Birth Control Options for Women - Oral Contraception

Combination Estrogen/Progestin Contraceptive Pills

Oral contraceptives that contain both estrogen and progestin are the more common type. At least 10 million American women and 100 million women worldwide use the combination OCs. When they were first marketed in the early 1960s, OCs contained as much five times the amount of estrogen and up to 10 times the amount of progestins currently used. After reports of severe complications (stroke, heart attack, and pulmonary embolisms) in young women, the hormone amounts were significantly reduced.

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Many different progestins are used. The estrogen compound used in most oral contraceptives is ethinylestradiol, and current dose levels range from 20 to 50 micrograms. Fifty micrograms of estradiol are considered in this report to be high dose, 30 to 35 micrograms are considered to be low dose, and 20 microgram are very low-dose. (It should be noted that the high doses found in current OCs are still much lower than in previous forms.) Expert groups recommend using the lowest possible progestin and estrogen doses (no higher than 50 micrograms).

Brands include the following and their effects vary by estradiol dose level and by the progestin used:

Desogestrel/estradiol: Desogen and Ortho-Cept are low-dose and Mircette is very low dose. Mircette has been associated with reduced menstrual cramps. According to major analyses, however, low-dose desogestrel poses a higher risk for blood clots than levonorgestrel.
Drospirenone/estradiol: Yasmin is a low-dose contraceptive. Drospirenone has effects similar to natural progesterone. It is derived from a compound found in some diuretics (water pills) and has no male hormone effects. At this time, it may have fewer side effects than older OCs, including weight gain and emotional swings. It also reduces PMS symptoms and severe cramps and may reduce acne.
Ethynodiol diacetate/estradiol: Demulen, Zovia are high-dose.
Gestodene/estradiol: Minesse is a low-dose oral contraceptive approved in Europe. Gestodene is associated with a higher risk for blood clots than levonorgestrel.
Levonorgestrel/estradiol: Levlen, Levora, Nordette, Portia, Triphasil, Seasonale, and Tri-Norinyl are low-dose and Alesse, Aviane, Levlite, and Lessina are very low-dose forms.
Norethindrone acetate/estradiol: Estrostep, Loestrin, and Microgestin are all available in low to very low dose.
Norethindrone/estradiol: Brevicon, ModiCon, Necon, Norethin Nortrel, Ortho-Novum are low dose. Ovcon is available in low and high doses.
Norethindrone/mestrano: Necon, Norinyl, and Ortho-Novum are high-dose.
Norgestimate/estradiol: Mononessa, Ortho-Cyclen, Ortho Tri-Cyclen, Sprintec are low dose.
Norgestrel/estradiol: Cryselle is low-dose and Ovral and Ogestrel are available in low-dose and high-dose forms.
Some of these brands are also available with iron. Of interest are injections and skin patches that are now available that contain both estrogen and progestin. Their side effects are similar to the combination OCs. Investigative progestins such as nestorone are being investigated in implants, gels, vaginal rings, and patches. [See Box Other Methods for Administering Combination Hormones.]