Combination Birth Control Pills

Combination birth control pills are oral contraceptives that combine natural or synthetic estrogens and progestins, similar to the natural sex hormones (estrogen and progesterone) produced in a woman's body. Unlike estrogen, several types of progestin can be found in various brands of combination pills.

• Understanding Progestin in Combination Birth Control Pills
• 8 Types of Progestin Found in Combo Pills

All combination birth control pills are available by prescription. This means that you cannot buy any of these pills over the counter. Your doctor may or may not require a pelvic exam and pap smear in order to prescribe these pills. Some doctors may prescribe combo pills on the basis of careful medical history and blood pressure measurement. You can always talk to your doctor first to find out what he/she requires to write a pill prescription.

• Share: Does Your Doctor Require a Pap Smear/Pelvic Exam for Your Pill Rx?

The pill; combo pills; combination pills

Types of Combination Birth Control Pills:

Combination birth control pills are categorized as monophasic, biphasic, or triphasic depending on whether the level of hormones stays the same during the first three weeks of the menstrual cycle or if it changes.

Combination birth control pills typically come in a one month supply. Combination pills are usually available in either 28-day or 21-day packs. Both versions have 21 active pills; these are the pills that include the hormones that prevent a woman from becoming pregnant.

• Choosing the Right Combination Birth Control Pill

In this type of pack, the last seven pills are known as reminder pills. They do not contain any hormones. These pills are taken during the fourth week, and their purpose is to help the woman maintain her routine of taking a pill everyday. Therefore, a woman will take a pill each day during the 4 week cycle.

21-Day Packs:

In this type of pack, the pills are taken for the first three weeks, and a woman takes nothing during the fourth week. She will start a new pack of pills eight days after the previous pack is completed. An example of a pill brand that comes in a 21-Day pack is Loestrin. These pill packs can be tricky because women need to remember to start their new pill pack without any reminder pills.

• Please Share: How Do You Remember When to Take Birth Control Pills?

There are two combination birth control pill brands that have 24 active days and only four placebo pills. These include:

• Yaz 28 (and Beyaz): the dosage regimen of YAZ is unique in that it contains 24 days of hormone pills, followed by 4 reminder day pills. This option may offer patients fewer hormone fluctuations than the traditional 21 days of active pills per 28 day cycle.
  
  
• Loestrin 24 Fe: approved by the FDA in February 2006, the pill brand was the first 24-day oral contraceptive approved in the US.

Extended cycle combination pills have more pills in each pack. These pills can allow you to completely skip your period or lower the frequency of your period. Studies show that extended cycle pills are safe. They can also be convenient and improve the quality of life for many women who suffer from menstrual-related problems.

• Seasonale is a continuous dosage pill that contains ethinyl estradiol/levonorgestrel. It can be taken continuously for 84 days and was FDA approved for routine contraception in September 2003. This regimen allows women to have less menstrual periods per year. This pill pack has have 77 active pills and 7 placebo pills

• Seasonique is another continuous dosage combination birth control pill and was approved by the FDA in May 2006. Seasonique is similar to Seasonale in that ethinyl estradiol/levonorgestrel is taken continuously for 84 days; but, with Seasonique, the final 7 days of the 3 month cycle contain low-dose ethinyl estradiol rather than placebo tablets. LoSeasonique is also available - this formulation has lower amounts of both estrogen and progestin.



• Lybrel is a low-dose continuous birth control pill. It is taken all 365 days of the year. In May 2007, it was the first pill FDA-approved to be used to completely stop a woman's monthly period. Many women who use Lybrel love not having their periods but share varying experiences with this pill brand.

Women can check their pill package insert to find out exactly which hormones are present and at what dosages throughout the cycle.

• Quiz: Extnded Cycle Pills
• Please Share: Would You Feel Comfortable Skipping Your Period or Having a Missed Period?

When using combination birth control pills, women will usually have withdrawal bleeding (her period) during the fourth week. The hormones contained in the active pills prevent pregnancy throughout the month, so even during the fourth week (regardless to whether she is taking reminder pills or no pills at all), a woman is protected against becoming pregnant.

How Combination Birth Control Pills Work

All combination pills contain estrogen (typically: ethinyl estradiol) and a specific type of progestin, designed to mimic the natural hormone of progesterone. These progestins include:

1. Desogestrel
2. Ethynodiol Diacetate
3. Levonorgestrel
4. Norethindrone
5. Norethindrone Acetate
6. Norgestimate
7. Norgestrel
8. Drospirenone

Unlike other combination birth control pills, these 2 brands contain the progestin drospirenone, which may increase potassium levels that could cause serious heart and other problems. These may not be the right method for you if you have ever had kidney, liver, or adrenal gland disease. There is alsom some concern that drospirenone-containing combination birth control pills may pose an increased risk of developing blood clots.

Estrogen Dosages:

Ethinyl estradiol is the type of synthetic estrogen found in oral contraceptives. The higher the number of micrograms of ethinyl estradiol leads to more potent effects of estrogen.

Low Dose Combination Pills:

These pills contain the lowest amount of estrogen (20 mcg) plus one of the types of progestin. Brand names of this type of pill include:

• Alesse
• Aviane-28
• Levlite
• Loestrin 1/20
• Mircette

Regular Dose Combination Pills:

These pills contain 30–35 mcg estrogen plus one of the types of progestin. Brand names of this type of pill include:

• Brevicon
• Demulen 1/35
• Desogen
• Femcon Fe
• Levlen
• Lo/Ovral
• Modicon
• Nordette
• Levora
• Loestrin
• Low-Ogestrel
• Necon 1/35
• Norinyl 1/35
• Ortho-Cept
• Ortho-Cyclen
• Ortho-Novum 1/35
• Ortho-Tri-Cyclen Lo
• Ovcon 35
• Seasonale
• Yasmin
• Zovia 1/35E

Phasic Combination Pills:

These pills have changing levels of estrogen and progestin to more closely mimic the hormonal phases during a woman’s menstrual cycle. Brand names of this type of pill include:

• Ortho Tri-Cyclen Lo
• Jenest-28
• Ortho-Tri-Cyclen
• Cyclessa
• Triphasil
• Tri-Levlen
• Ortho-Novum 10/11
• Trivora
• Tri-Norinyl
• Estrostep Fe
• Ortho-Novum 7/7/7

High Dose Combination Pills:

These combination pills have around 50 mcg of estrogen plus progestin. Brand names of this type of pill include:

• Ortho-Novum 1/50
• Ovral
• Demulen 1/50
• Ogestrel
• Ovcon 50

Common Questions About Combination Birth Control Pills:

• How Do I Switch to a New Pill?
• How Do I Use the Pill?
• What Medications Lower the Pill's Effectiveness?
• Are There Noncontraceptive Benefits of the Pill?
• How Can I Skip My Period Using The Pill?

Comparison to Progestin-Only Pills:

The combination birth control pill is slightly more effective than the progestin-only pill. Yet, some women's bodies do not react well to the estrogen in the combo pill, so it may be better for them to use the progestin-only pill.