet these needs; from pills to patches to rings and injections. Learn how each method functions and those ageless myths about hormonal contraception (you know which one’s we’re talking about) will disappear. Not everyone is a candidate for hormonal contraception. Discuss with your healthcare provider which method is the best choice for you.

The Pill

“The Pill” contains estrogen and progestin. The Pill works by suppressing ovulation (the release of an egg from the ovary). No egg means no fertilization. The pill comes in a monthly or a 3-month pack and is taken daily. The menstrual bleeding you experience while on the pill (or any hormonal contraception for that matter) is not really a menstrual period. The bleeding is in response to the withdrawal of the hormones. In the case of the pill, this occurs when the inactive pills at the end of the pack are started. With the one-month pack a “period” occurs every month, whereas with the 3-month pack the pill is taken continuously for 3 months so that your “period” occurs only four times a year. Many studies have been done which show this is a safe and effective regimen. Discuss the options with your healthcare provider to see which is best for you.

When used correctly, the Pill is 99.9% effective; only three women in 1000 will unintentionally become pregnant. In fact, it’s one of the most effective non-surgical methods when used consistently and correctly. Unintentional pregnancy associated with the Pill happens most often after a woman stops using the Pill and has unprotected sex without using another birth control method.

Instructions

Your health care provider will discuss with you what day to start your pill pack. Rutgers Health Services recommends a “Quick Start” – begin the Pill right away.  Or, your health care provider may instruct you to start on the first day of your period or on the first Sunday of your period. Use condoms for at least the first month.

Remember: consistent and correct use is what makes the Pill effective. Take 1 pill each day at the same time of the day; within an hour of your usual time is ok. Associating some other daily routine (like eating breakfast) with pill taking will help you remember.

What happens if I forget to take my pill?

That is a common question. If you:

Miss 1 pill – Take it as soon as you remember and take the next pill at your regular time. Use back up protection for 7 days.

Miss 2 pills – Take two pills as soon as you remember and take two pills the next day. Or take one pill every 12 hours until caugh up. Then return to your normal schedule making sure you use back up protection for 7 days.

Miss 3 pills – Throw away the whole pack and start a new pack. Don’t be alarmed if you spot or bleed after missing 3 pills. If you were a Sunday starter, begin your pill pack that following Sunday. If you started your pills on the first day of your period, start a new pack immediately. Continue taking the pills as directed and use back up contraception for the first 7 days after restarting your new pack.

The Pill is less effective:

  • When one or more pills are missed in one cycle. Be sure to use back up contraception (see above).
  • When certain other medications (such as antibiotics) are taken at the same time. Let your health care provider know about all medications you take (prescribed and recreational).

The "Patch"

The “Patch” is the Ortho Evra Transdermal Patch® – a smooth beige transdermal square (about the size of a mini-post-it) that you put directly on your buttocks, abdomen, or upper outer arm. “Transdermal” means that the estrogen and progestin are absorbed through your skin into your blood stream.

The Patch works much the same way as the Pill and is equally effective. It contains the hormones estrogen and progestin. It has a 99.9% success rate when used correctly. With typical use, eight out of 1000 women will unintentionally become pregnant while using the Patch.

Instructions

Unlike the Pill, the Patch is worn for one week, for 3 out of 4 weeks. You apply and change the Patch yourself weekly on the same day of the week. This gives you 3 weeks with the Patch and one week without to allow for your “period.” You can wear the patch on your upper arm, either side of your lower belly, and on your buttocks.

  • If you’ve used the Patch correctly (1 patch for 3 weeks and 1 week without) and you miss two periods in a row, it’s possible that you might be pregnant. Call your health care provider and get a pregnancy test. If it’s positive, stop using the Patch immediately.
  • The Patch should NOT be placed on or near your breasts.
  • Let your health care provider know about any and all medication that you are on (recreational or prescribed) in order to avoid drug interactions.
  • The Patch is less effective in women over 194 lbs.
  • The Patch only comes in one color, beige, so it is noticeable on most women’s skin. Some women report skin irritation (20%) where the Patch is adhered. This can be avoided by switching the location of the Patch each week.
  • There is a higher steady state of hormones due to continuous absorption, so that a woman will be exposed to more estrogen-related risks over the 3 weeks of patch use compared to the pill.

NuvaRing

The NuvaRing is not as scary as it may sound. It’s a 2-inch, soft, flexible, transparent ring that you insert into your vagina. It contains estrogen and progestin that are absorbed through the skin of the vagina. The Ring prevents pregnancy in the same way as the pill does. The NuvaRing is 99.2% effective. About eight out of 1000 women using the ring will unintentionally become pregnant.

Instructions

The Ring has a 3-week schedule – 3 weeks with the Ring and 1 week without. When first starting to use the Ring, count the first day of your period as “day one” and insert the Ring into your vagina between the first and fifth day of your period. Press the sides of the ring together and insert it into your vagina, just far enough so that it’s behind your pubic bone. The Ring stays in for 3 weeks, followed by 1 week with no ring inside the vagina.

After 3 weeks remove the Ring on the same day of the week and the same time of day that you put it in. To take it out you hook your finger under the rim and gently pull it out, wrap it, and throw it away. After a week, which allows for a “period,” start the process all over again.

The ring is not to be used with a diaphragm or cervical cap as a back-up method of birth control; condoms are ok.

The Ring is less effective when:

  • The unopened package is exposed to direct sunlight or very high temperatures.
  • It slips out of or is removed from your vagina and is not replaced within 3 hours.
  • The Ring does not stay in your vagina for 3 weeks in a row or it stays in longer than prescribed by your healthcare provider.
  • You are taking medications (recreationally or prescribed) that may interfere with the Ring.

Depo Provera

Depo-Provera is commonly known as “The Shot.” It is an injection of synthetic progestin (no estrogen) into your shoulder or buttocks that prevents pregnancy for 3 months.

Depo-Provera prevents ovulation, thickens cervical mucous, and thins endometrial tissue (the lining of your uterus). Depo Provera is 99.7% effective when used correctly and consistently. Only three in 1000 women will become pregnant unintentionally in the first year of use.

Instructions

Your health care provider will provide your Depo Provera injection four times a year. This means only one shot is needed every three months to prevent pregnancy.

Possible Side Effects

  • Loss of monthly period which usually occurs after the third shot
  • Irregular bleeding patterns which is usually light
  • Soreness at injection site, increase in appetite/weight gain, depression, hair loss, increased hair on your face or body, nervousness, and/or decreased sex drive.
  • Fertility may be delayed up to 1 year after injections stop.

Note: to promote bone health, women using Depo Provera should take an adequate intake of calcium and vitamin D, engage in regular exercise, and avoid tobacco use and excessive alcohol consumption.

Intra-Uterine Device (IUD)

An IUD is a t-shaped plastic device. The IUD prevents pregnancy by preventing fertilization. It is inserted into the uterus and can stay in place for up to 5 years – 10 years depending on the type of IUD. There are two types of IUDs.

Hormonal (Mirena)

  • Stays in place for up to 5 years
  • Progesterone-only

Non-Hormonal (Paraguard)

  • Stays in place for up to 10 years
  • May make periods heavier
  • An IUD is a prescription birth control and is inserted by a health care provider
  • STI testing is done before the insertion of an IUD
  • Progesterone related side effects (e.g., headache, nausea, breast tenderness, depression) are rare because of the small amount of hormone released
  • Both IUDs may result in irregular spotting in the first 1-3 months after insertion. A decrease in bleeding or no menstrual bleeding is common with the hormonal IUD (Mirena).
  • Either IUD may be used by women who have not had children.

An IUD is NOT to be used in the following situations: 

  • Pregnancy
  • Pelvic inflammatory disease-current
  • Sexually transmitted infections-current
  • Cervicits (current)
  • Undiagnosed abnormal vaginal bleeding
  • Cancer of the genital tract
  • Uterine abnormalities or fibroids
  • Allergy to any component of the IUD

Implants

Nexplanon is a hormonal contraceptive method that is inserted by a health care provider. The implant is:

  • A matchstick size (4 cm) plastic rod that is inserted under the skin of the upper arm.
  • Progesterone only
  • Can stay in place for up to 3 years

 

Implants work much the same way as the Pill and are equally effective. Less that 1 out of 100 women a year will become pregnant using the implant.
Implants may cause irregular bleeding and changes in period-they may become heavier or lighter.

