Should You Use Progestin-Only Birth Control?

Hormonal birth control is used by women to prevent pregnancy. It typically involves the combined use of synthetic progesterone (progestin) and estrogen. While the two hormones together are considered more effective, there are some women who have a sensitivity to synthetic estrogen and cannot take it. As a result, progestin-only options are available.

Women Who May Benefit from Progestin-Only Birth Control

Progestin-only birth control is also considered a safer option for women at risk of heart disease or stroke. Estrogen, by contrast, is known to increase cardiovascular risk, particularly in:

smokers over the age of 35
women with high blood pressure
women with a history of blood clots

Other women may also benefit from progestin-only birth control, including breastfeeding mothers (as progestin will not affect milk production or harm the baby), overweight or obese women, or women who have never given birth.

Even on its own, progestin-only options are between 87 and 99 percent effective in preventing pregnancy.

Common Side Effects of Progestin-Only Birth Control

All forms of progestin-only birth control share common side effects, some of which will resolve over time. They may include:

dizziness
headache
abdominal bloating
vaginal discharge
spotting or irregular vaginal bleeding
amenorrhea (no period)
prolonged periods
loss of libido
Increase or decrease in acne
anxiety and nervousness
skin rash or darkened patches of skin
bone density loss
decrease or increase in facial and/or body hair
breast tenderness

There are currently six forms of progestin-only birth control methods available in the United States:

Progestin-Only Birth Control Pills

As per their name, progestin-only birth control pills (also known as the mini-pill or POPs) do not contain any estrogen. They are available in 28-day packs which you take every day during your four-week cycle. All 28 pills contain progestin; there are no placebo pills.

The mini-pill only comes in one formulation in the U.S. called norethindrone.

Depo-Provera

Depo-Provera is a birth control injection that slowly releases progestin medroxyprogesterone acetate into your body, providing protection from pregnancy from 11 to 14 weeks. If you opt to use Depo-Provera, you would need four injections each year.

Depo-Provera injections offer the added benefit of lowering the pain associated with endometriosis.

Depo-Provera has a black box warning that cautions against possible bone loss and the increased risk for of osteoporosis. For this reason, Depo-Provera should never be used for more than two years and should be entirely avoided in teenagers.

Common side effects include weight gain, irregular bleeding, spotting, and prolonged bleeding. Once stopped, it may take up to a year or more to start ovulating again.

Mirena IUD

The Mirena IUD is a small intrauterine device (IUD) that continuously releases a small amount of progestin over a five-year period. Because Mirena contains progestin, it is seen to be somewhat more effective than the ParaGard IUD. The Mirena IUD has also been approved to help treat heavy periods.

The Mirena IUD is inserted by your doctor and has handy strings that allow you to check that the device is still in place. As with all intrauterine devices, complications may include the perforation to the uterus, infection, and accidental expulsion.

Skyla Progestin-Only IUD

Skyla is another progestin-only IUD option. It is a bit smaller than Mirena and ParaGard and is typically be easier for a doctor to insert. Once inserted, the Skyla slowly releases a form of progestin (called levonorgestrel) over a three-year period.

The complications of use are the same as for the Mirena IUD, which may include uterine perforation, infection, and expulsion.

Nexplanon

Nexplanon is the newer version of Implanon subdermal implant.This is a progestin-only birth control device contains 68mg of the progestin etonogestrel and consists of a flexible plastic implant about the size of a matchstick.

Nexplanon is inserted under the skin of the arm and can provide up to three years of pregnancy protection.

Nexplanon is radiopaque, meaning that it can be seen in X-ray. This helps your doctor see if it has been properly placed. Insertion requires a local anesthetic and generally takes a few minutes.

After implantation, you may experience bruising, pain, itching, burning, numbness, bleeding, scarring, or infection at the insertion site.

Noristerat Injection

The noristerat injection is a birth control delivery system containing progestin norethisterone enanthate. It is not available in the U.S. but is commonly used in the United Kingdom, Europe, Africa, and Central America.

The noristerat injection is designed to be a short-term birth control method. Women usually choose it after being immunized against rubella or while awaiting their partner's vasectomy to become effective. The noristerat injection will continuously release progestin into your system for up to eight weeks.