|Generic Name||Brand Name|
|Combination birth control pills with both estrogen and progestin||Alesse, Loestrin, Ortho-Cyclen, Ortho-Novum, Ortho Tri-Cyclen, Triphasil, Yasmin, Zovia|
One tablet is taken daily for 20 to 21 days, followed by 7
to 8 days of no medication, during which time there is a
How It Works
Estrogen and progestin birth control
Functional ovarian cysts do not form without
Why It Is Used
Birth control pills can be used to
treat women who have recurrent ovarian cysts with their menstrual
How Well It Works
Women who use high-dose
progestin birth control pills have a modestly
decreased risk of developing functional ovarian cysts. Low-dose birth control
pills seem to have a less preventive effect.1
Experts disagree about the use of birth control pills to shrink and
eliminate ovarian cysts that have already formed. Some studies show that the
cysts shrink at the same rate with or without birth control pill use.2
Combination hormonal pills, skin patches,
and vaginal rings have similar possible side effects because they all contain a
combination of estrogen and progestin. The pill causes hormone levels to peak
and drop each day. Each weekly patch takes 3 days after application to reach a
steady hormone level. The ring releases a steady dose every day throughout the
day. This may explain why the ring is less likely to cause headaches and nausea
than the pill or patch.
Common side effects of combination hormonal methods
The most common side effects are changes in menstrual periods,
- Very light or
- Bleeding between periods
(spotting), which usually decreases after using a hormonal method for 3 to 4
The contraceptive skin patch may
cause skin irritation at the site.
The contraceptive vaginal ring may cause:
- Vaginal discharge.
- Irritation and
inflammation of the vagina (vaginitis).
Less common side effects of combination hormonal methods
Less common side effects include:
- Nausea and vomiting, especially during the
first month of use. This side effect usually goes away after the first few
months of use.
- Frequent or more severe headaches.
Migraine headaches may get worse.
- Breast tenderness for the first few months.
- Depression or mood changes.
- Darkening of
the skin on the upper lip, under the eyes, or on the forehead (chloasma). This
may slowly fade after you stop using hormonal methods, but in some cases, it is
- Less interest in sex.
Rare but serious side effects of combination hormonal methods
The following symptoms, called ACHES, are rare but serious and should be reported to your
health professional immediately.
- Abdominal pain that is
severe or persists may be a sign of blood clots (thrombophlebitis) in the pelvis, liver blood clots or
tumors, or gallbladder disease.
- Chest pain
may be a sign of blood clots in the lungs (pulmonary embolism),
heart attack, or heart disease. Smoking increases this
- Headaches that are severe may be a
hypertension. Smoking increases this
- Eye problems, such as blurred vision
or loss of vision, may be a sign of migraine, blood clots in the eye, or a
change in the shape of the
- Severe leg
pain or sudden swelling of one leg may be a sign of leg blood clots (thrombophlebitis) or deep vein thrombosis (DVT).
Patch warnings. The patch
delivers more estrogen than the low-dose birth control pills do. Some research
has found that women using the patch are more likely to get dangerous blood
clots in the legs and lungs. The risk may be higher if you smoke or have
certain health problems. The U.S. Food and Drug Administration warns that you
talk to your doctor about your risks before using the patch.
Direct sunlight or high heat can increase, then lower, the amount of
hormone released from a patch. This can give you a big dose at the time and
leave less hormone for the patch to release later in the week. This increases
your risk of pregnancy. Avoid direct sunlight on the
hormone patch. Also avoid using a tanning bed, heating pad, electric blanket,
hot tub, or sauna while you are using a hormone patch.
Reference for a full list of side effects. (Drug Reference is not available in
What To Think About
Cancer protection, cancer risk? Recent studies have shown that using the Pill (with
estrogen and progestin) for a year or more helps protect against uterine
cancer. Long-term Pill use protects against ovarian cancer. However, the
research is mixed about breast cancer.3, 4 Breast cancer risk may be slightly increased by the Pill for
women with a family history of breast cancer.5 Women
who have a personal history of breast cancer should not take the Pill. If
you're considering hormonal birth control, let your health professional know if
you have any family history of breast cancer.
contraceptive methods are usually not prescribed for women who:
- Smoke and are older than 35.
diabetes and are older than 35 or have diabetes with
- Have migraines with visual changes
- Have a risk for blood clots, including a family history of
clots or a past clot in the lung (pulmonary embolism) or leg
coronary artery disease, uncontrolled high blood
pressure, or high
Other factors to consider include the following:
- Birth control pills may not be as effective when combined with
other medications. Be sure to tell your health
professional or pharmacist that you are taking birth control pills whenever you
get a new prescription. The herbal medication
St. John's wort also makes birth control pills less
effective. Be sure to tell your health professional about all
medications and supplements you are taking when starting hormonal birth
- After stopping high-dose birth
control pill use in order to start a planned pregnancy, it may take longer to
become pregnant than after stopping use of a low-dose pill, diaphragm, or
intrauterine device (IUD).7
- If you are
taking birth control pills,
take special precautions for backup birth control if you miss or skip pills.
- Birth control pills may not be as effective if you
are vomiting or have diarrhea. Use another method of birth control for 7 days
after vomiting or diarrhea, even if you have not missed any pills.
- The pill and the patch may not work as well if you are overweight
(body mass index greater than 25).8, 9 If you are overweight, ask your doctor about which birth
control methods are right for you.
Be sure to use a backup birth control method during the
first 7 days of starting hormonal contraception.
Emergency contraception is available if any birth
control method fails and you are concerned about unprotected sex.
Complete the new medication information form (PDF)(What is a PDF document?)
to help you understand this medication.
Holt VL, et al. (2003). Oral contraceptives, tubal
sterilization, and functional ovarian cyst risk. Obstetrics and Gynecology, 102(2): 252–258.
Smith RP (2002). Ovarian cysts. In Netter's Obstetrics, Gynecology, and Women's Health, pp.
271–272. Teterboro, NJ: Icon Learning Systems.
Practice Committee of the American Society for
Reproductive Medicine (2004). Hormonal contraception: Recent advances and
controversies. Fertility and Sterility, 82(Suppl 1):
Marchbanks PA, et al. (2002). Oral contraceptives and
the risk of breast cancer. New England Journal of Medicine, 346(26): 2025–2032.
Petitti DB (2003). Combination estrogen-progestin oral
contraceptives. New England Journal of Medicine,
Hatcher RA, Nelson A (2004). Combined hormonal
contraceptive methods. In RA Hatcher et al., eds., Contraceptive Technology, 18th ed., pp. 391–460. New York:
Speroff L, Fritz MA (2005). Oral contraception. In
Clinical Gynecologic Endocrinology and Infertility, 7th
ed., pp. 861–942. Philadelphia: Lippincott Williams and Wilkins.
Hatcher RA, et al. (2005). Pocket Guide to Managing Contraception 2005–2007. Tiger, GA: Bridging the Gap
Holt VL, et al. (2005). Body mass index, weight, and
oral contraceptive failure risk. Obstetrics and Gynecology, 105(1): 46–52.