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What is the hormonal method of contraception?
Contraception refers to the precautions taken before and/or after vaginal intercourse to prevent pregnancy. The hormonal method of contraception involves the use of hormones by the woman on a regular basis, and is one of the most effective methods of contraception.
Contraceptive hormones are available in the form of
- Implants under the skin
- Vaginal rings
- Skin patches
Certain intrauterine devices also come with a hormone delivery system. Currently hormonal contraceptives are available only for women, but efforts are on to develop male hormonal contraceptive that can inhibit sperm production.
How does hormonal contraception prevent pregnancy?
The woman’s body produces and maintains a fine balance of different sex hormones that aid ovulation and pregnancy. Hormonal contraception works at different levels to prevent pregnancy by disrupting the normal hormonal balance.
Hormonal contraceptives are formulations of progestin or a combination of progestin and estrogen. Hormonal contraception results from a combination of the following:
Who should not use hormonal birth control?
People who smoke or are over the age of 35 should avoid using hormonal birth control. Other conditions that preclude hormonal contraception include:
- Coronary artery disease
- Cerebrovascular disease
- Deep vein thrombosis and/or pulmonary embolism
- High blood pressure
- Congestive heart failure
- Vascular complications from diabetes
- Estrogen-dependent tumors or breast cancer
- Abnormal vaginal bleeding
- Known or suspected pregnancy
- Liver, kidney or adrenal gland problems
What are the types of hormonal contraceptives?
Oral contraceptives are hormonal pills for women. Dosage is one pill a day at the same time every day, starting on the first day of the period or the first Sunday after the period starts. Oral contraceptives are of two primary types:
Progestin-only oral contraceptive (mini-pills)
Mini-pills do not contain estrogen and are not widely used in the United States. Progestin-only pills are suitable for women who are breastfeeding or cannot take estrogen for any reason.
- Efficacy: Failure rate with typical use is 7% in the first year of use.
Combination oral contraceptives
Combination oral contraceptives contain progestin and ethinyl estradiol, a form of estrogen. Several formulations of combination contraceptives are available which come in packs of:
- 21-day pills: taken in 21-day cycles with seven no-pill days during which period menstruation should occur.
- 28-day pills: taken in 28-day cycles with hormonally active pills for 21 days and placebos for seven days. Having no gap in ingestion makes compliance easier.
- 91-day pills: taken in 91-day cycles with combination pills for 84 days and estrogen-only or placebo pills for seven days. Menstruation occurs only once in three months.
- 365-day pills: low-dose combination pills taken every day for a whole year. Periods may get lighter or stop altogether.
Current available formulations have lower dosages of estrogen than when hormonal birth control first entered the market. This made oral contraception safer and reduced the side effects.
- Efficacy: Failure rate ranges from 0.1% with perfect use to 5% for typical use.
- Regular menstruation
- Reduced bleeding helps increase iron levels in anemic women
- Women can manipulate their cycles by changing the regimen
- Prevents ectopic pregnancies and ovarian cysts
- Prevents pelvic inflammatory disease
- Protection for up to 15 years after discontinuation, against certain malignant cancers such as
- Epithelial ovarian cancer (40% reduced risk)
- Endometrial adenocarcinoma (50% reduced risk)
Emergency postcoital oral contraceptives
Emergency oral contraceptives can be taken within 120 hours (optimum efficacy up to 72 hours) after unprotected vaginal intercourse or after a suspected/known contraceptive failure. Emergency pills prevent pregnancy primarily by delaying ovulation.
- Efficacy: Efficacy depends on the unprotected intercourse and ovulation timings.
- Advantages: Prevents half to two-thirds of pregnancies if taken within 72 hours.
Metabolic effects of oral contraceptives
With the development of low-dose estrogen pills, safety has greatly improved. Risks from combination oral contraceptives include
- Venous thrombosis: Estrogen activates blood clotting and is a high risk for women who
- Hypertension: Estrogen elevates blood pressure and is not recommended for women with hypertension.
- Atherogenesis and stroke: Some of the androgen and progestin hormones may increase low-density lipoproteins (LDL) levels in blood, hence unsuitable for women at risk for cardiovascular disease.
- Hepatocellular adenoma: Benign liver tumors associated with oral contraceptives, which pose a risk of rupture of the liver’s covering (capsule). These may lead to extensive bleeding or even death.
- Breast and cervical cancer: The risk of breast or cervical cancer from oral contraceptive use is controversial. Studies indicate that the increase in risk for breast cancer is minimal or none. Risk for cervical cancer is minimal, although an annual Pap smear test is recommended.
A progestin-only formulation known as depomedroxyprogesterone acetate (DMPA) given as an intramuscular injection is effective for three months. A subcutaneous version with a lower dose of medroxyprogesterone acetate (MPA) is available now, but efficacy requires further study.
- Efficacy: DMPA is extremely effective and the failure rate is 0.3% in the first year of perfect use.
