Tag Archives: estrogen

Five Things to Know About the Morning-After Pill on Its 20th Anniversary

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Medication portion of PREVEN Emergency Contraceptive Kit. Photo: Smithsonian Institution

In 1993, the New York Times Magazine posited that the morning-after pill might be “the best-kept contraceptive secret in America.” Even many doctors had no idea there was a fallback contraceptive that could be used shortly after unprotected sex or cases of rape.

In many ways, the morning-after pill had been right in front of U.S. doctors for decades. In terms of chemical composition, it was not much different from standard birth control, using the same main ingredients — synthetic hormones — in higher doses. Moreover, many of their colleagues in Europe and Asia had already been prescribing morning-after pills for years.

In 1998, years of research and advocacy led to the first FDA-approved morning-after pill.

Here, however, the secret was still largely intact. A 1994 study by the Kaiser Family Foundation revealed that two-thirds of American women had never heard of the morning-after pill or other forms of emergency contraception (EC). Less than 1 percent had ever used them.

There was an information shortfall in large part because there was no contraceptive that was approved by the U.S. Food and Drug Administration (FDA) specifically for emergency use. Some providers worked around that absence by using the chemically similar estrogen and progestin medications that were approved for regular birth control. By upping the dosage, they created a suitable morning-after pill on their own. But drug makers couldn’t label or market those birth-control pills for emergency, post-coital use, since they weren’t FDA-approved for that purpose. It also spelled problems for federally funded clinics. Federal dollars couldn’t pay for an off-label medication hack, a makeshift morning-after pill that wasn’t officially approved. Continue reading →

Do Birth Control Pills Cause Breast Cancer? The Latest Study

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Last month, you might have seen headlines warning you that hormonal birth control increases risk for breast cancer. This news came from a study that examined the medical records of nearly 1.8 million Danish women — and the huge sample size lent heft to the findings, several of which stood in stark contradiction to commonly held beliefs about modern hormonal contraception.

Some types of hormonal contraception could increase breast cancer risk, while others may not. But the Pill also reduces risk for endometrial and ovarian cancers.

Birth control comes in two “flavors” — hormonal and nonhormonal. Hormonal contraception is among the most effective, and includes birth control pills, hormonal IUDs, the shot, the vaginal ring, the implant, and the patch. Nonhormonal contraception ranges from very effective, including surgical sterilization and the copper IUD, to the not-quite-as-effective, including condoms, diaphragms, and withdrawal. (With the exception of condoms, birth control does not provide protection against STDs.)

Hormonal contraception is one of the greatest achievements in the history of medicine, and offers those wishing to control their fertility an array of effective options. However, as with all effective medications, there is potential for side effects. And, because many forms of hormonal birth control contain types of estrogen, and exposure to estrogen is a risk factor for breast cancer, many people wonder if hormonal birth control might increase users’ chances of developing breast cancer later in life.

Most birth control pills contain a combination of two hormones: estrogen and progestin (synthetic progesterone). Other hormonal methods, such as the ring and the patch, also use combinations of these two hormones.

There are also pills that don’t contain estrogen, called POPs, or progestin-only pills — aka the “minipill.” Additionally, hormonal IUDs, the implant, and the shot are progestin-only methods.

What Previous Studies Have Shown

The connection between hormonal contraception and breast cancer is murky, because the association is difficult to study properly. There are so many different types of hormonal contraceptives, each with different dosages, different chemical formulations, and different ways of entering the body. We can’t tease these differences apart on the one hand, but make blanket statements about hormonal contraception as a whole on the other hand. But we can look at the available evidence and see where it points. Continue reading →

Let’s Talk Contraception: Can I Use Birth Control to Skip a Period?

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In 2003, the FDA approved Seasonale, an extended-cycle birth control pill. This pill, a combination of estrogen and progestin, is taken daily for 84 days followed by one week of inactive (placebo) pills, allowing a woman to have her period once every three months — four times per year.

Since that time, several other extended-cycle birth control pills have been marketed, including Lybrel, released in 2007, which offers women continuous contraception coverage with only one period per year.


Using birth control to skip periods doesn’t result in side effects quite this exaggerated.

Prior to Seasonale’s debut, certain types of birth control pills could be taken back to back, allowing users to have period-free weddings and honeymoons, or to treat certain conditions, such as endometriosis. But there was no consensus about how to use birth control pills this way, and no actual product marketed specifically for this type of use. Early studies on extended-cycle pills reported that users were highly satisfied using pills to have fewer periods — and wanted to continue using these pills to reduce periods after the study was completed.

Can skipping periods be beneficial or harmful? Is this a lifestyle choice that’s not “natural”? How many “normal” periods do you need in a lifetime? Continue reading →

Eight Great Heat-Friendly Contraceptives

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heat friendlyI don’t know if any of my fellow Arizonans have noticed, but it’s hot. It’s been hot. And all sources tell me that it’s likely to remain hot for a couple of months yet.

There are, of course, things we can do to make the heat more manageable for ourselves, such as drinking plenty of water and relegating intense outdoor activity to the early morning or late evening hours. There are also things we can do to help our contraceptives beat the heat if necessary, such as storing condoms or birth control pills away from extreme heat.

Still, some types of contraception require more intervention during the summer than do others. So — our top eight types of heat-friendly birth control!

