Oral Contraception Pill (OCP)

Combination OCPs are the most popular hormonal contraception option in the US, and are proven to be safe for most women.  They are typically formulated with an estrogen and a progestin hormone.

OCPs prevent pregnancy by inhibiting ovulation, thickening cervical mucus to impede sperm movement, and making the endometrium unfavorable for implantation.

There are many beneficial effects from the use of combined OCPs. Some of these include: increased bone density, reduced bleeding during periods and less anemia, decreased risk of ectopic pregnancy, improved dysmenorrhea, fewer premenstrual complaints, decreased risk of endometrial and ovarian cancers, reduction in various benign diseases of the breast, inhibition of excess hair growth, improvement of acne, prevention of artery hardening, and decreased activity of rheumatoid arthritis.

OCPs usually come in a 28-day pill pack where 21 pills contain hormone and the last 7 pills are inert or contain iron.  You take a pill every day and start a new pack when the old one is finished (every 28 days).  Bleeding occurs every month during the week when you take the last seven pills.

They can also be dosed continuously or with an extended cycle.  These usually consist of 84 active pills and seven inactive pills. Bleeding typically occurs only four times a year during the seven days of inactive pills.

Side effects of combination OCPs can include: breakthrough bleeding or spotting – more common with continuous-dosing or extended-cycle pills, breast tenderness, elevated blood pressure, headaches, nausea, and bloating. Some side effects, such as headaches, breast tenderness, and breakthrough bleeding, might decrease with continued use.

Combination OCPs also increase the risk of certain conditions, which can be serious. These include blood clots in the legs, heart attacks and stroke—especially if you smoke, liver disorders, and gallbladder disease.

For patients with health conditions where estrogen is contraindicated or for early postpartum patients, a progestin –only pill (POP) or mini pill, can be considered.  It is recommended that POPs be taken at the same time every day to be effective, and generally have a higher incidence of irregular bleeding and a slightly higher pregnancy rate.  OCPs do not protect against sexually transmitted infections (STIs).

OCPs may not be appropriate in certain patients as well, including those with a history of migraine with aura, and breast cancer.  It is important to discuss your medical history with your doctor in order to determine if OCPs may be suitable for you.

Vaginal Ring

The intravaginal hormonal contraceptive ring is a flexible ring containing an estrogen and a progestin, and it is a highly effective form of contraception.  The ring works by inhibiting ovulation (where the body releases an egg), so that the egg cannot accept a sperm and pregnancy is prevented.  Serum hormone levels with the ring are lower than comparable low-dose oral contraceptives.

The ring is initially placed within 5 days of the onset of menses. It is removed after three weeks of use for one week to allow for bleeding.  A new ring is inserted one week after this removal.

About 20% of women and 35% of men reported being able to feel the ring during intercourse.  If this is bothersome, the ring may be removed for sexual intercourse, but should be replaced within 3 hours.  If the ring has been out of the vagina for more than 3 hours, you may not be adequately protected from pregnancy, and must use an extra method of birth control until the ring has been in place for 7 days in a row.  The ring does not protect against STIs.

It is very important that your doctor check your progress at regular intervals to make sure the medicine is working properly and that it does not cause unwanted effects.  Vaginal bleeding of various amounts may occur during the first three months of use. If you suspect that you may be pregnant, stop using this medication and contact your doctor right away.  The ring may increase your risk of having blood clots, toxic shock syndrome (TSS), gallbladder disease, breast cancer, or cervical cancer.  It may also not be suitable for certain patients, such as those with vaginal bleeding for which a cause has not yet been determined.  It is important to review your medical history with your doctor and to talk to your doctor about ring, to determine if this is the right contraceptive option for you.

Contraceptive Injection (Depo-Provera)

Depot medroxyprogesterone acetate, also known as Depo-Provera, is a contraceptive injection that contains progestin.  It works by stopping your ovaries from releasing an egg, and it also thickens cervical mucus to keep the sperm from reaching the egg.  It is given as an injection into the muscle every 3 months, and an additional contraceptive method should be used for at least 2 weeks after the initial injection.

The effectiveness of the injection is comparable to that of OCPs.  Other benefits of the injection are a long duration of action, decreased menstrual cramps and pain, decreased menstrual blood flow or a temporary stop in menstruation, a decreased risk of endometrial cancer, and minimal to no impairment of lactation. Iron-deficiency anemia is also less likely in long-term users, likely due to its effect on decreasing blood loss in menses.

Side effects of the injection usually decrease or stop within the first few months.  They may include: irregular bleeding, abdominal pain, bloating, decreased interest in sex, headaches, fatigue, and increased hunger with subsequent weight gain.

Risks include delayed return to fertility, where it can take up to 10 months or more to begin ovulating again.  If you want to become pregnant in the next year or so, Depo-Provera is usually not recommended.  The injection may also cause a decrease in bone mineral density (BMD) that is reversible.  For this reason, it is suggested to take a break from the injection after using this method for two years.  Depo-Provera does not protect against STIs.  As with other contraceptives, it is important to carefully review your health history with your doctor before deciding if this is a suitable option for you.

Contraceptive Patch

The combined contraceptive approved patch contains estrogen and progestin hormones.  The patch works similarly to combination pills by releasing hormones that prevent ovulation, and that thicken cervical mucus to impede sperm movement.

The patch is an effective contraceptive method for women who prefer weekly application rather than daily dosing and who find a transdermal method acceptable.  It can be applied to the buttocks, upper outer arm, lower abdomen, or upper torso but avoiding the beasts.  A new patch is applied each week for 3 weeks, followed by a patch-free week to allow for bleeding.

Some benefits of the patch include a quick return to fertility if removed; not having to remember a daily pill, and a steady dose of hormones from the patch so that bleeding is regular every month.

Side effects of the patch may include breakthrough bleeding or spotting, skin irritation from the adhesive, breast pain or tenderness, headaches, mood swings, nausea or vomiting, an increased risk of blood-clotting problems, liver cancer, gallbladder disease, and high blood pressure.  The contraceptive patch does not protect against STIs.  In addition to discussing your medical history before starting the patch, it is important to inform your doctor if you experience side effects.