Oh, for a one-size-fits-all birth control method that’s easy to use and side-effect free. But science hasn’t yet perfected such a thing.
Until it does, if you’re one of the many women who cannot use birth control methods that contain estrogen, you do have several other options.
Many of the estrogen-free birth control alternatives contain progestin, which is a man-made version of the hormone progesterone.
In this article, we’ll take a closer look at:
- available progestin-only options
- how they work
- the pros and cons for each
The minipill is a type of oral contraceptive that contains pills that only have progestin.
None of the pills in the pack have any estrogen. The dose of progestin varies and is dependent on the formulation used in the birth control pill.
A minipill package consists of 28 pills, all of which contain the hormone progestin. It doesn’t contain any placebo pills.
To maximize the minipill’s effectiveness, you’ll need to take the pill at the same time every day.
If you miss a dose — even by as little as 3 hours — you’ll need to use a backup method of birth control for at least 2 days to be on the safe side.
There’s a new FDA-approved progestin-only pill called Slynd. It can be taken within a 24-hour period and still not be considered a “missed dose,” unlike the current progestin-only pill.
Because this pill is so new, there may currently be limited information and access. To learn more about Slynd, talk to your doctor.
How does the minipill work?
In the United States, the progestin-only oral contraceptive is known as norethindrone. According to the Mayo Clinic, norethindrone works by:
- thickening the mucus in your cervix and thinning the lining of your uterus, making it harder for sperm and egg to meet
- preventing your ovaries from releasing eggs
It’s important to understand that the progestin-only minipill may not consistently suppress your ovulation.
The American College of Obstetricians and Gynecologists (ACOG) estimates that around 40 percent of women will keep ovulating while taking norethindrone.
According to ACOG, the minipill is a good option for women who cannot take contraceptive pills containing estrogen.
This includes women who have a history of:
But progestin-only contraception isn’t the best choice for everyone. You may want to avoid the minipill if:
- you’ve had breast cancer
- you’ve had lupus
- you have trouble remembering to take medications at the right time
Some anti-seizure medications break down hormones in your body, which means that a progestin-only pill might not be as effective if you take anti-seizure medication.
If you’ve had bariatric surgery, talk to your doctor about the risks of taking an oral contraceptive.
Bariatric surgery may affect the way these
Before starting the minipill, talk to your doctor about what day to begin.
You can start using this pill on any day of your menstrual cycle, but depending on where you are in your cycle, you may have to use a backup birth control method for a few days.
If you start taking the minipill during the first 5 days of your period, you should be fully protected, and you won’t need any additional contraception.
If you start on any other day, you’ll need to use an extra method of protection for at least 2 days.
If your period has a short cycle, you should use additional birth control until you’ve been on the minipill for at least 2 days.
All oral contraceptives have potential side effects, and they vary in intensity from person to person.
The Cleveland Clinic reports these side effects from the progestin-only minipill:
- You don’t have to interrupt sex to take care of birth control.
- You can take this pill if estrogen isn’t recommended for you due to high blood pressure, deep vein thrombosis, or cardiovascular disease.
- Your periods and cramps might lighten up.
- You can use this method if you’re breastfeeding.
- You need to be vigilant and precise about when you take the pill.
- You might experience spotting between periods.
- Your sex drive might decrease.
- Your body hair might grow differently.
If you want hormonal birth control without estrogen, the minipill is just one option. There are several other progestin-only birth control options. Each one works differently and has unique side effects and risks.
Here’s a quick rundown of your options.
Depo-Provera is an injection. It works the same way as the progestin-only pill. It thickens the mucus around your cervix to prevent sperm from reaching an egg. Additionally, it stops your ovaries from releasing eggs.
Each injection lasts around 3 months.
Progestin shot pros
- You don’t have to think about taking a birth control pill every day.
- Many people consider an injection less invasive than using an IUD.
- If you get the shots at recommended intervals, it’s over 99 percent effective at preventing pregnancy.
In the United States, progestin implants are marketed under the name Nexplanon. The implant consists of a skinny, flexible rod that your doctor inserts just under the skin on your upper arm.
Like the minipill and progestin injection, an implant releases small amounts of progestin into your system.
- the lining of your uterus to thin
- your cervical mucus to thicken
- your ovaries to stop releasing eggs
Once in place, the implant is extremely effective. According to the
Progestin implant pros
- You don’t have to think about birth control every day.
- You don’t have to interrupt sex to take care of birth control.
- It’s highly effective.
- It can be used immediately after childbirth or an abortion.
- It’s safe to use while you’re breastfeeding.
- It’s reversible. Your doctor can remove it if you want to get pregnant.
Progestin implant cons
- A doctor needs to insert the implant.
- There may be a high upfront cost if this contraceptive method isn’t covered by insurance.
- Your periods may become harder to predict. They could become heavier or lighter, or they could go away altogether.
- You may experience breakthrough bleeding.
- You could experience side effects like headaches, skin breakouts, weight changes, or tender breasts.
- The implant can migrate, or it may be difficult to remove when it’s time for removal. If either situation arises, some patients may need imaging tests and, in rare cases, surgery to remove the implant.
Another option is an intrauterine device (IUD) that your doctor inserts into your uterus. Made of plastic, this small, t-shaped device releases small amounts of progestin, preventing pregnancy for up to 5 years.
According to ACOG, an IUD doesn’t interrupt pregnancy. It prevents it.
Progestin IUD pros
- You don’t have to think about birth control very often.
- It’s 99 percent effective at preventing pregnancy.
- Your periods may get lighter. Cramps may get better, too.
- An IUD is reversible and won’t affect your fertility or make it harder to get pregnant in the future.
Progestin IUD cons
- It can be uncomfortable to have the IUD inserted.
- Your periods may be harder to predict.
- You could experience spotting or breakthrough bleeding, especially at the beginning.
- Your IUD could come out.
- In rare cases, your uterus could be punctured when the device is implanted.
- In rare cases, you may experience an ectopic pregnancy.
If you want to use nonhormonal birth control methods, talk to your doctor or healthcare provider about these options:
Many of these methods are less effective at preventing pregnancy than methods that involve hormones.
Spermicide, for example, fails roughly 28 percent of the time, so it’s important to understand the risks as you weigh your options.
The progestin-only minipill is one of several birth control methods that doesn’t contain estrogen.
The minipill works by suppressing ovulation and changing your uterus and cervix to make it unlikely that sperm will be able to fertilize an egg.
If you want to use hormonal birth control without estrogen, you could also try progestin-only shots, implants, or IUDs.
If you want to use a hormone-free birth control method, you could explore options like condoms, a diaphragm, cervical caps, a copper IUD, sponges, tubal ligation, or vasectomy.
Since all birth control methods have side effects, talk to your doctor about the type of contraception that works best for you.
Be sure to tell your doctor know about any health conditions you have, as well as any supplements and medications you take, as they could reduce the effectiveness of your contraception.