8 Types of Progestin in Combination Birth Control Pills

Norethindrone

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

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:

• Nausea
• Migraines
• Fluid retention

Disadvantages of this progestin include limited effects against acne.

Examples of pills that contain this progestin include:

• Loestrin
• Junel
• Estrostep

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:

• Demulen
• Kelnor
• Zovia

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.

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:

• Alesse
• Aviane
• Portio
• Triphasil
• Tri-Levelin
• Nordette
• Continuous birth control pills like Seasonique and Lybrel

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

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:

• Migraines
• Dysmenorrhea, or painful cramps

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

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

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.

Examples of pills that contain this progestin include:

• YAZ and Beyaz
• Yasmin
• Zarah
• Loryna
• Syeda
• Gianvi
• Ocella
• Vestura
• Nikki

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.