Could progestin-only birth control be right for you?

When it comes to birth control, every option seems to come with a caveat. Fortunately, there are more options for birth control than there were several years ago including something called progestin-only birth control. 

What is progestin?

A female steroid hormone called progesterone is one of the most important to the process of fertility. It’s released during the second half of the menstrual cycle during ovulation. And in order to maintain a pregnancy, you need the right amount of progesterone.

“Progestin is a synthetic progesterone used as a hormonal contraceptive and menopause treatment,” says Christina Madison, Pharm.D., an associate professor of pharmacy practice at the Roseman University of Health Sciences – College of Pharmacy.

So, by disrupting the amount of progesterone in your body with progestin, you can control your fertility. As with any hormonal birth control method, progestin-only birth control does not protect you from sexually transmitted infections. 

In birth control, progestin prevents pregnancy by hindering ovulation and making your cervical mucus less attractive to sperm. Progestin also thins the lining of the uterus, and as a result the uterus is less likely to welcome an implanted egg. 

Progestin-only birth control

There are several reasons progestin-only birth control, often called the mini-pill, might be better than other methods. It is most commonly prescribed postpartum. “Hormonal contraceptives either contain progestin or a combination of progestin and another hormone called estrogen,” says Queen Buyalos, R.Ph., creator of Mommy Queendom. “Estrogen reduces breast milk production.”  Because of that, some breastfeeding mothers will want to avoid birth control containing estrogen. 

Even in people who are not postpartum, progestin-only contraception is seen as an alternative to those containing estrogen but with the same format, usually a pill but sometimes an implant, IUD, or shot. Estrogen has been known to have some side effects. Estrogen can cause weight gain, bloating, and increased blood pressure, Buyalos says. “Therefore, if you did not want some of the estrogen side effects, it would make sense to choose progestin-only pills,” she says. Progestin has a much lower instance of side effects. 

There are also serious health considerations when it comes to estrogen. “Progestin-only birth control is typically used in individuals who are unable to take estrogen therapy due to contraindications from medical conditions to pose an unacceptable risk,” Dr. Madison says. There is a long list of contraindications for estrogen use including migraine with aura, smoking and over the age of 35, high blood pressure, history of blood clots, cancer risk or past cancer, especially breast cancer or undiagnosed masses, uncontrolled diabetes, and other conditions. 

Side effects

Progestin-only birth control side effects are less common among other birth control options, but you may still get some common side effects such as:

• Headache
• Fatigue
• Acne flare
• Breast tenderness
• Mood changes

If these side effects affect your quality of life, speak to your gynecologist or healthcare provider. Many users find these side effects minor and manageable or that they only occur when you first start the medication. 

Also, if you are sensitive to mood changes, you should mention that in your appointment as well. “Ultimately, if the patient is on too much or too little progesterone it can alter their mood,” Dr. Madison says. “This is definitely the case when some has too much progesterone that was being supplemented by the use of contraceptive products.” 

While estrogen birth control has a higher instance of mood issues, progestin can come into play as well. You can look into non-hormonal birth control options like certain IUDs or condoms. Speak to your healthcare provider or gynecologist about what might work best for you. 

Serious side effects

More severe side effects come from a progestin deficiency and can include:

• Late breakthrough bleeding/spotting 
• Delayed onset of menstrual bleeding 
• Hypermenorrhea, aka heavy menstrual periods, which can lead to anemia

If you experience these more severe side effects, speak to your healthcare provider about options. You may be able to wait and see if your cycle normalizes or you may need to seek an alternate method. 

Progestin excess can cause: 

• Weight gain
• Depression
• Decreased sex drive, 
• Hirsutism, a type of hair growth
• Acne 
• Hair loss 
• Decreased or no menstrual bleeding 
• Insulin resistance
• High blood pressure
• Increased breast size 
• Swelling of the arms or legs

While many of these side effects are not necessarily life-threatening, things like high blood pressure and insulin resistance can be very dangerous if untreated or in combination with other health issues. 

Is progestin-only birth control right for you?

Choosing a birth control method is equal parts what is right for your body and what is right for your lifestyle. If you are looking for an option postpartum or a birth control with less side effects, the mini-pill could be right for you. 

Progestin-only birth control as an oral-contraceptive—if used with absolute perfection—fails less than 0.5% of the time. However, many people miss a pill and the failure rate goes up significantly. It is only effective if you take it at the same time every day to keep a stable dose in your system. So, Dr. Madison advises to only choose the progestin-only oral contraceptive pill if you can take it every day at the same time.

For those taking the pill postpartum, it’s recommended to set an alarm, leave yourself a reminder, or put the pill somewhere you won’t forget to take it. Failure to take the pill at the same time every day can lead to ovulation and pregnancy if you are sexually active. In this case, you should seek emergency contraception. If you have worries about your ability to adhere to the schedule, you can also use a back-up method of birth control.

It’s important to note that progestin-only birth control—in any form—does not protect against STIs, so you will need a backup method in that case as well.

Ultimately, your choice of birth control is a decision you can make with your healthcare provider after he or she views your full medical history to rule out contraindications. 

Progestin-only birth control options

The generic of progestin-only birth control is available as norethindrone 35 mcg or drospirenone 4mg. These options come in pill form most commonly, but there are also formulations available as an injection, IUD, and implant.

Pills

Here are some common progestin-only birth control pills:

RELATED: See more birth control pill options

Injections

You can also get injections of progestin-only birth control. Usually, you need a shot to a muscle every three months to prevent pregnancy. This is a particularly good option if you are finding it difficult to take a pill every day. 

The only major obstacle with this type of method is that you need to schedule your shot during a certain window of time to keep a stable dose of progestin in your system to prevent ovulation. If you travel or have too busy of a schedule to make an appointment every three months or so, you may want to look into other options. However, many people find this contraceptive method the most convenient and the lowest effort. 

Here are some common progestin-only birth control injections:

IUDs

Additionally, there are intrauterine devices, IUDs, which use progestin as the main contraceptive method. These are inserted by a healthcare provider into the uterus and can remain there for several years. IUDs are becoming a popular option among people seeking contraception because, once it is inserted, you merely need to check its position monthly and will not need to do anything else to ensure your dosage. In rare instances, IUDs can “travel” and lose their position or move into the bladder. This requires laparoscopic surgery but, again, is a very rare complication. 

Many people find this birth control method preferable if they do not want more children in the near future. It is easy to remove an IUD but requires some preparation. Therefore, people who may want to try for conception soon may want another method of contraception. 

Here are some common progestin-only birth control IUDs:

Implants

Finally, there are implants with progestin-only birth control. A healthcare provider puts this implant under your skin and it slowly releases progestin over several years. Much like an IUD, implants are a “set it and forget it” contraceptive method for the most part. Similarly, you merely need to check the position and monitor yourself for side effects or complications. There are less products on the market at the moment, which may limit your choices regarding this contraceptive method. 

Here is the most common implant available: