8 Types of Progestin in Combination Birth Control Pills

Combination birth control pills are birth control pills that contain progestin and estrogen. These pills typically include a series of active pills to take for a certain time period. After this time period, there's a short break from taking the pills.

However, placebos pills (typically containing sugar) are commonly taken during this break to help in remembering not to forget to take the active pills. Only the active pills contain progestin and estrogen.

The estrogen in combination birth control pills is usually Ethinyl estradiol, a synthetic form of estrogen.

Progesterone is a hormone that plays an important role in pregnancy and menstruation. Progestin is any natural or man-made substance that has progesterone-like properties. Progestins are categorized by generation, indicating when they were introduced into the market. There are eight different types of progestin within these generations.

This article looks at the eight types of progestin in birth control pills and what these progestins do in your body.

Progestin Effects

Progestin has a few different effects on the female body:

  • Progestational effects: These help prevent ovulation and lessen monthly bleeding.
  • Androgenic effects: These are unwanted side effects like acne and body hair growth.
  • Estrogenic effects: These depend mostly on the amount of Ethinyl estradiol in the pills. These effects help counter the androgenic effects.

Progestin Generations

There are four generations of progestins. Different generations have some different qualities. Keep in mind that newer isn't always better.

  • First generation: Norethindrone, norethindrone acetate, and ethynodiol
  • Second generation: Desogestrel and norgestrel
  • Third generation: Norgestrel and norgestimate
  • Fourth generation: Drospirenone

Some combination pills that sound very similar have different progestins. For example, Ortho-novum 1/35 and 7/7/7/ contain norethindrone. Ortho-novum 1/50 contains norgestrel.

1

Norethindrone

Assorted contraceptive pills in their packaging

Adam Hart-Davis / Getty Images

Norethindrone is a first-generation progestin. It is available in the following formulations:

  • Monophasic: This means there is the same amount of estrogen and progestin in each pill that comes in a pack, excluding the placebos. 
  • Biphasic: This means that the amount of progestin in each pill increases about halfway through the pack. The estrogen amounts stay the same.
  • Triphasic: This means the amount of hormone in each pill changes every seven days. There may be changes to both the estrogen and progestin amounts.  

Norethindrone has low progestational activity. It also has slight estrogenic activity. It tends to be less androgenic than second-generation progestins. It may be more androgenic than newer progestins.

In pills that contain less than 50 micrograms of Ethinyl estradiol, this progestin may improve your cholesterol. It can help raise good cholesterol and lower bad cholesterol.

Other advantages of norethindrone include:

  • As the first progestin in use there are many years of data on its safety
  • It may be helpful in women who experience depression on other combination birth control pills

Disadvantages may include limited effects against acne.

Examples of pills that contain this progestin include:

  • Nortrel
  • Brevicon
  • Modicon
  • Ortho-novum 1/35
  • Ortho-novum 7/7/7/
  • Ovcon
2

Norethindrone Acetate

Norethindrone acetate is another first-generation progestin. It has low progestational activity and slight estrogenic effects.

This progestin tends to be less androgenic than the second-generation progestins. It also tends to be more androgenic than newer progestins.

The brand of birth control pill called Estrostep was designed to more closely mimic a woman's natural cycle. This pill provides increasing levels of estrogen with a constant progestin dose. It is the only triphasic brand with this progestin.

This brand may be helpful for women who have minor estrogen-related side effects with other combination pills. These side effects may include:

Disadvantages of this progestin include limited effects against acne.

Examples of pills that contain this progestin include:

3

Ethynodiol Diacetate

Ethynodiol diacetate is a first-generation progestin. It has viable progestational activity but weak estrogenic effects and little androgenic activity.

Ethynodiol diacetate is made from norethindrone. This means it is easily converted to norethindrone within the body.

Birth control pills that contain this progestin may help women with endometriosis. This is a condition where the lining of the uterus grows outside of the uterus.

Side effects of pills that contain this progestin include breast tenderness and breakthrough bleeding. This is menstrual-like bleeding that happens mid-cycle.

Examples of pills that contain this progestin include:

4

Levonorgestrel

Levonorgestrel is a second-generation progestin. It is the most widely prescribed birth control progestin worldwide. It has progestational and androgenic effects.