Certain medications may cause implants to be less effective. Inform your health care provider if you take any of the following:

  • Certain TB medications
  • Certain HIV medications
  • Some medications use to manage a mental illness
  • Some yest infection medications that are taken orally
  • Herbals such as St. John’s Wort
  • Some anti-seziure medications.

Potential Benefits of Hormonal Contraception

Using hormonal contraceptives has other potential benefits. Each method has its own specific positives but in general:

  • Decreased risk of breast cysts, ovarian and uterine cancer, as well as the incidence of ovarian cysts
  • Sexual intercourse can still be spontaneous
  • Help with acne
  • Hormonal methods are reversible – meaning that once you stop taking using them, you can become pregnant
  • Regulates your period and reduces menstrual cramps
  • Most do not have to be remembered daily (except the Pill)
  • Consistent contraceptive protection!

Potential Disadvantages of Hormonal Contraception

As with all medicine, there are possible side effects of hormonal contraception. Make sure to inform your health care provider that you are using a form of hormonal contraception – especially if other medications are being prescribed. Not everyone will experience the same side effects, and some women will have severe or frequent side effects, while others will have minor or moderate ones. Side effects can include:

  • Spotting or bleeding between periods (called “break-through” bleeding)
  • Appetite changes
  • Nausea
  • Breast tenderness or fullness
  • Mood changes, irritability, depression
  • Changes in sex drive
  • Hormonal changes can result in vaginal itching, increased vaginal discharge and possible vaginitis
  • Headaches
  • Skin irritation (with the Patch)
  • Hormonal contraception DOES NOT protect against sexually transmitted infections (STIs).

Most side effects usually clear after 2-3 months of using the particular method. If symptoms persist after 3 months, talk with your health care provider to discuss alternative methods.

When to contact a health care provider?

Because there is a small risk blood clots, stroke and heart attack with use of hormonal contraception you must consult your health care provider IMMEDIATELY if you have any of these symptoms:

A – Abdominal pain
C – Chest pain (severe), shortness of breath, cough, arm/shoulder pain or weakness
H – Headache (severe), dizziness, weakness, sudden intellectual impairment
E – Eye problems, complete or partial loss of vision, sudden visual impairment, “floating” dots of light or dark spots
S – Severe leg pain, especially in one calf, swelling

The Myths

There are many myths and misconceptions about hormonal contraception. We’ve all heard one or more of these. Some people believe the misinformation and this prevents them from using hormonal contraception, which is safe and reliable. Take this brief true/false quiz to test your knowledge about hormonal birth control.

True or False?

I can’t get pregnant if I stay on the Pill too long.

False: fertility is not affected by being on the Pill. So if you stop taking the Pill and don’t want to get pregnant, use a back-up method of contraception such condoms.

If you use hormonal contraception, you have to take “a break” from it every so often.

False: you don’t have to take a “birth control” break. Your body will not be harmed from using hormonal birth control for extended periods of time. In fact, hormonal contraception has several protective factors. It may help protect against ovarian and uterine cancers over time.

Hormonal contraception increases your chances of breast cancer.

False: there is no association between hormonal contraception use and breast cancer in women of childbearing age.

Hormonal contraception protects you against sexually transmitted infection.

False: NO! Hormonal contraception provides absolutely no protection against sexually transmitted infections (STIs). If you are sexually active, the only way to avoid contracting/transmitting an STI is to use condoms (male/female) and dental dams. The only way to protect yourself from STIs completely is to avoid all sexual intercourse and intimate contact.

I’ll gain a ton of weight on hormonal birth control.

False: today’s hormonal contraception is not our mom’s or our grandmother’s forms of contraception. Technology has refined and reduced the amount of hormones in hormonal contraception. This means fewer side effects including weight gain. Not every woman who uses a hormonal method will gain weight. Those who do are most likely to gain 3-5 pounds and that is mainly water weight that is lost in the first three months.

How do I get Hormonal Contraception?

Hormonal contraception, including Emergency Contraception, is available by prescription only from a health care provider. RHS prescribes hormonal methods and you can fill your prescription the Rutgers Pharmacy. Our prices are very competitive and we accept most insurance prescription plans.

Questions? Not sure which is the method for you? Talk with your health care provider to see if hormonal contraception is right for you. Also consider your relationship status and frequency of sexual activity. Want to make an appointment to discuss birth control options? Call 732-932-7402 to make an appointment at any RHS Student Health Center, regardless of location.