Looking to maintain a regular cycle? Estrogen-progestin combination options - Mayo Clinic Press (2024)

There are several kinds of combined estrogen-progestin birth control options, which include pills, patches and vagin*l rings. They can offer several advantages, including menstrual regulation with less bleeding and pain. Some of these options help with acne, premenstrual dysphoric disorder, polycystic ovary syndrome and excess hair growth. These birth control options are also used to help with menstrual migraine headaches, ovulation pain and ovarian cysts, and they even reduce the risk of ovarian cancer.

“Somebody who’s having a lot of cramping, pain and heavy bleeding, these do actually help with reducing the amount of bleeding and the amount of pain that they experience during the menstrual cycle,” says Suneela Vegunta, M.D.

These types of birth control principally work by keeping your ovaries from releasing an egg (ovulating).

Estrogen-progestin combination oral contraceptive pills

How well do they work? 7% of typical users will get pregnant in a year.

Birth control pills are a popular choice. They’re easy to use, and Dr. Vegunta says that the current options are lower dose and better tolerated compared with what was available several years back.

When taken properly every day, these pills are highly effective in preventing pregnancy but are not foolproof. This is because birth control pills are often taken for three weeks, with an “off” week when you take inactive pills or no pills and experience bleeding.

“During their one week off period, a few women can actually start to ovulate because their ovaries can become active again,” Dr. Vegunta says. “That can lead to unwanted pregnancies.”

In an attempt to boost the effectiveness, Dr. Vegunta now recommends taking these pills not only consistently and correctly but for 12 weeks straight before the off week. This use of pills may be slightly more effective in pregnancy prevention,and it allows women to have just four periods a year. Other regimens involve taking active pills continuously for one year, which can stop all menstrual-like bleeding.

Some women are hesitant to use this 12-week-on, one-week-off schedule (84/7) because it sounds unnatural, and they’re worried that this is harmful. Dr. Vegunta says women have told her they worry that if they don’t bleed and flush it out, the lining of their uterus will build up in their bodies.

Dr. Vegunta says this is not a concern, as the lining of your uterus stays thin because of the pill’s progestin. Plus, having only four periods a year is safe and can even be beneficial for certain women, such as those who have anemia or menstrual migraines.

“There’s no reason for women to have one menstrual cycle per month, even though that’s how we are created, but it’s not essential,” Dr. Vegunta says.

However, birth control pills are not for everyone. For one thing, there are possible side effects such as nausea, bloating and breast tenderness, though these may fade with time. A more serious concern — even though this is uncommon — is the increased risk of blood clots especially in women who are smokers, obese or both. Secondly, some women just don’t want the hassle of remembering to take a pill every day. Patches and vagin*l rings may be good options for these women.

Contraceptive patches

How well do they work? 7% to 9% of typical users will get pregnant in a year.

For this method, you place a small patch on your skin once a week for three weeks so that you wear a patch for a total of 21 days. You skip wearing a patch in the fourth week — which allows bleeding to occur. The patch protects against pregnancy by releasing hormones into your bloodstream that prevent ovulation. Ovulation is the process in which a mature egg is released from the ovary.

Patches may have a slightly higher risk for blood clots than the pills and should not be used in women with a BMI of more than 30.

If you’re not very familiar with the patch — brand names include Xulane and Twirla — you’re not alone. Many women prefer to just go with a pill or a ring, Dr. Vegunta says.

vagin*l rings

How well do they work? 9% of typical ring users will get pregnant in a year; 3% of Annovera users.

One type of disposable vagin*l ring — known by the brand names NuvaRing, EluRyng, Haloette and EnilloRing — is inserted into the vagin* for three weeks. You then take it out and leave it out for a week, when you will experience bleeding. Then you insert a new ring for the next three weeks.

“So instead of taking 21 pills, you can just use one ring,” Dr. Vegunta says.

These rings expose you to slightly less estrogen as compared with regularly used pills and are not as likely to cause nausea.

There’s another vagin*l ring, known as Annovera, which follows the three-weeks-in, one-week-out pattern, but with a reusable ring for a year. This gives you the convenience of not having to get a new ring every month.

Like the pills and patches, vagin*l rings deliver estrogen and progestin, which keep your ovaries from releasing an egg.

All rings are self-inserted manually high into your vagin*. You can use your index finger to hook and remove the ring. Since it’s in your vagin*, it is possible for a sexual partner to feel it during sex.

“That’s why we recommend putting it higher up, so patients don’t feel it and the partners don’t feel it during intercourse,” Dr. Vegunta says.

If a vagin*l ring comes out, don’t panic. You can rinse it and reinsert it, and as long as it’s not outside your body for more than two hours for Annovera or three hours for the other rings, it will still effectively prevent pregnancy.

Though the rings are not approved for this use,they can be used continuously for more than three weeks, which achieves longer periods without bleeding.