From the Guidelines
The lowest form of estrogen for birth control is found in ultra-low-dose combination pills containing 10 micrograms of ethinyl estradiol, such as Lo Loestrin Fe. Other low-dose options include pills with 20 micrograms of ethinyl estradiol like Yaz, Loestrin 1/20, and Junel Fe 1/20 1. These low-dose formulations were developed to reduce estrogen-related side effects while maintaining contraceptive effectiveness. Hormonal birth control works by preventing ovulation, thickening cervical mucus, and thinning the uterine lining.
Key Considerations
- Women seeking minimal estrogen exposure might also consider progestin-only methods like the mini-pill, hormonal IUDs, or the implant, which contain no estrogen at all 1.
- When starting any hormonal contraceptive, it typically takes seven days to become effective, so using backup contraception during this initial period is recommended 1.
- If you're concerned about estrogen-related side effects like nausea, headaches, or blood clot risk, discuss these ultra-low or estrogen-free options with your healthcare provider to find the most appropriate choice for your specific health needs 1.
Important Factors to Discuss with Your Healthcare Provider
- Medical history and current health status to determine the safest and most effective contraceptive option
- Potential interactions with other medications
- Lifestyle and personal preferences to choose a method that fits your needs
- Regular follow-up appointments to monitor the effectiveness and potential side effects of the chosen contraceptive method 1
From the FDA Drug Label
New acceptors of oral contraceptive agents should be started on preparations containing 0. 035 mg or less of estrogen. The lowest form of estrogen for birth control is 0.035 mg or less of estrogen.
- This dosage is recommended for new acceptors of oral contraceptive agents 2 and 2.
- Minimizing exposure to estrogen is in keeping with good principles of therapeutics.
- The dosage regimen prescribed should be one which contains the least amount of estrogen that is compatible with a low failure rate and the needs of the individual patient.
From the Research
Lowest Form of Estrogen for Birth Control
- The lowest form of estrogen for birth control is 20 micrograms of ethinyl estradiol (EE) 3, 4, 5.
- Studies have shown that 20 micrograms EE preparations have similar cycle control to 35 micrograms EE preparations, but with fewer side effects such as bloating, breast tenderness, and nausea 3.
- A low-dose monophasic combination oral contraceptive containing 100 microg levonorgestrel and 20 microg ethinyl estradiol (Alesse) has been shown to be effective and safe, with a Pearl index of 0.88 and a cumulative rate of withdrawal due to accidental pregnancy of 1.9% 4.
- New extended-cycle pill formulations with low-dose estrogen, such as 20 μg ethinyl estradiol and 100 μg levonorgestrel, have been developed to reduce side effects and improve cycle control 5.
- Alternative estrogens, such as 17β-estradiol (E₂), have been investigated as potential replacements for EE in combined oral contraceptives, with similar efficacy and cycle control 6, 7.