Pills: Birth control pills, used by 32 percent of women of reproductive age, contain synthetic versions of two female hormones: estrogen and progesterone. (The so-called minipill contains synthetic progesterone only.) These hormones prevent a woman's ovaries from releasing a ripe egg cell every month.
A woman who uses this method of contraception should take her pill each day at about the same time. With some brands, there is a pill to take every day of the month. With others, a woman takes a pill for 21 days, stops for seven days, then starts over.
Patches: The same type of hormones found in birth control pills can also be administered with a skin patch. Called Ortho Evra, this new contraceptive option calls for application of one patch a week for three weeks, then one week patch-free.
Vaginal inserts: Contraceptive hormones are also available in the form of a vaginal ring (NuvaRing). Like pills and patches, the ring is used for three weeks and skipped for one.
Shots: Administered in the doctor's office, the contraceptive shot Depo-Provera works in much the same way as the Pill, but need be taken only once every three months. Though Depo-Provera has been in use abroad since 1969, it was not available in the U.S. until 1993. A monthly shot called Lunelle was introduced in 2000.
Implants: The contraceptive implant Norplant, also relatively new in the U.S., works on the same hormonal principle. The implant consists of a slow-release female hormone contained in six thin, rubbery capsules. A doctor inserts the capsules beneath the skin on the inside of the woman's upper arm. The gradually released hormone prevents pregnancy round-the-clock for five years. If she wants to get pregnant before the five years are up, she can have the implant removed.
Pros and Cons of Hormonal Contraception
High reliability is a major advantage of hormonal contraception: The risk of accidental pregnancy is less than 3 percent. The hormones make for lighter and more regular menstrual periods, and reduce the cramps associated with periods. They also lower the statistical risk of tubal pregnancy, pelvic infections, and certain types of cancer (particularly ovarian cancer).
However, not all women are candidates for hormone-based contraception. A woman should use none of the hormonal methods if she has, or has ever had:
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Breast, uterine, or cervical cancer
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Blood clots in a leg, lung, or eye
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Unusual, unexplained vaginal bleeding
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Angina pectoris (chest pain from a heart condition)
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A liver tumor of any kind
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Jaundice while pregnant or taking the pill
One disadvantage of hormonal contraception is the possibility of nausea and vomiting, the most common side effects. Other possible side effects include breast tenderness, bleeding between periods, missed periods, weight gain or loss, depression, headaches, and blurred vision. In most women, the side effects disappear after a month or two. In others, switching to a different brand may diminish the problems.
Rarely, hormonal contraceptives precipitate a serious medical problem: an internal blood clot, stroke, heart attack (in women aged 40 and over), or liver tumor. Cigarette smoking increases the risk that such a problem will develop. So does the presence of high blood pressure, high cholesterol, or diabetes. For these reasons, it is important for any woman who uses a hormonal contraceptive to have regular medical checkups.