Several low-dose estrogen brands containing this progestin are available.

Levonorgestrel birth control has also been FDA approved for emergency contraception. This type of birth control is taken after unprotected sex. Examples include Plan B One-Step and Next Choice.

The FDA says all combination pills with this progestin are safe and effective for emergency contraception under the Yuzpe method.

This is a method of emergency contraception that involves taking two doses of combination birth control pills 12 hours apart.

According to a 2018 review, levonorgestrel was associated with the lowest risk of blood clots of all combination birth control pills.

Disadvantages of this progestin include the slight chance of negatively impacting cholesterol levels. It may also increase androgenic side effects like acne.

Examples of pills that contain this progestin include:

5

Norgestrel

Norgestrel is a second-generation progestin. It is a mixture of dextro-norgestrel and levonorgestrel. Levonorgestrel is the active ingredient.

Norgestrel has high progestational activity. It also has strong antiestrogen effects. It is high in androgenic activity. 

This progestin may help prevent endometriosis. Unwanted side effects may include acne and weight gain.

Examples of pills that contain this progestin include:

  • Ovral and Lo/Ovral
  • Ogestrel and Lo-ogestre
  • Cryselle
  • Ortho-novum 1/50

Recap

Levonorgestrel and norgestrel are second generation progestins. Levonorgestrel is the most commonly prescribed progestin. 

6

Desogestrel

Desogestrel is a third-generation progestin. It has high progestational selectivity. This means it minimizes the androgenic effects and estrogenic activity.

This progestin has a lower negative impact on things like:

  • Metabolism
  • Weight gain
  • Acne
  • Other side effects typical of older progestins

Desogestrel may have a small positive effect on cholesterol. It may cause slight increases in good cholesterol.

Clinical trials show a possibly higher risk of non-fatal blood clots with desogestrel pills. This is compared to pills that contain levonorgestrel.

Mircette is a low-dose estrogen/desogestrel pill. This medicine includes only two placebo days. This may be helpful for women who have side effects while taking the placebos, including:

Desogestrel appears to come with a higher risk of blood clots than other options. In fact, desogestrel combined with 30 to 40 micrograms of Ethinyl estradiol appears to have the highest blood clot risk of all combination birth control pills.

Pills containing this progestin have a few advantages, including:

  • Reducing menstrual cramps
  • Reduced risk of migraines
  • Positive effects on cholesterol
  • Less weight gain

The primary disadvantage is the higher risk of blood clots.

Examples of pills that contain this progestin include:

  • Mircette
  • Ortho-Cept
  • Apri
  • Solia
  • Desogen
  • Cesia
  • Reclipsen
  • Velivet
  • Casiant
7

Norgestimate

Norgestimate is a third-generation progestin. It has high progestational activity. It shows slight estrogenic effects. It tends to be less androgenic.

It has minimal effect on cholesterol. It also has little impact on carbohydrate metabolism. This means it probably won't have an effect on the way your body processes blood sugar. 

This progestin may help improve acne. In fact, birth control pills containing norgestimate are the only ones approved by the FDA for treating acne.

Ortho Tri-Cyclen Lo contains norgestimate and a mid-level dose of estrogen. This pill may help reduce side effects like nausea and vomiting. At the same time, it is less likely to cause spotting, which is a common side-effect of low-estrogen pills.

Pills containing this progestin may increase your risk for headaches. They may also cause a reduced libido or sex drive.

Examples of pills that contain this progestin include:

  • Ortho Tri-cyclen Lo
  • Mylan (generic Ortho Tri-Cyclen)
  • Sprintec
  • TriNessa
  • Previfem
  • Estarylla

Recap

Third generation progestins like desogestrel and norgestimate may reduce unwanted side effects like acne. Desogestrel may increase the risk of blood clots. 

8

Drospirenone

Drospirenone is a fourth generation progestin. It has low androgenic activity. This type of progestin may help reduce acne.

Drospirenone and estrogen seem to reduce the symptoms of mild PMS. These symptoms include:

  • Increased appetite
  • Negative mood
  • Water retention

People with kidney, liver, or adrenal disease should not take pills containing this progestin. This is because it may cause higher potassium levels.

The brands YAZ and Beyaz have 24 days of active pills and four days of placebos. This combination may cause fewer hormone fluctuations than other pills.