Subcutaneous contraceptive implants
A subcutaneous implant consists of a thin, 4-cm rod implanted usually under the skin in the triceps area in the upper arm of the woman. The rod contains progestin (desogestrel or etonogestrel), which is released in a prescribed dosage every day.
- Efficacy: A contraceptive implant is more effective than surgical sterilization. With proper insertion the failure rate is 0.05% for at least three years.
- Longevity of the implant
- Lack of estrogen-based risks such as thromboembolism
- Immediate return to fertility upon removal
- No adverse effect on breast milk production
Combination skin patch contraceptives
Skin patch contraceptives are applied on the skin and contain a combination of an estrogen (ethinyl estradiol) and a progestin (levonorgestrel or norelgestromin). The patch releases hormones in prescribed dosage for a week, and three patches are used for three consecutive weeks with a week’s gap before the next cycle.
- Efficacy: Failure rate is one pregnancy per 100 women in one year, similar to other combination methods.
- Easier compliance
- Reduced side effects such as nausea and vomiting as it is not metabolized by the liver
- May cause skin irritation
- May get dislodged unnoticed
- Risk for thromboembolism
- Less effective for women with body mass index (BMI) higher than 30
Contraceptive vaginal ring
A flexible ring containing etonogestrel/ethinyl estradiol (NuvaRing) combination is placed inside the vagina. The ring releases a prescribed dosage of hormones, daily for three weeks. The reproductive organs directly absorb the hormones.
The contraceptive vaginal ring is placed within five days from the start of menstruation. After three weeks of wearing the ring, the woman removes it for a week, and then replaces it with a new ring. A reusable ring (Annovera) with a combination of segesterone/ethinyl estradiol can be used for a year.
- Efficacy: With NuvaRing less than one in 100 women become pregnant in a year of perfect use. Clinical trials with Annovera show two to four in 100 women get pregnant in one year.
- Ease of use and rapid return to fertility upon discontinuation
- Reduced side effects such as nausea and vomiting because of low estrogen dose
- Not metabolized by the liver
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Contraception refers to the precautions taken before and/or after vaginal intercourse to prevent pregnancy. The hormonal method of birth control involves the use of hormones by the woman on a regular basis, and is one of the most effective methods of contraception.
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Birth Control Options
Birth control is available in a variety of methods and types. The method of birth control varies from person to person, and their preferences to either become pregnant or not. Examples of barrier methods include barrier methods (sponge, spermicides, condoms), hormonal methods (pill, patch), surgical sterilization (tubal ligation, vasectomy), natural methods, and the morning-after pill. Side effects and risks of each birth control option should be reviewed before using any birth control method.
Birth Control Pill vs. Depo-Provera Shot
Birth control pills (oral contraceptives) and the Depo-Provera shot are two hormonal methods of birth control. Both methods work by changing the hormone levels in your body, which prevents pregnancy, or conception. Differences between "the pill" and "the shot." Birth control pills are available as combination pills, which contain the hormones estrogen and progestin, or mini-pills that only contain progestin. In comparison to the Depo-Provera injection, which prevents pregnancy for three consecutive months. Both methods of birth control are very effective in preventing pregnancy. Both the combination pill (if you take them as directed) and shot are up to 99% effective in preventing pregnancy. While the mini-pill is only about 95% effective in preventing pregnancy. Both methods cause weight gain, and have other similar side effects like breast pain, soreness or tenderness, headaches, and mood changes. They may lead to decreased interest in sex in some women. There are differences between the other side effects of these methods (depending upon the method) that include breakthrough bleeding or spotting, acne, depression, fatigue, and weakness. Both oral contraceptives and the Depo-Provera shot have health risks associated with them, such as, heart attack, stroke, blood clots, and cervical cancer. Birth control pills appear to increase the risk of cervical cancer. Talk with your OB/GYN or other doctor or health care professional about which birth control method is right for you.
DVT and Birth Control Pills (Oral Contraceptives)
Deep vein thrombosis (DVT) is a blood clot that has traveled deep into the veins of the arm, pelvis, or lower extremities. Oral contraceptives or birth control pills can slightly increase a woman's risk for developing blood clots, including DVT. DVT symptoms and signs in the leg include leg or calf pain, redness, swelling, warmth, or leg cramps, and skin discoloration. If a blood clot in the leg is not treated, it can travel to the lungs, which can cause a pulmonary embolism (blood clot in the lung) or post-thrombotic syndrome, both of which can be fatal if not treated immediately. Increased risk factors for DVT and birth control pills include over 40 years of age, family history, smoking, and obesity. Other medical problems that increase the risks of blood clots, for example, lung or heart disease, or inflammatory bowel disease or IBD (Crohn's disease and ulcerative colitis (UC). Other options for preventing pregnancy include IUDs, birth control shots, condoms, diaphragms, and progestin-only oral contraceptives.
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