From the Guidelines
The lowest form of estrogen for birth control available is Lo Loestrin Fe, which contains 10 micrograms of ethinyl estradiol. This ultra-low-dose option provides effective pregnancy prevention while minimizing estrogen-related side effects 1. Other low-dose options include pills with 20 micrograms of ethinyl estradiol, such as Yaz, Loestrin 1/20, and Junel Fe 1/20. For those who need to avoid estrogen completely, there are hormone-free options like copper IUDs (ParaGard) or progestin-only methods like the minipill, hormonal IUDs (Mirena, Kyleena, Skyla), the implant (Nexplanon), or Depo-Provera injections. Some key points to consider when choosing a low-estrogen birth control method include:
- The vaginal contraceptive ring, which releases 15 μg ethinyl estradiol daily, is another option for women who want a low-estrogen method 1
- Lower estrogen doses help reduce risks of blood clots, stroke, and heart attack, particularly in women with risk factors like smoking, high blood pressure, or being over 35 1
- Despite lower hormone levels, these methods remain highly effective when used correctly, though they may have different side effect profiles including potential breakthrough bleeding It's essential to consult with a healthcare provider to determine the best birth control option based on individual needs and medical history.
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 available is 0.035 mg or less of estrogen 2 2.
- This dosage is recommended for new acceptors of oral contraceptive agents.
- The goal is to minimize exposure to estrogen and progestogen while maintaining a low failure rate and meeting the individual patient's needs.
From the Research
Lowest Form of Estrogen for Birth Control
- The lowest form of estrogen for birth control available is 10 μg of ethinyl estradiol, as seen in extended-cycle oral contraceptives 3, 4.
- These extended-cycle oral contraceptives provide 84 days of a low-dose, combined active pill containing levonorgestrel 100 μg and ethinyl estradiol 20 μg, followed by 7 days of ethinyl estradiol 10 μg 3.
- Another option is a 24-day oral contraceptive regimen of norethindrone acetate 1 mg/ethinyl estradiol 20 μg, which has been shown to be effective and well-tolerated 5.
- Natural estrogen, such as estradiol 17-β, is also being used in combined oral contraceptives, offering an alternative to ethinyl-estradiol 6, 7.
- Estradiol-based formulations have been shown to have similar efficacy and cycle control as ethinyl estradiol-based COCs, with potential benefits including a better metabolic and vascular profile 6, 7.