Is Progestin-Only Birth Control the Right Option for You? (original) (raw)

Progesterone-only birth control is a type of hormonal birth control that does not contain synthetic estrogen. Instead, it uses synthetic forms of progesterone called progestins.

The oral form of this type of birth control is also called the minipill. Because it does not contain estrogen, the minipill may have fewer side effects than other forms of hormonal birth control.

Progestin-only birth control is considered a safer form of birth control for those who are over the age of 35 and smoke, or are at risk for heart attack or stroke. It is between 93% and 99% effective in preventing pregnancy.

Here's what to know about who should consider progestin-only birth control, what the options are, and the potential risks.

Progestin-only birth control contains only a progestin, a synthetic form of the hormone progesterone. In the body, progesterone is a sex hormone produced in the ovaries. It plays a role in the menstrual cycle and the early stages of pregnancy

Progestin-only birth control works by thickening cervical mucus, making it harder for sperm to enter the uterus. It also helps prevent ovulation, which occurs when your ovary releases an egg. It is not as good at preventing ovulation as other types of birth control pills, however. This makes it slightly less effective than other birth control methods although the minipill is still considered very effective at preventing pregnancy.

Progestin-only birth control is considered safer for certain people, and it may have fewer side effects than birth control pills that contain estrogen.

Progestin-only vs. Combination Birth Control Pill

In comparing these two types of hormonal birth control, there are some differences:

Why Use Progestin-Only Birth Control?

Your healthcare provider may recommend a progesterone-only birth control method if:

Who Shouldn't Use Progestin-Only Birth Control

Progestin-only contraception may not be appropriate for you if:

Common Side Effects

Progestin-only birth control pills share common side effects, some of which will resolve over time. They may include:

Side effects of the progestin injection include:

Risks

Serious side effects are rare, but they include:

Combined estrogen and progestin oral contraceptives may increase the risk of getting breast cancer, endometrial cancer, and liver tumors. It is not known whether progestin-only oral contraceptives also increase the risks of these conditions.

When to Call a Healthcare Provider

Although these symptoms are uncommon, call your healthcare provider right away if you experience:

A 2016 review of the use of progestin and breast cancer risk concluded that, unlike other oral contraceptives, studies indicate that progestin-only formulations do not increase the risk of breast cancer. The researchers noted that the six studies reviewed had small sample sizes, so larger-scale clinical studies are needed.

Advantages and Disadvantages of Progesterone-Only Birth Control Pills

Advantages

Disadvantages

Before You Start

Before you begin taking a progestin-only medication, your healthcare provider will want to assess your overall health. You should tell them if you take any other medications or supplements as well and if you smoke.

Your healthcare provider will advise you on when your chosen method will become effective against pregnancy. For example, the minipill needs to be taken for a week before it becomes effective. Therefore, you will need to use a barrier method of birth control if you are sexually active during that time.

An injectable will be immediately effective if it is given within the first seven days after your period has started; if it has been longer than that, you will need a backup method for the first week after the injection.

An IUD becomes effective immediately upon insertion.

Things to Keep in Mind

If you opt for the minipill, it is very important that you take it at the exact same time every day. The Depo-Provera shot must be given every four months. Another thing to consider before starting a progestin-only method is whether you hope to become pregnant in the future. Fertility returns right away after you discontinue some of these methods (such as the minipill), while it may take several months with others (such as the Depo-Provera injection).

Types of Progesterone-Only Birth Control

Progestin-only birth control comes in many different forms. Here's a rundown:

Birth Control Pills

As their name suggests, progestin-only birth control pills do not contain any estrogen. They are available in 28-day packs which you take every day during your four-week cycle. All 28 pills contain progestin; there are no placebo pills.

The progestin-only pill comes in three formulations in the United States, including norethindrone, which comes in a generic form, or with brand names including:

In July 2023, the Food and Drug Administration (FDA) approved Opill (norgestrel), a progestin-only oral contraceptive, to be sold over the counter (OTC). Opill is the first and only birth control pill available without a prescription.

Depo-Provera Injections

Depo-Provera is a birth control injection that slowly releases progestin medroxyprogesterone acetate into your body, providing protection from pregnancy from 11 to 14 weeks. If you opt to use Depo-Provera, you will need four injections each year. The injection also comes in a generic form.

Depo-Provera injections offer the added benefit of reducing the pain associated with endometriosis.

Depo-Provera has a boxed warning that cautions against possible bone loss and the increased risk of osteoporosis. For this reason, Depo-Provera should never be used for more than two years and should be entirely avoided in teenagers.

Common side effects include weight gain, irregular bleeding, spotting, and prolonged bleeding. Once stopped, it may several months to a year to start ovulating again and become pregnant.

Mirena IUD

The Mirena IUD is an intrauterine device (IUD) that continuously releases a small amount of progestin for up to seven years; it is more than 99% effective at preventing pregnancy. The Mirena IUD has also been approved to help treat heavy periods.

The Mirena IUD is inserted by your healthcare provider and has strings that allow you to check that the device is still in place. As with all intrauterine devices, complications may include perforation of the uterus, infection, and accidental expulsion.

Skyla IUD

Skyla is another progestin-only IUD option. It is a bit smaller than Mirena and is typically easier for a healthcare provider to insert. Once inserted, the Skyla slowly releases a form of progestin (called levonorgestrel) over a three-year period.

The complications of use are the same as for the Mirena IUD, which may include uterine perforation, infection, and expulsion.

Nexplanon Subdermal Implant

Nexplanon is the newer version of the Implanon subdermal implant. This is a progestin-only birth control device that contains the progestin etonogestrel and consists of a flexible plastic implant about the size of a matchstick.

Nexplanon is inserted under the skin of the arm and can provide up to three years of pregnancy protection. Nexplanon is radiopaque, meaning that it can be seen in an X-ray. This helps your healthcare provider see if it has been properly placed. Insertion requires a local anesthetic and generally takes a few minutes.

After implantation, you may experience bruising, pain, itching, burning, numbness, bleeding, scarring, or infection at the insertion site.

Noristerat Injection

The Noristerat injection is a birth control delivery system containing progestin norethisterone enanthate. It is not available in the United States but is commonly used in the United Kingdom, Europe, Africa, and Central America.

The Noristerat injection is designed to be a short-term birth control method. Women may choose it after being immunized against rubella (to prevent pregnancy while the virus is active) or while awaiting their partner's vasectomy to become effective. The Noristerat injection will continuously release progestin into your system for up to eight weeks.

Which Type Is Right for You?

When deciding which form of progesterone-only birth control method to choose, you should take into account the convenience factor, among other things. Can you reliably take the minipill at the same time every day, or are you better off with the injection, IUD, or implant, which you don't have to think about for months or years?

Also, if you know if or when you might like to become pregnant, consider whether a method that is instantly reversible (the minipill, for example) is preferable to one that may not restore fertility for months once you stop it (such as the injection). The best way to make an informed decision is to discuss these pros and cons with your gynecologist.

Frequently Asked Questions