YAZ has also been FDA-approved to help treat the mood disorder premenstrual dysphoric disorder (PMDD).

Drospirenone has been linked to an increased risk of blood clots in several studies.

A 2017 review looked at 17 studies on drospirenone. It found that the risk of blood clots ranged from no increase to a 3.3 times increased risk. This is compared to levonorgestrel, the birth control pill thought to have the lowest risk.

Based on the best studies the review concluded that the risk is only slightly increased.

Some of the same researchers looked at the risk of blood clots in first-time users and in people who stopped taking birth control pills and then started again. The study included over 55,000 participants.

This study found that the risk of blood clots was 3.19 times higher with drospirenone than with levonorgestrel for first-time users. The risk was 1.96 times higher in restarters.

People who have other risk factors for blood clots may wish to consider a birth control pill other than those with drospirenone or desogestrel. In some cases, an entirely different form of birth control may be preferable.

Examples of pills that contain this progestin include:

  • YAZ and Beyaz
  • Yasmin
  • Zarah
  • Loryna
  • Syeda
  • Gianvi
  • Ocella
  • Vestura
  • Nikki
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Choosing an Oral Contraceptive

There are a lot of different reasons why you may choose one birth control pill over another. Fortunately, researchers have done some of the footwork in figuring out which pills may help minimize side effects, including:

  • Acne
  • Weight gain
  • Breast tenderness
  • Migraines
  • Breakthrough bleeding
  • Menstrual cramps
  • Moodiness and irritability
  • Depression

This can help give you the tools you need to work with your doctor on choosing the pill that is right for you.

Summary

Progestin is the synthetic form of the hormone progesterone. It is used in combination birth control pills.

Progestin helps prevent ovulation and may reduce monthly bleeding. It may also have unwanted side effects like acne. 

There are eight different types of progestin. They are grouped according to generation, or the time they became available.

First generation progestins have been around longer and have more data associated with their use. Second generation progestins like levonorgestrel have also been well-studied and widely used. Newer third and fourth generation progestins have advantages, too.

All progestins come with potential side effects. Make sure you discuss these with your doctor before deciding which combination birth control pill is right for you.

A Word From Verywell

There are a lot of different progestins. Trying to figure out the differences can seem overwhelming.

It's always a good idea to discuss your options with your doctor. Let your doctor know what your goals are for using birth control. Make sure to also discuss the side effects you most want to avoid, and those you're more willing to tolerate.

Be your own advocate. You are more motivated than anyone to look out for your health and well-being. Comparing the different progestins in birth control pills is an important part of managing your health care.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. National Center for Biotechnology Information. PubChem compound summary for CID 9270, ethynodiol diacetate.

  3. UpToDate. Combined estrogen-progestin oral contraceptives: patient selection, counseling, and use.

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  5. National Center for Biotechnology Information. PubChem compound summary for CID 13109, levonorgestrel.

  6. World Health Organization. Emergency contraception.

  7. Oedingen C, Scholz S, Razum O. Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: the role of the progestogen type and estrogen dose. Thromb Res. 2018;165:68-78. doi: 10.1016/j.thromres.2018.03.005

  8. Gunardi ER, Surya R, Syafitri I, Pasidri Y. Impact of one-rod levonorgestrel implant on the blood chemistry profileSci Rep. 2021;11(1):20141. doi:10.1038/s41598-021-99801-z

  9. Bosanac SS, Trivedi M, Clark AK, Sivamani RK, Larsen LN. Progestins and acne vulgaris: a reviewDermatol Online J. 2018;24(5):13030/qt6wm945xf. doi:10.5070/D3245040035

  10. Larivée N, Suissa S, Khosrow‐Khavar F, Tagalakis V, Filion KB. Drospirenone‐containing oral contraceptive pills and the risk of venous thromboembolism: a systematic review of observational studies. BJOG. 2017;124(10):1490-9. doi:10.1111/1471-0528.14623

  11. Larivée N, Suissa S, Coulombe J, Tagalakis V, Filion KB. Drospirenone-containing oral contraceptive pills and the risk of venous thromboembolism: an assessment of risk in first-time users and restarters. Drug Saf. 2017;40(7):583-96. doi:10.1007/s40264-017-0525-2

Additional Reading

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.