Page 8: Hormonal Methods (Part 1)

Hormonal Contraception refers to birth control that contains estrogen and/or progestins. These synthetic hormones are similar to those produced by the ovaries and are responsible for the process of ovulation and the menstrual cycle.

There are two categories of hormonal contraception:

  • Combined hormonal contraceptives (CHC) - those containing both estrogen and progestin (i.e. pill, vaginal ring)
  • Progestin-only agents - those containing only progestin (i.e. Progestin-only pill, Depo-Provera®, Nexplanon and some IUDs )


Consider the following when selecting a hormonal method of birth control.

  • Hormonal contraception offers NO PROTECTION against sexually transmitted diseases. Condoms can be used to reduce the risk of STD's.
  • All forms of hormonal contraception require a prescription from a health care provider.
  • Fertility usually returns quickly after a method is discontinued. Therefore when a woman stops using a Hormonal Contraceptive method she must make plans to have another method of birth control immediately available unless a pregnancy is planned.
  • Hormonal Contraceptives can help regulate menstrual periods, lessen cramps and decrease the amount of period flow. They are often prescribed to treat medical conditions such as ovarian cysts, severe cramps, irregular or absent periods, hormone imbalances, acne, etc.


Combined hormonal contraceptives have effectiveness ratings - in the 97-99 percentiles. They work in three ways:

  • Prevents ovulation (the release of an egg)
  • Cervical mucus thickens, making it more difficult for sperm to enter the uterus
  • Thins the lining of the uterus. This change helps prevent a fertilized egg from implanting in the uterus.


Risks related to combined hormonal contraceptives

Abnormal blood clotting is the primary risk related to the use of combined hormonal contraception. In a small number of women the estrogen changes the way that the body forms blood clots. Blood clots may form in the legs, lungs, brain or other vital organs and cause serious health problems. Factors contributing to the risk include the following:

Smoking: contributes to narrowing of blood vessels and slows blood flow; blood clotting occurs more quickly if blood flow is not adequate. Therefore, women are encouraged to STOP SMOKING when they are using any combined hormonal contraceptive method. Age and how much a woman smokes are additional risk factors.

Migraine headaches: cause a higher risk of stroke. This risk increases when women who have migraine headaches take estrogen, especially when they experience auras or symptoms such as flashing lights, visual disturbances, weakness affecting one side of the body, difficulty walking, etc..

Other contributing factors that increase the risk of blood clotting problems include being overweight, diabetes, high cholesterol and high blood pressure. It is important to realize that for most women the risk of taking CHC's are lower than those risks associated with pregnancy and childbirth.

If you experience any of the following warning signs, you should seek medical care immediately. Inform them that you are using hormonal contraception.

  A - Abdominal pain (severe, sudden onset)
  C - Chest pain, shortness of breath, coughing up blood
  H - Headache (severe, unrelenting), numbness, or weakness in arms or legs
  E - Eye problems: sudden vision changes, blurring, flashing lights
  S - Severe leg pain in calf or thigh

SIDE EFFECTS are similar among all CHC methods. Most side effects are temporary and seldom serious. Most will occur within the first 1-3 months of use and should resolve as the body adjusts to the medication. Most women will experience only a few of these side effects. Consult your healthcare provider if the side effects last more than three cycles.

The most common side effects are listed below:

  • Spotting or break through bleeding refers to bleeding that occurs while a woman is taking active birth control pills or using the ring. The bleeding may be only light spotting or may seem as heavy as a regular period. Contact your health care provider if you have cramps or fever along with the bleeding, or if you notice a change in your normal vaginal discharge prior to the onset of bleeding. If you are on the pill be sure you are taking it at the same time every day. DO NOT discontinue the pill or ring until you have talked to your health care provider; the bleeding will often subside within the first two months of use.
  • Nausea can occur when a woman first begins using the CHC method. It does not last more than a few weeks and rarely causes vomiting. Nausea may be reduced by eating small frequent meals; if on the pill - try taking it at night with food.
  • Breast tenderness may occur at any time in the menstrual cycle but may be worst just prior to the period. A few women report an increase in breast size/fullness. Contact your health care provider if you notice a breast lump or notice changes only in one breast. Decreasing your caffeine intake may reduce tenderness.
  • Skin changes/acne may occur initially, but with continued use over 3-6 months, your complexion will often improve. Infrequently, areas of the skin may spontaneously darken. Contact your health care provider if this occurs.
  • Mood swings, irritability and depression may increase during the first few weeks of CHC use. If it persists or develops into depression it is important to talk with your health care provider. Vitamin B-6 50-100 mg per day may help relieve minor symptoms.
  • Fatigue may occur in the first month of use but usually tapers off quickly.
  • Weight changes of usually only 3-4 pounds may occur. Some women report changes in appetite. Sometimes weight gain is related to fluid retention.
  • Headache warning signs: Contact your health care provider right away for headaches that are more severe than most headaches experienced in the past; that do not respond to over-the-counter remedies; or that are occurring much more frequently.


If you experience persistent or very unpleasant side effects, we urge you to talk with your health care provider before you stop your birth control method. It may be possible to offer some suggestions that will help you adjust to the medication. If you stop your hormonal birth control you will be immediately at risk for pregnancy. Use some other method of birth control such as a condom.

Refer to the health information flyer that comes with each package of hormonal contraceptives for a complete list of side effects. If any symptom is severe or persistent, contact your health care provider. McKinley students may call the Dial-A-Nurse at 217-333-2700 (select Women's Health).