Combined Hormonal Birth Control: Pill, Patch, and Ring
Overview Expand All
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Combined hormonal birth control methods release estrogen and progestin into the whole body. These hormones prevent pregnancy mainly by stopping ovulation (the release of an egg from one of the ovaries). They also cause other changes in the body that help prevent pregnancy. The mucus in the cervix thickens, making it hard for sperm to enter the uterus. The lining of the uterus also thins.
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With typical use—meaning that the method may not always be used consistently or correctly—9 in 100 women will get pregnant during the first year of using these methods. With perfect use—meaning that the method is used consistently and correctly each time—fewer than 1 in 100 women will get pregnant during the first year.
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Combined hormonal methods have several benefits in addition to protecting against pregnancy:
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They may make your period more regular, lighter, and shorter.
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They help reduce menstrual cramps.
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They decrease the risk of cancer of the uterus, ovary, and colon.
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They may improve acne and reduce unwanted hair growth.
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They can be used to treat certain disorders that cause heavy bleeding and menstrual pain, such as fibroids and endometriosis.
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Used continuously, they can reduce the frequency of migraines associated with menstruation (although they should not be used if you have migraines with aura). They can also be used to treat heavy bleeding and pain by stopping the menstrual period.
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Combined hormonal methods are safe for most people, but they are associated with a small increased risk of deep vein thrombosis (DVT), heart attack, and stroke. The risk is higher in some people, including those who
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are older than 35 and smoke more than 15 cigarettes a day
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have multiple risk factors for cardiovascular disease, such as high cholesterol, high blood pressure, and diabetes
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have a history of stroke, heart attack, or DVT
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have a history of migraine headaches with aura
You should not use combined hormonal methods during the first 3 weeks after delivery because the risk of DVT is higher in the weeks after childbirth. If you have additional risk factors for DVT, you should wait to use combined hormonal methods until after the first 4 to 6 weeks following delivery.
The risk of DVT may also be slightly higher if you are taking pills containing a progestin called drospirenone or if you are using the patch. But the risk of DVT is higher during pregnancy and in the weeks after childbirth than when taking drospirenone-containing pills or using the patch.
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If you are breastfeeding, estrogen may affect your milk supply. It is recommended that you wait until the fifth week after delivery to start using these methods, when breastfeeding has been well established.
Combined Hormonal Birth Control Pills Expand All
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In the United States, combined hormonal birth control pills are available by prescription only.
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21-day pills—Take one pill at the same time each day for 21 days. Wait 7 days before starting a new pack. During the week you are not taking the pill, you will have your period.
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28-day pills—Take one pill at the same time each day for 28 days. Depending on the brand, the first 21 pills or the first 24 pills contain estrogen and progestin. The remaining pills may be estrogen-only pills; pills that contain a dietary supplement, such as iron, but no hormones; or inactive pills (containing no hormones or supplements). During the days you are taking the hormone-free pills, you will have your period.
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90-day pills—Take one pill at the same time each day for 84 days. Depending on the brand, the last seven pills either contain no hormones or contain estrogen only. With both brands, you will have your period on the last 7 days every 3 months.
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365-day pills—Take one pill at the same time each day for a year. In time, your bleeding may become lighter and may even stop.
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Most side effects are minor and often go away after a few months of use. Possible side effects include
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headache
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nausea
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breast tenderness
Breakthrough bleeding usually is a temporary side effect as the body adjusts to a change in hormone levels. It may last longer than a few months with continuous-dose pills.
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Vaginal Ring Expand All
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The vaginal ring is a flexible, plastic ring that is placed in the upper vagina. It releases estrogen and progestin that are absorbed through the vaginal tissues into the body.
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A health care professional must prescribe the vaginal ring, but you insert it yourself.
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You fold the ring and insert it into the vagina. It stays there for 21 days. You then remove it for 7 days. During the week the ring is not used, you will have your period.
There are two types of vaginal rings. One type of vaginal ring requires inserting a new ring each month. Another type of vaginal ring can be reused for up to a year. The reusable ring should be washed and stored in its case when not in use.
If you use the monthly ring, you can choose to skip the ring-free week. Just insert a new ring every 21 days with no ring-free week in between. This is called continuous use. With continuous use, your period may become lighter and even stop. There are not yet studies on continuous use of the reusable ring.
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Most side effects are minor and often go away after a few months of use. Possible side effects include
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headache
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nausea
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breast tenderness
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vaginal discharge
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vaginal irritation
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breakthrough bleeding
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Birth Control Patch Expand All
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The birth control patch is a small (1.75 square inch) adhesive patch that is worn on the skin to prevent pregnancy. The patch releases estrogen and progestin, which are absorbed through the skin into the body.
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A health care professional must prescribe the patch, but you do not need to visit a health care professional to apply or remove the patch. The patch is less effective in women who weigh more than 198 pounds.
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The patch can be worn on the buttocks, chest (except the breasts), upper back or arm, or abdomen. You wear a patch for a week at a time for a total of 3 weeks in a row. During the fourth week, a patch is not worn, and you will have your period.
After week 4, a new patch is applied and the cycle is repeated. You apply the patch on the same day of the week even if you still are bleeding.
To use the patch as a continuous-dose form of birth control, apply a new patch every week on the same day without skipping a week.
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Most side effects are minor and often go away after a few months of use. Possible side effects include
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skin irritation
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breast tenderness
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headache
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breakthrough bleeding
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Aura: A sensation or feeling experienced just before the onset of certain disorders like migraine attacks or epileptic seizures. These sensations may be flashing lights, a particular smell, dizziness, or seeing spots.
Breakthrough Bleeding: Vaginal bleeding that happens in between regular periods.
Cardiovascular Disease: Disease of the heart and blood vessels.
Cervix: The lower, narrow end of the uterus at the top of the vagina.
Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.
Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.
Estrogen: A female hormone produced in the ovaries.
Fibroids: Growths that form in the muscle of the uterus. Fibroids usually are noncancerous.
Hormones: Substances made in the body that control the function of cells or organs.
Ovaries: Organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.
Ovulation: The time when an ovary releases an egg.
Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.
Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.
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FAQ185
Last updated: November 2023
Last reviewed: November 2023
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This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.
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