From the Guidelines
The best monthly cycle hormonal birth control option is typically a combined oral contraceptive pill (COC) containing both estrogen and progestin, such as Yaz, Yasmin, Ortho Tri-Cyclen, or Lo Loestrin Fe. These pills are taken daily for 21-24 days followed by 4-7 placebo days or a pill-free week, depending on the specific formulation. Most COCs contain ethinyl estradiol (20-35 mcg) paired with various progestins. These medications work by preventing ovulation, thickening cervical mucus to block sperm, and thinning the uterine lining to prevent implantation. The effectiveness rate is approximately 91% with typical use and 99% with perfect use, as noted in the U.S. Selected Practice Recommendations for Contraceptive Use, 2013 1.
Some key points to consider when using COCs include:
- Side effects may include nausea, breast tenderness, headaches, and spotting, particularly in the first few months
- To use COCs effectively, take them at the same time each day, and if you miss a pill, follow the package instructions for your specific brand
- Before starting, consult with a healthcare provider to determine the most appropriate option based on your medical history, as factors like smoking, age, and certain health conditions may influence which formulation is safest for you, as discussed in the context of contraception for adolescents 1
It's also important to note that while other options like the transdermal contraceptive patch are available, they may have higher risks of certain side effects, such as venous thromboembolism (VTE), as highlighted in the 2012 package insert for the patch 1. Therefore, COCs remain a preferred choice for many women due to their established safety profile and effectiveness.
From the Research
Monthly Cycle Hormonal Birth Control Options
- There are several monthly cycle hormonal birth control options available, each with its own unique characteristics and benefits 2, 3, 4, 5, 6.
Effectiveness of Different Options
- Ethinylestradiol 30microg/drospirenone 3mg (Yasmin, petibelle) is a highly effective combined contraceptive pill, with a corrected Pearl index of 0.41-0.71 and a pregnancy ratio of 0.3-0.84 2.
- Drospirenone/ethinyl estradiol 24/4 is also an effective oral contraceptive, with a unique dosing regimen that combines the lowest dosage of ethinyl estradiol with drospirenone, an innovative progestin 3.
- Estetrol-drospirenone combination oral contraceptive has been shown to be effective, with a Pearl index of 2.65 and a method-failure Pearl index of 1.43 4.
Safety and Tolerability
- EE/DRSP is generally well tolerated, with a frequency and type of adverse events similar to those observed with other combined contraceptives 2.
- Drospirenone/ethinyl estradiol 24/4 has been shown to be safe and effective, with a low risk of adverse events and no significant changes in clinical, hemodynamic, and autonomic parameters 3, 5.
- Estetrol-drospirenone combination oral contraceptive has been shown to have a predictable bleeding pattern and low adverse event rates, with no thromboembolic events reported 4.
Non-Contraceptive Benefits
- Some hormonal birth control options, such as drospirenone/ethinyl estradiol 24/4, have been shown to have non-contraceptive benefits, including improved symptoms of premenstrual dysphoric disorder (PMDD) and moderate acne vulgaris 3.
- Combined oral contraceptives have also been shown to offer well-documented health benefits, including a decrease in the risk of ovarian and endometrial carcinoma 6.