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The Pill, Patches and Rings

Hormonal contraception options (birth control pills/patches/rings) are made up of synthetic hormones.  They are used to “fool” your body into thinking you already have enough of these hormones circulating around in your body.  The body needs these hormones every 24 hours with a pill or continuously in a patch or ring.    If your body does not have these hormones when expected, it may start to make them.  Your ovaries make these hormones naturally.  If your ovaries have to make these hormones, they may release an egg at the same time and this could cause you to get pregnant or to start bleeding.  That is why it is important to take your pills or change your patch or ring at the same time to keep your ovaries suppressed (or fooled) so they will not release an egg.

It does not make any difference what time of the day you take your pill or change your patch or ring, as long as it is consistent!!  The same time each day/week/month is essential no matter whether it is morning or evening.  Remember even a short difference (30 minutes) may lead to break through bleeding.

Oral contraceptive pills

Pills are the most popular form of contraception and they are made up of either a  combination of estrogen and progesterone or progesterone only.  There are at least 50-60 types of pills and they are available in both generic and non-generic types.  They are packaged as 21, 28 or 84 tablets. The estrogen dose varies from pill to pill but there is only one type of estrogen.   There are at least 10 different types of progestins that make up pills and this component differs the most.  The tablets in the pack consists of either the same dose every day (monophasic)  for 3 weeks/12 weeks or they differ in the dose on a week to week basis (triphasic).     

The progesterone only pill (or “mini” pill) is used frequently after birth of a child if a woman is nursing or if a woman cannot take estrogen.   It is highly effective but only has a two hour “forgiveness” window.  This means that the pill if not taken within two hours from the time the day prior, pregnancy can occur. 

Nuvaring (www.nuvaring.com)

This form of contraception has been on the market for several years and is a silicone flexible vaginal ring that contains estrogen and progesterone that are absorbed continuously through the vagina. These rings are changed every 3 weeks and left out for one week each month to allow a menses. They can also be used continuously (changed every three weeks) to avoid menses.  Advantages include not having to remember a pill daily and the dose of estrogen exposure is low in comparison to the patch and the pill.   Disadvantages include that it must be placed and removed from the vagina without an applicator and takes minimal practice.  There is no pain/discomfort or interference with intercourse associated with the ring. 

Ortho Evra patch (www.orthoevra.com)

This form of contraception has also been on the market for several years and this 4 cm opaque skin tone patch can be applied to the buttock, abdomen, upper outer arm or upper back.  They are changed weekly for 3 weeks and then none is worn for one week to allow a menses.  They can be used continuously to avoid a menses.  It is just as effective as the pill and ring and delivers continuous hormones through the skin and into the bloodstream.  Advantages include not remembering to take a pill daily.  Disadvantages include the possible side effect of skin irritation and difficulty adhering to the skin.   Caution should be used in those women susceptible to more estrogen as there is exposure to 60% more estrogen with the patch over the pill and there is a weight restriction of 190 pounds to assure effectiveness. 

When can they be started?

You can either start the pill/patch/ring on the first day of your menses or start it on the Sunday following the first day of your menses. 

How effective are these methods and how long should back-up method be used?

They are 96-97% effective and a back-up method is needed for at least one week, but ask your health care provider what they recommend. 

Who should not take hormonal contraception?

Those women with a history of breast cancer, stroke, significant congenital or acquired heart disease or blood clots, uncontrolled high blood pressure, liver disease, smokers age 35 or greater, pregnant women,  and those women with unexplained vaginal bleeding.

What are some of the side effects of hormonal contracption?

Side effects may include unpredictable break through bleeding or lack of bleeding, acne, weight gain, breast pain, nausea, headaches and mood irritability.  These are uncommon and should be discussed with your health care provider.

What medications can affect the effectiveness of the pill?

Both antibiotics and St. John’s Wort decrease the effectiveness of the pill.  Other medications may affect how the body clears medications and it is wise to consult your gynecologist if there are any questions concerning these.  Back up method consisting of condoms plus a foam or gel should be used for at least one week after these medications are stopped or until you have a menses. 

What is the reversibility of hormonal contraception?

Generally it is recommended that a woman has two menses after stopping hormonal contraception before trying to conceive as the return to ovulation and normal menses takes two months on average.   Barrier contraception and keeping track of your first day of your last menstrual cycle is important until you have had two menses.

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