Hormonal Contrceptives

Hormonal contraceptives prevent pregnancy by stopping a woman's ovaries from releasing an egg (ovulation). They can also work by making it difficult for the sperm to enter the uterus by thickening the cervical mucus, as well as preventing the fertilized egg from implanting in the uterus. It is important for a woman to know the benefits and risks of each of the hormonal contraceptive options in order to choose the method that best suits her needs.

ORAL CONTRACEPTIVES

There are two types of oral contraceptives (OCS) : combination pills that contain both estrogen and progestin, and progestin-only pills. The combination OC pill is 99% effective if used properly. The pills that are in use today have lower doses of estrogen and newer types of progestins compared to the first ones that came on the market 40 years ago. Other health benefits provided by combination OCS include protection against uterine and ovarian cancer, pelvic inflammatory disease and osteoporosis. Another advantage is that many women will have more regular, lighter and less painful periods. Certain antibiotics and seizure medications may interact with OCS.

The most common side effects associated with OCS include nausea, headache, breast tenderness, spotting or bleeding between periods, weight changes, and mood changes such as irritability or anxiety. Many of these side effects will disappear after the first few months of taking the pill. The risk of blood clots, heart attacks and stroke with the use of OCS is relatively rare in healthy, non-smoking women. The risk is increased in women who smoke (especially if they are over the age of 35) or who have other risk factors for heart disease or stroke.

Progestin-only O (also called mini-pills) may be an option for women who have experienced side effects from estrogens or who cannot take estrogens. These can also be used in women who are breast-feeding. They are slightly less effective than combined OCS (95% effective) because their main action is on the cervical mucus and they prevent ovulation in only about half of the users. The progestin-only pill is taken every day without a break. The most common side effect is irregular bleeding and spotting. Other side effects include depression, headache, breast tenderness and ovarian cysts.

INJECTABLE CONTRACEPTIVES

The contraceptive injection, Depo-Provera, contains progestin and is injected by a health care professional into the buttocks or arm muscle every three months. It is over 99% effective in preventing pregnancy. About half of women will have extremely light to no periods within one year, though irregular vaginal bleeding can occur in some women.

CONTRACEPTIVE IMPLANT

The contraceptive implant, Norplant, consists of six small capsules that are inserted into the skin of the upper arm and slowly releases small amounts of progestin. It is 99% effective in preventing pregnancy for a period of five years. Many women will have menstrual cycle changes, with irregular periods for several months.

Side effects of Depo-Provera and Norplant include depression, headache, acne, breast tenderness, weight gain due to increased appetite, and ovarian cysts.