What birth control methods have higher progestin levels?

Birth Control Methods with Higher Progestin Levels

Depot medroxyprogesterone acetate (DMPA) injections contain the highest levels of progestin among available birth control methods, making them an excellent choice for women who need or prefer higher progestin formulations. 1

Progestin-Only Methods Ranked by Progestin Content

Highest Progestin Content

1. Depot Medroxyprogesterone Acetate (DMPA) Injections

   • Contains 150mg of medroxyprogesterone acetate per injection 1
   • Administered every 3 months (13 weeks)
   • Serum concentrations plateau at about 1.0 ng/mL for about three months 2
   • Progestin can be detected in serum for up to 9 months after injection 2

2. Progestin-Releasing IUDs

   • Levonorgestrel IUD (Mirena) releases progestin locally 3
   • Provides high local concentrations with lower systemic levels
   • Can be beneficial for patients needing localized progestin effects 3

3. Progestin Implants

   • Etonogestrel implant (Implanon/Nexplanon) 3
   • Releases progestin continuously over 3 years
   • Provides stable hormone levels 4

4. High-Dose Progestin Pills

   • Norethisterone derivatives (10mg daily dosing) 3
   • Medroxyprogesterone acetate (MPA) tablets 3
   • Chlormadinone acetate and nomegestrol acetate (strong antigonadotropic activity) 3

5. Standard Progestin-Only Pills (POPs)

   • Lower daily dose compared to other methods 3
   • Must be taken at the same time each day for effectiveness

Clinical Considerations When Choosing Higher Progestin Methods

Effectiveness

• DMPA has extremely high effectiveness with typical use failure rates of only 0.3% 1
• Implants have the lowest failure rate at 0.05% 4
• Both are more effective than combined hormonal methods or progestin-only pills 3

Benefits of Higher Progestin Methods

• Independent of user compliance (except for returning for injections) 5
• Highly effective contraception 1
• No estrogen-related side effects 3
• Can be used by women with contraindications to estrogen 3
• May reduce menstrual bleeding over time, with many DMPA users developing amenorrhea 6

Potential Side Effects of Higher Progestin Methods

• Menstrual irregularities (most common side effect) 5
• Weight gain (particularly with DMPA) 5
• Possible mood changes 7
• With DMPA, return to fertility may be delayed for several months after discontinuation 2

Special Populations Who May Benefit from Higher Progestin Methods

• Women with contraindications to estrogen-containing contraceptives 3
• Women with SLE (systemic lupus erythematosus) 3
• Women with history of venous thromboembolism 3
• Women who have difficulty with daily compliance 5
• Women with heavy menstrual bleeding who would benefit from menstrual suppression 6

Practical Considerations

• DMPA requires injections every 3 months (13 weeks) 1
• Implants provide continuous contraception for 3 years 4
• Levonorgestrel IUDs provide contraception for 3-7 years depending on the specific product 3
• Higher-dose progestin pills require daily administration 3

Common Pitfalls to Avoid

• Failing to counsel patients about expected menstrual changes with high-progestin methods
• Not considering the delayed return to fertility with DMPA when family planning is a near-term goal
• Overlooking the need for backup contraception when initiating progestin-only methods
• Not providing adequate counseling about managing side effects, which can lead to discontinuation

When selecting a birth control method with higher progestin levels, DMPA injections provide the highest systemic progestin dose, while levonorgestrel IUDs provide high local concentrations with lower systemic effects. The choice should prioritize effectiveness and safety based on the individual's health profile and contraceptive needs.