Minimizing Birth Control Side Effects

How to Choose the Right Birth Control Pill

Birth Control Effects. Anne Rippy/The Image Bank/Getty Images

With so many combination birth control pills available, how do you know which is the best one to help minimize birth control effects? In general, combination hormonal contraceptives contain a synthetic estrogen (to stabilize the endometrium and reduce unwanted spotting) and a progestin (for its contraceptive effects). Knowing the differences between the progestins and about estrogenic effects, androgenic effects and progestational selectivity, can help minimize the pill's side effects.

Use this guide to help decide upon a pill or to pick a different pill brand to help lessen a birth control effect that you may be experiencing.

A Quick Explanation About Choosing a Birth Control Pill:

To briefly explain how the combination of these activities may cause side effects, let's look at some specific combination birth control pills. Oral contraceptives that tend to have high androgenic effects and low estrogen activity, for example, are more likely to cause unwanted hair growth and acne side effects. Additionally, a progestin with higher androgenic effects may tend to produce less breast tenderness, bloating and mood changes.

It is important to remember, though, that the majority of women using a pill with this combinations do not end up developing acne; this side effect is more likely to occur in those women who have a tendency toward androgenicity.

Birth control pills containing this high androgenic/low estrogenic pattern include:

Since there are different types of progestins, they each have a different potency in terms of progestational, estrogenic, and androgenic effects. The result of these effects is dependent on the combination of the type and levels of progestin and estrogen.

So typically, the balance (or ratio) between the estrogen and progestin in a pill brand may play a role in the side effect you are experiencing. Although a specific pill brand may have certain characteristics due to its estrogen and progestin dose and potency for androgenic effects, women may respond differently to these components. Also, the type of pill you may be using monophasic/biphasic/triphasic or extended cycle may help alleviate certain side effects. Because of that, please note that the following are general guidelines, and may not apply to all women.

To be a little more technical, in order to determine the total combination of these three effects, a person needs to multiply the actual dose of these three components (effects) times the relative potency of that component in order to classify a birth control pill brand as having high androgenic effects, being estrogen dominant, or progestin dominant. Given the complexity of figuring this out on your own, the decision as to which birth control pill to use should be discussed with your healthcare provider.

This information is not intended to be a substitute for that discussion. You can use this information to begin a conversation with your doctor about which pill type may be best for you.

It is also important to give the pills you are currently taking a fair trial of at least 2 to 3 months. If you have switched your pill brand, you should also give the new ones a 2- to 3-month trial because it often takes a few months just for your body to adjust to the new hormones in your birth control pill.

Choosing a Birth Control Pill by Minimizing Its Side Effects:

With that being said, you can now try to determine what pills brand may be best for you. Just another reminder, the following chart is a relative classification, so it may not apply to every female. When choosing a combination birth control pill, you may be able to minimize side effects by switching to (or initially picking) a pill brand suggested in the below chart based on which side effect you are trying to lessen or alleviate.

Side Effect (Problem)Progestin/Estrogen/Androgenic EffectsTry Using These Pill Brands (to minimize side effect)
Acnehigher estrogen, lower androgen potencyDemulen 1/50, Brevicon, Mircette, Modicon, Necon, Othro-Cyclen, Ortho-TriCyclen, Yasmin
Break through bleeding (spotting)higher estrogen, higher progestin potency, lower androgen potencyDemulen 1/50, Desogen, Ortho-Cept, Ovcon 50, Yasmin, Zovia 1/50E, Estrostep FE**
Breast sorenesslower estrogen, lower progestin potencyAlesse, Levlite
Depressionlower progestin potencyAlesse, Brevicon, Levlite, Modicon, Necon 1/35, Ortho-Cyclen, Othro-TriCyclen, Ovcon 35,Tri-Levlen, Triphasil, Trivora
Endometriosis or endometriosis preventionlower estrogen, higher progestin potency, higher androgen potencyDemulen 1/35, Levlen, Levora, Loestrin 1.5/30, Loestrin 1/20 Fe, LoOvral, Nordette, Zovia 1/35E 
(used either continuously with no days of placebo pills or with only 4 days of placebo pills for prevention)
Headaches (not menstrual migraines)lower estrogen, lower progestin potencyAlesse, Brevicon, Levlite, Modicon, Necon 1/35, Ortho-Cyclen, Othro-TriCyclen, Ovcon 35 , Tri-Levlen, Triphasil, Trivora
Moodiness or irritabilitylower progestin potencyAlesse, Levlite, Loestrin 1/20 Fe, Yasmin, Yaz, Beyaz (or any pill with less estrogen than currently on)
Severe menstrual crampshigher progestin potencyDemulen 1/35, Demulen 1/50, Desogen, Mircette, Loestrin 1.5/30, Ortho-Cept, Yasmin, Zovia 1/35E, Zovia 1/50E
Weight gainlower estrogen, lower progestin potencyAlesse, Levlite, Loestrin 1/20 Fe, Yasmin, Yaz, Beyaz (or any pill with less estrogen than currently on)

**Estrostep FE contains the progestin norethindrone acetate (this progestin typically has a higher androgen potency). Therefore, although Estrostep FE follows more of a high androgenic/low estrogenic pattern, this brand is a triphasic pill that was actually designed to help prevent breakthrough bleeding while attempting to keep hormone exposure as low as possible. Estrostep FE is a good example as to why the information in this chart should be viewed more in terms of being general guidelines, and may not always hold from one woman to another.

Remember, every woman could react differently to specific birth control methods, so this information is meant to be a general overview. Also, it is important to point out that the main reason to use hormonal birth control is for contraception (to prevent an unintended pregnancy) -- considering potential noncontraceptive benefits of birth control as well as unwanted side effects can be part of the discussion you have with your doctor when determining which hormonal method may be best suited for you.


Jelovsek, R. (2003). Accurate Answers to Questions About Birth Control Pills. [e-book]. Accessed via private subscription.

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