Quick disclaimer: I made this list based on the single criterion that these methods are unlikely to be affected by the heat of an Arizona summer. When selecting a contraceptive method, there are loads of other factors to consider. So the methods on this list are not necessarily the most effective or appropriate methods for every person needing birth control.

8 Birth Control Vaginal Ring (NuvaRing)

  • Why It’s Heat Friendly: In terms of storage, it’s technically not; NuvaRing comes with the same temperature recommendations as oral contraceptive pills. However, since the ring is only inserted once per month, folks getting their rings one at a time don’t have to worry about longer-term storage.
  • Cons: In addition to the same risks and side effects of estrogen-containing contraceptives, NuvaRing isn’t the heat-friendliest choice for users getting more than one month at a time. Continue reading →

Let’s Talk Contraception: NuvaRing, Another Contraceptive Choice

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Would you like an alternative to a daily pill for contraception? NuvaRing is a flexible vaginal ring containing a combination of two hormones used to prevent pregnancy: a progestin and an estrogen. It is placed inside the vagina where it releases a continuous small dose of these hormones, and is left in place for three weeks. Then you remove it and wait one week, during which you usually will have your period. After this ring-free week, you insert a new ring.

The vaginal ring is an excellent alternative for people who don’t want to take a daily pill for contraception.

Used properly, it is nearly as effective as oral birth control pills, is easily reversible and frees you from having to remember to take a pill each day. You can use tampons, vaginal yeast medications, and spermicides when wearing the ring, but you should not use a diaphragm because it may not fit properly. In some vaginal conditions, such as a prolapsed (or falling) uterus, you may not be able to use the ring because it might slip out more easily. The NuvaRing can only work when it’s inserted properly in order to release its hormones. Most women report they cannot feel the ring once it’s inserted.

Most of the side effects of the NuvaRing are similar to birth control pills. Cigarette smoking is definitely not recommended because it may increase your risk for strokes or heart attacks, especially if you are older than 35. There have been several reports that the ring may put you at an increased risk for blood clots, and this is still being studied. If you have concerns about this or have a personal or family history of blood clots, heart attacks, or strokes, it’s important to talk with your health care provider before using the ring. Continue reading →

Let’s Talk Contraception: Emergency Contraception

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The Centers for Disease Control and Prevention (CDC) recently reported that 1 in 9 American women — 11 percent — has used the “morning-after pill.” This means that in the United States, 5.8 million sexually active women between the ages of 15 and 44 have used emergency contraception, an increase in use of 4.2 percent from 2002. Most women say their reasons for using emergency contraception are because they engaged in unprotected sex or feared that their method of contraception failed.

The best way to prevent pregnancy is reliable birth control. But sometimes we need a back-up method.

It has also been reported that half of all pregnancies in the United States are unintended. For that reason, the availability of a range of contraceptive options is very important. Emergency contraception is the last choice for a woman to decrease her chance of becoming pregnant after unprotected sex. There are several products available for emergency contraception in the United States. There are many options, and they include:

  • regular birth control pills in specific doses
  • PlanB One-step
  • Next Choice
  • ella
  • copper IUD or intrauterine device (Paragard)

The Yuzpe regimen, which used ordinary birth control pills in specific combinations, was named after a Canadian physician who developed the method in the 1970s. Several brands of birth control pills are approved for this use to prevent pregnancy. This method uses the combined estrogen and progesterone hormones in your regular birth control pills in certain prescribed combinations.

Research showed the progesterone component of contraceptive pills was most effective at preventing pregnancy, so Plan B was developed as a two-pill regimen of levonorgestrel (a type of progesterone). When Plan B was first released, it consisted of one pill taken as soon as possible and another taken 12 hours later. Plan B One-Step, the newest version of Plan B, now has the same dosage of levonorgestrel in just one pill. It should be taken as soon as possible after unprotected sex. This one-dose regimen has been shown to be more effective with fewer side effects. Continue reading →

Let’s Talk Contraception: Do Birth Control Pills Cause Blood Clots?

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Alarming ads urge you to call a lawyer if you’ve been “injured” taking certain birth control products, such as Yaz, Yasmin, or NuvaRing. These injuries include venous thromboembolisms (VTEs), heart attacks, and strokes. It’s frightening to wonder if you are endangering your health by taking a pill to prevent pregnancy or treat dysmenorrhea (painful cramps).

Should you stop taking your pills? What is a VTE and why should you worry? VTE is a blood clot that usually starts in your leg, but may break loose and travel to your heart or brain and cause a heart attack or stroke. It can be life-threatening, so it is a serious side effect to be concerned about. All birth control pills may increase your risk for a VTE, but it has always been considered so small that most women can safely take the pill. About 3 to 9 women in 10,000 who use birth control pills for more than one year may have a VTE compared to 1 in 5 women out of 10,000 who are not pregnant and not on the pill.

Birth control pills are considered very safe for the majority of women, but all medications carry some risk of adverse effects.

When oral birth control pills were first developed, they contained much higher doses of estrogens and progestins — types of hormones — especially estrogen. It was also noticed that there was a higher risk for developing a blood clot while using birth control pills than in nonpregnant women who didn’t take the pill. It was thought that the high dose of estrogen was responsible for this risk. So, with continuing research and development, eventually the dose of estrogen was decreased to the lower level used today to minimize the chance of a clot. The type of estrogen in pills today is almost exclusively ethinyl estradiol. Continue reading →