Hormonal Birth Control Methods (Non-Pill Options)

Birth control pills may not be an option for every woman desiring contraception. Some women may prefer a method that does not involve remembering to take a daily pill. Other women may not be able to use the estrogen commonly found in some birth control pills for health reasons or because they are breastfeeding and prefer not to take a daily pill. For these women, there are other options that provide convenient pregnancy protection.

Non-pill hormonal birth control options include: the birth control patch, also known as Ortho Evra; the birth control ring, also known as NuvaRing; the birth control implant, also known as Implanon or Nexplanon; the intrauterine device or IUD, also known as Mirena or Skyla; and the birth control shot, also known as Depo-Provera or Depo-subQ Provera 104

Advantages

  • Convenient pregnancy protection,
  • No need to remember to take a daily pill
  • A high level of effectiveness; progestin-only forms may have slightly lower effectiveness
  • Some methods last for years
  • Progestin-only forms may be used by women who are breastfeeding or cannot use estrogen

Warnings

Hormonal birth control should NOT be used by women who have a history of breast cancer, endometrial or cervical cancer, undiagnosed vaginal bleeding, liver tumors or disease, increased clotting or stroke risk, or if pregnant.

Smoking increases the risk of serious heart side effects when using a combined estrogen and progestin birth control, including the ring or the patch. Combination estrogen and progestin birth control should NOT be used in women over 35 years of age who smoke due to an increased risk of rare but serious side effects, such as heart attack, blood clots, and stroke.

Women of any age should avoid combination hormonal birth control if they have a history of uncontrolled high blood pressure, chest pain, diabetes, severe headaches, heart or liver disease, blood clots or stroke. Cardiovascular risks increase with age, weight, family history of heart disease, and number of cigarettes smoked per day (>15 per day). Women should talk to their healthcare professional about their cardiovascular risk before deciding which birth control method to use.

The patch, vaginal ring, IUD, implant or birth control shot do not protect against any form of sexually transmitted disease (STD), including HIV and AIDS. A male latex or female condom should be used in combination with these other birth control options if protection against STDs is needed.

Let your physician know if you have migraine headaches when discussing birth control options.

Breastfeeding mothers should avoid the estrogen in combined hormonal birth control as it may reduce milk supply. Birth control options for breastfeeding women include IUDs, progestin only pills (“mini-pills”), the implant or the birth control shot.

Common Side Effects

  • Spotting between periods
  • Possible weight gain
  • Breast swelling or tenderness
  • Nausea or upset stomach
  • Mood changes vaginal infections and irritation, vaginal secretion, headache, weight gain, and nausea

Serious Side Effects

  • Blurred vision
  • Severe stomach pain
  • Severe headache
  • Swelling or pain in the legs
  • Chest pain, heart attack, blood clots, stroke

Other warnings and side effects exist for individual birth control options. It is important to review the specific consumer information for the birth control of choice and discuss any questions or concerns with your healthcare provider.

Tell your healthcare provider about all other medications you take, including prescription, over-the-counter, vitamin and herbal supplements. Certain medications may make birth control less effective. Be sure to have a complete drug interaction review each time you start a new medication.

Hormonal Birth Control Options (Non-Pill)

Generic Name Brand Name Details
Etonogestrel/ethinyl estradiol vaginal ring NuvaRing Vaginal ring inserted by patient and worn continuously for 3 weeks, then removed for 1 week to allow menses; remove the ring 3 weeks after insertion on the same day of the week and at the same time of day; replace with a new ring each month; contains estrogen and progestin; costs roughly $15-$90 per month; 1% failure rate if always used correctly; prescription required but no fitting needed; can lead to local vaginal irritation; other common side effects include vaginal infections, irritation or secretion; provides no STD protection
Etonogestrel subdermal implant Implanon; Nexplanon Healthcare provider-inserted matched-sized rod placed under the skin of upper arm; replace after 3 years, but may be removed at any time; progestin-only implant; effective for 3 years; <1% failure rate; $500-1000 per implant but lasts for 3 years; cannot use if breast cancer; may cause irregular periods initially; may lighten or eliminate periods; provides no STD protection
Levonorgestrel intrauterine device (IUD) Mirena; Skyla Healthcare provider-inserted progestin-only IUD; inserted within 7 days of menses onset; replace after 5 years for Mirena or 3 years for Skyla; $500-$1000 per IUD; very effective, <1% failure rate if used as directed; may lighten or eliminate periods; if a period is missed, promptly be evaluated for pregnancy; do not use if pregnant, unexplained vaginal bleeding, liver disease, breast cancer, pelvic infection following pregnancy or abortion in the past 3 months, cancer of the uterus or cervix, infection in the cervix; provides no STD protection; under a limited distribution plan in the U.S., call 1-866-318-3531 or www.whcsupport.com for more information
Medoxyprogesterone acetate injection Depo-Provera, Depo-subQ Provera 104; generics available Injection of progestin-only hormone given in the arm every 12 weeks; costs $50-$100 per injection; may lighten or eliminate periods; <1% failure rate if used as directed; do not use if pregnant, breast cancer, at risk for bone fractures, taking aminoglutethamide; may initially cause irregular bleeding; may be a good birth control option if breastfeeding; provides no STD protection
Norelgestromin/ethinyl estradiol transdermal patch Ortho Evra Apply 1 patch once a week for 3 weeks, then remove in week 4 to allow menstruation, then repeat; 1% failure rate if used correctly; may be less effective in women who weigh over 198 pounds; may result in lighter periods and less cramping; cost is roughly $20-$50 per month; may cause skin irritation; prescription required; provides no STD protection

See Also:

Last updated: 2013-11-03 by L. Anderson, PharmD.

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