Types of Progestin (Progesterone) Pills

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Progesterone is a naturally occurring hormone that helps prepare the lining of your uterus for pregnancy. Progestin is any natural or man-made substance that has progesterone-like properties. Progestins are categorized by generation, indicating when they were introduced.

Progestin is used in combination (estrogen plus progestin) and progestin-only birth control pills. Birth control pills are commonly used to prevent pregnancy, but they may also be prescribed for other conditions such as irregular periods and endometriosis.

This article looks at the brand and generic names for progestin and what these progestins do in your body.

The estrogen in combination birth control pills is usually ethinyl estradiol, a synthetic form of estrogen.

Progestin Effects

Progestin has a few different effects on the female body:

  • Progestational effects: These help prevent ovulation and lessen monthly bleeding.
  • Androgenic effects are unwanted side effects like acne and body hair growth.
  • Estrogenic effects depend mostly on the amount of ethinyl estradiol in the pills. These effects help counter the androgenic effects.

Different progestins may vary in these effects. For example, some may have lower progestational effects but higher androgenic effects, or vice-versa. This can have an effect on whether or not a pill causes certain side effects like acne or breakthrough bleeding.

Progestin Generations

There are four generations of progestins. Different generations have different qualities. Keep in mind that newer isn't always better. Some progestins are more likely to cause unwanted side effects, so talk to your healthcare provider about which pill might be best for you.

  • First generation: Norethindrone, norethindrone acetate, and ethynodiol. These progestins are less potent than newer generations, so they may cause breakthrough bleeding.
  • Second generation: Levonorgestrel and norgestrel. These progestins are more potent than first-generation progestins but may cause androgenic side effects such as acne and weight gain.
  • Third generation: Desogestrel and norgestimate. Third-generation progestins are more potent than first-generation progestins but are less likely to cause androgenic side effects than second-generation progestins.
  • Fourth generation: Drospirenone. Fourth-generation progestins are the most potent compared to previous generations and are less likely to cause breakthrough bleeding even when pills aren't taken on a strict schedule. They are also less likely to cause androgenic side effects.

Some combination pills that sound very similar have different progestins. For example, Ortho-novum 1/35 and 7/7/7 contain norethindrone. Ortho-novum 1/50 contains norgestrel.

Combination Oral Contraceptives

Combination pills contain estrogen and different doses and types of progestin. The different types are listed below.

Norethindrone

Assorted contraceptive pills in their packaging

Adam Hart-Davis / Getty Images

Norethindrone is a first-generation progestin. It is available in the following formulations:

  • Monophasic: This means there is the same amount of estrogen and progestin in each pill that comes in a pack, excluding the placebos. 
  • Biphasic: This means that the amount of progestin in each pill increases about halfway through the pack. The estrogen amounts stay the same.
  • Triphasic: This means the amount of hormone in each pill changes every seven days. There may be changes to both the estrogen and progestin amounts.  

Norethindrone has low progestational activity. It also has slight estrogenic activity. It tends to be less androgenic than second-generation progestins. It may be more androgenic than newer progestins.

This progestin may improve your cholesterol in pills that contain less than 50 micrograms of ethinyl estradiol. It can help raise good cholesterol and lower bad cholesterol.

Other advantages of norethindrone include the following:

  • As the first progestin in use, there are many years of data on its safety
  • It may be helpful in women who experience depression on other combination birth control pills

Disadvantages may include limited effects against acne.

Examples of pills that contain this progestin include:

  • Nortrel
  • Brevicon
  • Modicon
  • Ortho-novum 1/35
  • Ortho-novum 7/7/7
  • Ovcon

Norethindrone Acetate

Norethindrone acetate is another first-generation progestin. It has low progestational activity and slight estrogenic effects.

This progestin tends to be less androgenic than second-generation progestin. It also tends to be more androgenic than newer progestins.

The brand of birth control pill called Estrostep was designed to mimic a woman's natural cycle closely. This pill provides increasing levels of estrogen with a constant progestin dose. It is the only triphasic brand with this progestin.

This brand may be helpful for women who have minor estrogen-related side effects with other combination pills. These side effects may include:

Disadvantages of this progestin include limited effects against acne.

Examples of pills that contain this progestin include:

  • Loestrin
  • Junel
  • Estrostep

Ethynodiol Diacetate

Ethynodiol diacetate is a first-generation progestin. It has viable progestational activity but weak estrogenic effects and little androgenic activity.

Ethynodiol diacetate is made from norethindrone. This means it is easily converted to norethindrone within the body.

Birth control pills that contain this progestin may help women with endometriosis. This is a condition where the lining of the uterus grows outside the uterus.

Side effects of pills that contain this progestin include breast tenderness and breakthrough bleeding. This is menstrual-like bleeding that happens mid-cycle.

Examples of pills that contain this progestin include:

  • Demulen
  • Kelnor
  • Zovia

Levonorgestrel

Levonorgestrel is a second-generation progestin. It is the most widely prescribed birth control progestin worldwide. It has progestational and androgenic effects.

Several low-dose estrogen brands containing this progestin are available.

Levonorgestrel birth control has also been FDA-approved for emergency contraception. This type of birth control is taken after unprotected sex. Examples include Plan B One-Step and Next Choice.

The FDA says all combination pills with this progestin are safe and effective for emergency contraception under the Yuzpe method.

This emergency contraception method involves taking two doses of combination birth control pills 12 hours apart.

According to a 2018 review, levonorgestrel was associated with the lowest risk of blood clots of all combination birth control pills.

Disadvantages of this progestin include the slight chance of negatively impacting cholesterol levels. It may also increase androgenic side effects like acne.

Examples of pills that contain this progestin include:

Norgestrel

Norgestrel is a second-generation progestin. It is a mixture of dextro-norgestrel and levonorgestrel. Levonorgestrel is the active ingredient.

