The Alternative Birth Control Pill You've Never Heard Of
Many women use birth control pills as their go-to method of contraception. But for others, the traditional Pill is not an option. Thanks to its estrogen content, the Pill you know and love is a nonstarter for women who are nursing or who have certain health concerns. Fortunately, the Pill isn't the only pill game in town.
What many women don't know is that there is another Pill option out there—called the progestin-only pill (POP), or the minipill—that doesn't get nearly as much airtime.
What's the difference between a progestin-only pill and a combination pill?
Combination birth control pills contain both estrogen and progestin, a synthetic form of the hormone progesterone, and work by preventing ovulation. Progestin-only pills, on the other hand, only contain that one active ingredient and work a little differently. "POPs mainly cause the cervical mucus to thicken as a barrier to sperm entering the uterus and thin out the endometrial lining, making implantation of any embryo difficult," Alexander Chiang, M.D., assistant clinical professor in the department of obstetrics and gynecology at the David Geffen School of Medicine at UCLA, tells SELF. They also sometimes prevent ovulation, but not reliably: About 40 percent of women who use progestin-only pills will continue to ovulate, according to the American Congress of Obstetricians and Gynecologists.
Who should take the mini pill over a combination pill?
"Progestin-only pills are typically prescribed to breastfeeding mothers opting for the Pill, or to women who have a medical condition in which the estrogen component of the combo pill is contraindicated," Melissa Walsh, M.D., an ob/gyn in the department of obstetrics, gynecology, and women's health at Montefiore Medical Center, tells SELF. Estrogen interferes with milk production for new moms, and because it increases blood clotting, taking the hormone can actually be dangerous for women with a history of heart attack or stroke, or who are smokers and over 35 years old.
Are the side effects any different between the two?
Since POPs are very low-dose, they are less likely to cause the headache, weight gain, and nausea side effects that are more associated with combo pills in some women," Walsh says. However, as a result, spotting between periods and irregular periods are more likely than with a combo pill. "This is because the dosage is very low and time-sensitive, therefore, your body's own hormonal cycle may be able to break through the POP medication level," Walsh explains. "This is most commonly seen in young, non-breastfeeding women."
Is the minipill as effective as the combination pill at preventing pregnancy?
Nope. That's probably its biggest downfall. The typical user-failure rate for the combination pill is anywhere from 2 to 3 percent; the progestin-only pill has a failure rate of over 9 percent. This is in part because there's less room for error. "This pill has to be taken at the same time every day (maximum within three hours) to be effective," Chiang says. The mucous-thickening and endometrium-thinning effects only last up to 20 hours, making the pill quite time-sensitive. "A back-up contraceptive (e..g., condoms) should be used for at least two days if the POP is taken more than three hours late or forgotten on any day," Walsh notes.
Bottom line: POPs aren't the most user-friendly birth control option. Most ob/gyns will always give you a combination pill—they just generally work better. But if you can't take estrogen because it's a health risk or you're breastfeeding, a progestin-only pill may be a good option. Talk to your doctor about the minipill—and other birth control options that don't contain estrogen, like the implant, Mirena IUD, and injections—to find the method that'll work best for you.