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Pill, Patch, Ring

(Combination Estrogen – Progestin Birth Control Methods)

These three methods are highly effective, safe, and reversible methods of contraception.  Because of the number of users, birth control pills (BCPs) are one of the most extensively studied medications worldwide.  The Ring and the Patch are recent innovations.  Much of the data that has been gathered over the past 50 years about BCPs is felt to be applicable to the Ring and Patch.

Effectiveness

There are actually two important statistics – the "typical user" statistic of 95%, and the "perfect use" statistic of 99.9%.  (Regarding the Patch:  Research shows that women weighing more than 198 pounds have a higher failure rate than women weighing less than 198 pounds.)

How it Works

BCPs are taken orally each day.  A new Patch is applied to the skin once a week for three weeks.  The Ring is inserted vaginally and left in place for three weeks.  These methods contain synthetic estrogen and progesterone, which inhibit ovulation.  (They also thicken cervical mucus further decreasing the likelihood of pregnancy.)

Safety

These methods are safe for most healthy women.  For this group there are fewer health risks than in a normal pregnancy.

A medical history and a physical exam along with periodic re-evaluation will determine who is not a good candidate for any of these methods.

Health Benefits

In addition to preventing pregnancy, many BCP* users experience some of the following:

  • Improved menstrual regularity
  • Decreased menstrual cramps and flow
  • Reduced menstruation related anemia
  • Decreased risk of ovarian and uterine cancer
  • Decreased risk of benign breast disease
  • Reduced acne and excessive hair growth (hirsutism)
  • Prevention of functional cysts

*(The Patch and Ring have not been on the market long enough to know whether the above benefits also apply to them.)

Side Effects

If a side effect does occur these are the most common:

BCP Patch Ring
Initial irregular bleeding
Nausea
Headaches
Mood swings
Breast tenderness (first 3-4 months)
Headaches
Skin irritation at Patch site
Initial irregular bleeding
Headaches
Vaginal discharge and/or irritation
Nausea

Most starters have no side effects.  If a minor side effect does occur most users will find that it will go away within days to weeks.  If a symptom persists beyond 12 weeks a different estrogen/progestin formula will often solve the problem.

Regarding weight gain:  The doses of estrogen in these methods are 10-20 times less than when contraceptives were first marketed (1960).  Repeated studies have shown that when matched groups of non-users and pill starters are assessed over time for weight gain, both groups showed the same fluctuations.  In other words, these low doses today are very unlikely to cause weight gain.

Risks

Serious complications related to the low dose estrogen/progestin containing methods of today are very rare.  All of the severe problems that do occur are related to heart and blood vessel diseases, including thromboembolic disorders (blood clots), high blood pressure, stroke, or heart attack.

Estrogen/progestin containing methods are safe throughout reproductive life in women who:

  • Have no cardiovascular risk factors, i.e.
    • High blood pressure
    • Obesity and/or inactive
    • Cerebrovascular or coronary artery disease
  • Have no headaches with focal neurologic symptoms
  • Are not smokers – especially over age 35
  • Do not have increased blood clotting risks

Discontinuing Your Method

Fertility may return (you begin to ovulate) often within days of stopping so begin another effective method immediately should you desire to avoid pregnancy.

Occasionally, reestablishing regular periods may be delayed for weeks following discontinuation.

There is no medical need to take periodic breaks from estrogen/progestin containing methods.  In healthy women these methods can be used until menopause if desired.

Protecting Reproductive Health and Future Fertility

Hormone containing contraceptives have a 50 year plus history of use and research has proven that these methods do not cause a future risk of infertility – regardless of the number of years of use.

Sexually acquired infections are the primary causes of later infertility and cervical cancer.  A combination method (condom PLUS pill, patch or ring) is considered optimum for women until they have a mutually exclusive relationship with an infection-free partner. 

Other Resources

www.managingcontraception.com

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