Norgestrel has high progestational activity. It also has strong antiestrogen effects. It is high in androgenic activity. 

This progestin may help prevent endometriosis. Unwanted side effects may include acne and weight gain.

Examples of pills that contain this progestin include:

  • Ovral and Lo/Ovral
  • Ogestrel and Lo-ogestre
  • Cryselle
  • Ortho-novum 1/50

Desogestrel

Desogestrel is a third-generation progestin. It has high progestational selectivity. This means it minimizes the androgenic effects and estrogenic activity.

This progestin has a lower negative impact on things like:

  • Metabolism
  • Weight gain
  • Acne
  • Other side effects typical of older progestins

Desogestrel may have a small positive effect on cholesterol. It may cause slight increases in good cholesterol.

Clinical trials show a possibly higher risk of non-fatal blood clots with desogestrel pills. This is compared to pills that contain levonorgestrel.

Mircette is a low-dose estrogen/desogestrel pill. This medicine includes only two placebo days. This may be helpful for women who have side effects while taking the placebos, including:

Desogestrel appears to come with a higher risk of blood clots than other options. Desogestrel combined with 30 to 40 micrograms of ethinyl estradiol appears to have the highest blood clot risk of all combination birth control pills.

Pills containing this progestin have a few advantages, including:

  • Reducing menstrual cramps
  • Reduced risk of migraines
  • Positive effects on cholesterol
  • Less weight gain

The primary disadvantage is the higher risk of blood clots.

Examples of pills that contain this progestin include:

  • Mircette
  • Ortho-Cept
  • Apri
  • Solia
  • Desogen
  • Cesia
  • Reclipsen
  • Velivet
  • Casiant

Norgestimate

Norgestimate is a third-generation progestin. It has high progestational activity. It shows slight estrogenic effects. It tends to be less androgenic.

It has minimal effect on cholesterol. It also has little impact on carbohydrate metabolism. This means it probably won't have an effect on the way your body processes blood sugar. 

This progestin may help improve acne. In fact, birth control pills containing norgestimate are the only ones approved by the FDA for treating acne.

Ortho Tri-Cyclen Lo contains norgestimate and a mid-level dose of estrogen. This pill may help reduce side effects like nausea and vomiting. At the same time, it is less likely to cause spotting, which is a common side-effect of low-estrogen pills.

Pills containing this progestin may increase your risk for headaches. They may also cause a reduced libido or sex drive.

Examples of pills that contain this progestin include:

  • Ortho Tri-cyclen Lo
  • Mylan (generic Ortho Tri-Cyclen)
  • Sprintec
  • TriNessa
  • Previfem
  • Estarylla

Drospirenone

Drospirenone is a fourth generation progestin. It has low androgenic activity. This type of progestin may help reduce acne.

Drospirenone and estrogen seem to reduce the symptoms of mild PMS. These symptoms include:

  • Increased appetite
  • Negative mood
  • Water retention

People with kidney, liver, or adrenal disease should not take pills containing this progestin. This is because it may cause higher potassium levels.

The brands YAZ and Beyaz have 24 days of active pills and four days of placebos. This combination may cause fewer hormone fluctuations than other pills.

YAZ has also been FDA-approved to help treat the mood disorder premenstrual dysphoric disorder (PMDD).

Drospirenone has been linked to an increased risk of blood clots in several studies.

A 2017 review looked at 17 studies on drospirenone. It found that the risk of blood clots ranged from no increase to a 3.3 times increased risk. This is compared to levonorgestrel, the birth control pill thought to have the lowest risk.

Based on the best studies the review concluded that the risk is only slightly increased.

Some of the same researchers looked at the risk of blood clots in first-time users and in people who stopped taking birth control pills and then started again. The study included over 55,000 participants.

This study found that the risk of blood clots was 3.19 times higher with drospirenone than with levonorgestrel for first-time users. The risk was 1.96 times higher in restarters.

People who have other risk factors for blood clots may wish to consider a birth control pill other than those with drospirenone or desogestrel. In some cases, an entirely different form of birth control may be preferable.

Examples of pills that contain this progestin include:

  • YAZ and Beyaz
  • Yasmin
  • Zarah
  • Loryna
  • Syeda
  • Gianvi
  • Ocella
  • Vestura
  • Nikki

Progestin-Only Birth Control Pills

Progestin-only birth control pills contain only progestin and do not have any estrogen in them. They may be prescribed if you experience intolerable side effects when using a combination birth control pill. They are sometimes referred to as "the mini-pill."

Progestin-only pills work by thickening the mucus in the cervix, which helps prevent sperm from entering the uterus. It also thins the lining of the uterus. Progestin may also prevent ovulation, but not for everyone.

Progestin-only birth control pills are made with the first-generation progestin norethindrone. Brand names include:

  • Camila
  • Errin
  • Heather
  • Incassia
  • Jencycla

Progestin-only pills do not always stop ovulation and should be taken at the same time every day. With most progestin-only pills, if you miss the time you typically take the pill by more than 3 hours, you need to use a backup birth control method for the next 2 days. 

Summary

Progestin is the synthetic form of the hormone progesterone. It is used in combination birth control pills and in progestin-only birth controls. Progestin helps prevent ovulation and may reduce monthly bleeding. It may also have unwanted side effects like acne. 

Progestin types are grouped according to generation, or the time they became available. First-generation progestins have been around longer and have more data associated with their use. Second-generation progestins like levonorgestrel have also been well-studied and widely used. Newer third and fourth-generation progestins have advantages, too.

All progestins come with potential side effects. Make sure you discuss these with your healthcare provider before deciding which combination birth control pill is right for you.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
Dawn Stacey

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.