Tag Archives: progestin

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 →

Ovarian Cancer, Endometrial Cancer, and the Pill

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The most popular method of birth control in the United States is the Pill, followed by tubal ligation (permanent sterilization, or getting your tubes tied) and condoms. The Pill is a hormonal method of contraception, while sterilization and condoms are nonhormonal. The distinction between hormonal and nonhormonal methods of birth control are simply that the former contain synthetic versions of human hormones, while the latter do not.

By suppressing ovulation and thinning the uterine lining, the Pill can reduce risk of ovarian and endometrial cancers.

Glands in our bodies, called endocrine glands, produce hormones; additionally, testes and ovaries — which are parts of the human reproductive system — manufacture hormones. Human hormones are powerful chemicals, which do all sorts of jobs, from triggering puberty to helping us extract energy from the foods we eat. So it’s not a huge stretch to wonder if exposure to the hormones present in certain birth control methods — such as the Pill, in addition to the patch, the ring, the shot, the implant, and some types of IUDs — might have unintended effects on the body. Because hormones can play a role in cancer — either in protecting against it or aiding in its development — researchers are very interested to know if the Pill might increase or decrease risk for various types of cancer.

It’s actually a bit tricky to investigate the possible associations between the Pill and various types of cancer. First of all, there are dozens of types of birth control pills, all with different versions of synthetic hormones, at different dosages, and in different proportions to one another. Furthermore, the types of oral contraceptives on the market change over time — today’s birth control pill is not your mother’s birth control pill. Studying “the Pill” as a single entity could obscure differences between brands. Secondly, most cancers tend to develop later in life, many years after someone may have taken oral contraceptives. Researchers need to be careful to control for all the variables that might increase or decrease cancer risk. 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 →

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: 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 →

Endometriosis Treatment

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endo medsIt’s still March, so it’s still Endometriosis Awareness Month! Today we’ll be looking at endometriosis treatment questions and answers. If you missed the first two posts in this series, you can click to read more about an overview of endometriosis as well as info about diagnosing endometriosis.

Why are there so many treatment options? Which one is best?

There are so many options because there is no “magic bullet” option — that is, no single treatment that works best for everyone. The two main categories of treatment include medication and surgery, but each option has its own benefits and drawbacks. When deciding on the best option for a given individual, some helpful questions to consider might be:

  • Do I have any current health concerns that would render some treatments unsafe? What types of health risks are acceptable to me?
  • Am I currently trying to conceive, or will I be in the next six to 12 months? Will I ever want to be pregnant in the future?
  • Aside from significant health risks, what types of factors — side effects, treatment frequency or duration, cost — would make a treatment difficult for me? How long do I need this treatment to last before I can reevaluate?

For specific questions, your best bet is to check with your health care provider. Continue reading →