Hormonal Contraceptives: More Than Just A Good Birth Control Option

Hormonal contraceptives are more than just birth control.

Sure, they are more effective at preventing pregnancy than barrier methods like condoms, the cervical cap or the contraceptive sponge. That is mostly because you don’t have to remember to use them every time you have sex.

Of course, you should always use condoms when having sex to reduce or prevent exposure to sexually transmitted infections.

But, hormonal contraceptives also have additional benefits that other forms of birth control do not have.  Because of the way they work to prevent pregnancy, they also cause the lining of the uterus to become thinner.

When the uterine lining is thinner, it produces less prostaglandin. Prostaglandins are natural chemicals produced by the lining of the uterus or the endometrium that cause the muscle and blood vessels of the uterus to constrict causing uterine cramping during your period. When this lining is thinner you have less bleeding and less cramping.

  • Thinner uterine lining = fewer prostaglandins = less painful periods.
  • Thinner uterine lining= less bleeding = lighter menstrual flow

In other words, combined hormonal contraceptives are a very effective way to manage a variety of gynecologic problems that cause increased menstrual pain or abnormal uterine bleeding.

There are different types of hormonal contraceptives.

They can be divided into two main categories:

  • combined hormonal contraceptives 
  • progestin only contraceptives.

Combined Hormonal Contraceptives

Combined hormonal contraceptives are those that contain both estrogen and progesterone. They work by suppressing ovulation. By giving your body a steady amount of hormones this contraceptive type interrupts the normal menstrual cycle that relies on changing hormone levels to trigger ovulation.

When ovulation does not happen the lining of the uterus doesn’t get as thick as usual. A thinner lining means less bleeding and less pain. There is a hormone free week built into the dosing schedule of the combined hormonal contraceptive methods. During this week, you will have a withdrawal bleed which is usually much lighter and less painful than your normal period. The types of combined hormonal contraceptives currently available in the US are:

Although the hormone delivery system is different these three methods work in the same way to reduce menstrual pain and bleeding.

Progestin-Only Contraceptives

There are several different types of progestin-only contraceptives. Most of these methods will inhibit ovulation most of the time, but they also work by thinning the lining of the uterus. Since they don’t contain any estrogen, most of these methods will thin the lining so much that you may not even have any withdrawal bleeding.

Although in some women, when the lining gets too thin they will start to have irregular bleeding. This is a major reason why many women discontinue progestin-only contraceptives. The progestin-only contraceptive comes in different forms:

  • The Progestin only pill (POP) or “mini pill” suppresses ovulation most of the time. It mainly works by thinning the lining and changing the cervical mucous. It is really important that you take this pill at the same time every day if you are using it for birth control.
  • Depo-Provera is an injectable contraceptive. It is given every three months. It suppresses ovulation and thins the lining of the uterus.
  • Nexplanon is an implantable contraceptive. It sits under the skin of your arm and slowly releases progestin hormones for three years. It works both by suppressing ovulation and thinning the lining of the uterus.
  • Mirena/Skyla are intrauterine devices that also contain progesterone. They slowly release progesterone directly into the uterus for 5 and 2 years respectively. These IUDs do not suppress ovulation but they work primarily by thinning the lining of the uterus so that implantation cannot occur.

Choosing which hormonal contraceptive is best to control your symptoms of menstrual pain or abnormal uterine bleeding is based on:

  • the cause of your bleeding
  • your medical history
  • your preference 

Please speak with your healthcare provider so they can help you decide which method is best for you.

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