Birth control is a way for a couple to  prevent pregnancy. There are different types of birth control, including the Intrauterine Device (IUD), implant, shot, patch, ring, and the oral contraceptive pill (the pill). The type of birth control you decide to use is a personal decision and will often be based on a doctor’s recommendation.

Hormonal contraceptives include the pill, the patch, and the vaginal ring. They all contain synthetic (man-made) versions of the hormones progesterone (called progestin) and  oestrogen. 

Hormonal contraceptives usually work by changing the cervical mucus, making it harder for the sperm to swim or find the egg. They also  prevent the body from ovulating. 

They are several types of hormonal contraceptives or hormonal birth control, and they include:

Oral Contraceptives

Oral contraceptives, also known as birth control pills are medications taken by mouth to prevent pregnancy. They are widely used, but before use, you should explore what side effects they cause, as well as how well they work. That way you will discover if they are also the best option for you.

They are two types of oral contraceptives:

1. Combined pills 
2. Mini pills

Combined pills

Combined pills contain the hormones oestrogen and progestin. Taken throughout the cycle, most of the month you will take an active pill, meaning it contains hormones. Inactive pills (hormone free, or placebo) pills will be taken at certain times, depending on the exact pill you are on. There are different types of combined pills:

• Multiphasic pills: These are taken for a one-month cycle, they provide varying levels of hormones throughout the cycle. During the last week of your cycle, an inactive (placebo) pill is taken, which causes a withdrawal bleed.
• Monophasic pills: Mostly used in one-month cycles. However, each of these active pills offers you an equivalent dose of the hormone. Just like multiphasic pills, in the last week of your cycle an  inactive placebo pill is taken, causing a withdrawal bleed.
• Extended-cycle pills: These work differently from the multiphasic and monophasic pills. They are used for a 13-week cycle. The active pills are taken for 12 weeks, while the inactive pills are taken during the last week of your cycle. This results in you having withdrawal bleeding only three to four times per annum. 

Mini pills

Mini pills are birth control pills that only contain the hormone progestin. Therefore, they are known as progestin-only pills. There are no inactive pills and they are taken continually throughout the cycle, meaning  you may or may not menstruate whilst using them. These pills are  a good choice for  women who cannot take oestrogen or have a history of blood clots in the lungs or in the legs. 

Mini pills usually solidify the cervical mucus and  weaken the lining of the uterus (the endometrium), thus preventing sperm from reaching the egg. The pills also suppress ovulation; however, this is not constant, and can sometimes vary month to month. For optimal efficiency, you should take the mini pill every day at about the same time.

Your doctor might recommend the mini pill if:

• You have health problems, such as blood clots.
• You are breast-feeding, as oestrogen can inhibit the production of breast milk.

These pills are not appropriate for everyone. You should avoid, or seek medical advice, if: 

• You have ever had or have breast cancer.
• In case of liver disease.
• You have unexplained uterine bleeding.
• You are on medications for HIV/AIDS, seizures, or tuberculosis.

As with all forms of birth control, there are several benefits and disadvantages that come with the use of birth control pills (oral contraceptives): 

Benefits

• Birth control pills can be used to treat painful periods.
• They manage unwanted symptoms of perimenopause; such as irregular periods, and even hot flushes.
• They can help to reduce negative side effects of premenstrual syndrome like cramps and mood swings.
• Can be used to avoid the need for hysterectomy in those with debilitating endometriosis.
• When used for at least 5 years the pill protects against the risk of endometrial cancer by 50% and also ovarian cancer by 20%.

Disadvantages 

• For some women, these birth control pills can lead to an increase in blood pressure, increasing the risk of type 2 diabetes and heart disease.
• The extra hormones can lead to an increased risk of blood clots, especially for smokers.
• Can lead to weight gain. 
• Increased risk of certain types of cancer, including  cervical, liver, and  breast cancer has been connected to pill use.
• When one stops taking the pills, the menstrual cycle can take months, and even years, to return  to normal. 

Mirena coil

The Mirena coil is classified as a hormonal IUD that can offer long-term birth control, for up to 5 years after being inserted. It can be used by all premenopausal women, including teenagers.

It is a T-shaped plastic frame, which is inserted into the uterus. It releases the hormone progestin, preventing pregnancy as it stops ovulation.

It has been approved for use by the Food and Drug Administration (FDA).

As well as being used as a contraceptive, the Mirena is prescribed to women with:

• Endometriosis.
• Heavy menstrual bleeding.
• Abnormal growth of the uterus lining (endometrial hyperplasia).
• Abnormal growth of the uterine tissue on the muscular wall of the uterus (adenomyosis).
• Fibroids.

There are several benefits and disadvantages to using the Mirena:

Benefits

• You do not require your partner’s participation.
• It can remain in place when inserted for up to five years.
• You can remove it at any time and theoretically experience a quick return to your normal fertility.
• You can breast-feed while using it. 
• No risk of complications, such as endometriosis, pelvic infection and severe period pain. These can all be triggered by birth control methods that contain oestrogen. As such, the coil is often recommended for women with endometriosis, and fibroids.

Disadvantages

• Possible association with cervical and endometrial cancer.
• Irregular menses, which can improve after 3-6 months of use.
• It does not protect you from STIs.
• You might have irregular bleeding.
• Acne.
• Headaches.
• Breast tenderness.
• Mood changes.

If you conceive whilst the Mirena is in place, then the fertilised egg might be implanted outside the uterus, generally in a fallopian tube. This is known as an ectopic pregnancy and can be very dangerous. 

Vaginal Ring

Just like other hormonal birth controls, the vaginal ring prevents pregnancy through the release of hormones into the body. One can use the vaginal ring for 3 weeks, remove it and allow menstruation to occur, then after a week insert a new ring.

There are two vaginal rings with FDA approval in the United States: NuvaRing and Annovera.

Benefits

• Easy to use and comfortable.
• Can be removed at any time and fertility should be restored  quickly.
• Good for women experiencing latex (condom) allergies.
• No weight gain.
• Not likely to trigger irregular bleeding, unlike oral contraceptives.

Disadvantages

• Can cause Vaginal irritation or  infection. 
• Increased  vaginal discharge.
• Not recommended for women who have a history of blood clots, heart attacks, stoke and those over 35 years of age.
• Diarrhoea.
• Headache.
• Breast tenderness.
• Nausea.
• Abdominal pain.
• Depression

Understanding your options as an individual and taking an open evaluation of the relationship you are in is certainly part of your choice process. It will help you in deciding which, if any, type of hormonal birth control is most suitable for you.

Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and menopause. 

Get in touch if you have any questions about this article or any aspect of women’s health. We’re here for you. 

Sources

• Cooper DB, Mahdy H. Oral Contraceptive Pills. [Updated 2020 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430882/
• “Hormonal IUD (Mirena).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 26 Feb. 2020, www.mayoclinic.org/tests-procedures/mirena/about/pac-20391354.
• “Minipill (Progestin-Only Birth Control Pill).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Dec. 2020, www.mayoclinic.org/tests-procedures/minipill/about/pac-20388306.
• “Vaginal Ring.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 12 Feb. 2020, www.mayoclinic.org/tests-procedures/nuvaring/about/pac-20394784.
• “What Should I Do If I Miss a Pill (Combined Pill)?” NHS Choices, NHS, www.nhs.uk/conditions/contraception/miss-combined-pill/.