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Side effects. Common side effects of combination OCs include headache, nausea, bloating, breast tenderness, and bleeding between periods. The estrogen component in combination OCs is usually responsible for these side effects. In general, today’s OCs are much safer than OCs of the past because they contain much lower dosages of estrogen.
However, all OCs can increase the risk for migraine, stroke, heart attack, and blood clots. The risk is highest for women who smoke or who have a history of heart disease risk factors (such as high blood pressure or diabetes) or past cardiac events. Women who have certain metabolic disorders, such as polycystic ovary syndrome (PCOS), are also at higher risk for the heart-related complications associated with these pills.
Progestins
Progestins (synthetic progesterone) are used by women with irregular or skipped periods to restore regular cycles. Because of this, they may also help menstrual pain. They also reduce heavy bleeding and may protect against uterine and ovarian cancers. Progestin-only contraceptives may be a good option for women who are not candidates for estrogen-containing OCs, such as women smokers over the age of 35.
Progestins can be delivered in various forms.
Oral. Short-term treatment of anovulatory bleeding may involve a 21-day course of an oral progestin on days 5 - 26. Medroxyprogesterone (Provera) has shown benefit in treating patients with chronic pelvic pain (but not those with pain due to endometriosis, primary dysmenorrheal, or chronic active pelvic inflammatory disease).
Intrauterine Device (Mirena). An intrauterine device (IUD) that releases progestin can be very beneficial for menstrual disorders, regardless of its contraceptive effects. In the United States, a levonorgestrel-releasing intrauterine system, also called an LNG-IUS, is sold under the brand name Mirena. The LNG-IUS has been proven to reduce heavy bleeding and pain in many women who suffer from menorrhagia and dysmenorrhea. It is the only IUD approved by the FDA to treat heavy menstrual bleeding.
Many doctors recommend the LNG-IUS as a first-line treatment for severe heavy menstrual bleeding, particularly for women who may face hysterectomy (removal of uterus) or conservative surgery such as endometrial ablation (destruction of the endometrial lining). This device is considered a good long-term option, particularly for women who may desire future pregnancies. Research also indicates that women who choose the LNG-IUS are as satisfied with their quality of life as those who choose surgery.
The LNG-IUS remains in place in the uterus and releases the progestin levonorgestrel for up to 5 years. Progestin released by an IUD mainly affects the uterus and cervix, and so it causes fewer widespread side effects than progestin pills do. (However, the other type of IUD -- the Copper T -- may increase bleeding.)
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Review Date: 07/26/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
