Hormonal Contraception
Insight from Pharmacy Fellows: Dr. Tiffany Vu and Dr. Derek Huang, and Professor of Pharmacology: Dr. Roshanak Rahimian.
Birth control information is primarily sourced from the CDC’s Reproductive Health Home.
https://www.cdc.gov/reproductivehealth/contraception/index.htm
The Centers for Disease Control and Prevention (CDC) reports in their National Health Statistic Report (2023), that based on 2015-2019 data, “virtually all women of reproductive age who had ever had sexual intercourse with a male partner used at least one contraceptive method at some point in their life.” 87.8% of the aforementioned women, had used the following methods: the pill, an injectable, contraceptive patch, contraceptive ring, contraceptive implant, or intrauterine device.
Contraceptive Pills: Combined Oral Contraceptives and Progestin Only Pill
The oral contraceptive pill contains estrogen and progestin, as opposed to the progestin-only pill. Dr. Tiffany Vu, current fellow at Thomas J. Long School of Pharmacy, comments on the differences between the combined oral contraceptive pill and the progestin-only pill.
“There are different patient populations where one [contraceptive pill] is preferred over the other,” says Dr. Vu. Per the CDC, “If you have a history of blood clots or breast cancer, your doctor may not advise you to take the pill. ” Dr. Vu mentions that the component estrogen is what increases the risk of blood clots and breast cancer.
Dr. Roshanak Rahimian, Professor of Pharmacology at Thomas J. Long School of Pharmacy, comments that progestin-only pills have a low risk of cardiovascular events and are particularly indicated for women with contraindications to combined contraceptives.
Of note, the CDC mentions the difference between extended contraceptive use and continuous contraceptive use. Extended contraceptive use encompasses a 4–7-day period of a hormone-free interval. An explanation of extended contraceptive use and continuous contraceptive use is explained by the CDC: “Extended contraceptive use is defined as a planned hormone-free interval after at least two contiguous cycles… continuous contraceptive use is defined as uninterrupted use of hormonal contraception without a hormone-free interval. (CDC 2023)”
Dr. Vu states that extended versus continuous dosing is up to patient preference, and what they prioritize. For example, “some are on oral contraceptives because they want a regular period, and some do not,” says Dr. Vu. Discussions with prescribers can occur to learn about extended dosing or continuous dosing options.
The Implant, Injection, Patch, and Hormonal Vaginal Contraceptive Ring
Other forms of hormonal contraception include the implant, injection, patch, and ring (CDC 2023).
Implant
The implant is a progestin-containing rod, which is inserted under the skin of the upper arm. The rod releases progestin into the body over three years.
Injection
Injections contain progestin as well. Injections are given every three months from a healthcare provider.
Patch
The patch contains both estrogen and progestin. Per the CDC Birth Control Methods in 2023, “You put on a new patch once a week for three weeks, during the fourth week you do not wear a patch, so you can have a menstrual period.”
Hormonal Vaginal Contraceptive Ring
The ring contains both progestin and estrogen. Similar to the patch, the ring is worn for three weeks. It is taken out on the fourth week of the menstrual period. A new ring is put in following the completion of the fourth week.
Dr. Derek Huang, a current fellow at Thomas J. Long School of Pharmacy, comments on nuances of the injection: “The injection may not be ideal in patients with a history of osteoporosis, or at risk of osteoporosis due to its side effect profile of loss of bone mineral density,” says Dr. Huang.
For the patch, Dr. Huang mentions that different patch brands may be less efficacious depending on the patient’s weight, or body mass index (BMI).
In regards to accessing other forms of hormonal birth control, Dr. Vu adds, “For injections, they can be administered in the arms, abdomen, buttocks, and thighs based on patient preference. Also, patients don't necessarily need to go to a healthcare provider to receive their shots either; they can be self-administered as well but still have the advantage of only being dosed every 3 months and not daily.”
According to the National Survey of Family Growth from the National Center for Health Statistics Data (2017-2019), the percentage of women aged 15-49 who use the 3-month injectable, contraceptive patch or ring, and implant, are 2.0%, 1.1%, and 2.0%, respectively. Note that the percentage of women who used the contraceptive ring or patch are reported jointly at 1.1%.
Intrauterine: The Copper IUD and Levonorgestrel IUD
There are two kinds of intrauterine devices, or IUDs: one that contains a hormone (the levonorgestrel IUD), and one that does not (the copper IUD).
“The levonorgestrel intrauterine system … releases a small amount of progestin each day to keep you from getting pregnant. It stays in your uterus for up to 3 to 8 years depending on the device. The copper intrauterine device… is shaped in the form of a T… it can stay in your uterus for up to 10 years” (CDC 2023).
“IUDs have to be placed by a healthcare provider, “ says Dr. Vu. “The longest-lasting IUD is the copper IUD or the Paragard. It can also be used as emergency contraception versus other hormonal ones that you can’t use as emergency contraception.”
Permanent Procedures
Permanent Contraception Procedures include male sterilization and female sterilization (for example, tubal ligation).
Dr. Huang mentions that in male sterilization, the flow of semen is disrupted, and in female sterilization, the flow of the egg coming out of the fallopian tube is disrupted.
Regarding tubal ligation, Dr. Rahimian comments: “tubal ligation doesn’t change your hormones. It also doesn’t affect your period or cause menopause.” Dr. Rahimian explains that tubal ligation prevents the egg from moving from the ovaries, preventing its passage through the fallopian tubes to the uterus. Additionally, this prevents the passage of sperm from traveling to the egg via the fallopian tubes.
Emergency Contraception (EC)
As mentioned above, the copper IUD can serve as a form of emergency contraception, which is most effective if inserted within 5 days of unprotected sex.
Dr. Vu also mentions Ella and Plan B as other forms of emergency contraception. Ella and Plan B are both oral pills. Plan B can be obtained over the counter, whereas Ella requires a prescription.
Dr. Rahimian mentions use of EC is most effective within 72 hours of unprotected sex. Per the FDA’s Drug Safety Information for Plan B, Plan B “usually stops or delays the release of an egg from the ovary.”In terms of furnishing emergency contraception Dr. Vu explains, “in California, we are lucky in terms of autonomy, as pharmacies are able to furnish emergency contraception.” For reference, according to the National Conference of State Legislatures in 2023, “Seven states permit pharmacists to dispense emergency contraception without a prescription: California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Washington.”
Disclaimer
Always speak with your primary care provider about which birth control method is right for you. This article’s intent is to relay information about current contraceptive methods and pharmacology backgrounds, not to make recommendations.
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Phone: 209-946-2315
Website: Student Health Services | University of the Pacific
