Our bodies make the sex hormones-estrogen, progesterone, and testosterone- naturally, but sometimes doctors prescribe synthetically-made ones therapeutically. Like any drug, we should only use them when the benefit clearly outweighs the risks, after considering issues of safety, effectiveness, side effects, ease of use, and cost.
post updated January 11, 2023
This information is current as of the publication date; it is general medical information that helps doctors and patients make decisions about what is right for them. Medical recommendations and practice change as we learn new things. Discuss with your physician or appropriate healthcare provider.
Hormone Pills for birth control
Most oral contraceptives, OCPs, or birth control pills consist of two hormones, an estrogen, usually ethinyl estradiol and a progestin-norethindrone,levonorgestrel, desogestrel, norgestimate, or drospirenone.
For women who cannot or prefer not to take estrogen, norethindrone can be used alone. The FDA has approved another progestin-only pill.
The new pill contains drospirenone . It prevents pregnancy effectively although was not specifically tested opposite norethindrone. Another benefit of the drug is controlling acne. As with other new drugs, Slynd, brand name, is more expensive than generic norethindrone.
Homones through the skin
Hormonal birth control can be delivered by patches applied to the skin, that is transdermal. These also contain an estrogen-ethinyl estradiol and a progestin-levonorgestrel, or norelgestromin, 1 patch every 3 weeks with 1 week off.
Vaginal hormone birth control
Women have had the option of using an estrogen/progestin vaginal ring, kept in place for 3 weeks, then removed and replaced with a new ring 7 days later. (Nuvaring, ethinyl estradiol/etonogestrel) .
Now there is a new option- a ring that contains a different progestin. Annovera is a silicone elastomer device containing ethinyl estradiol and segesterone. The cost, $2000, (per GoodRx) sounds excessive, but this ring can be reused for 13 4-week cycles,unlike Nuvaring which is replaced every 4 weeks. Both rings effectively prevent pregnancy.
Three LARCs –Long-acting reversible hormone contraception
Three forms of long-acting reversible hormone contraception (birth control) are available to women in the United States.
The birth control injection (shot) is a progestin, depot medroxyprogesterone acetate (Depo Provera). Women who use this method receive an injection every 90 days which effectively prevents pregancy.
Etonogestrel, a contraceptive implant, slowly releases the hormone progestin and does not have estrogen. It can be used in women who cannot take estrogen. The small device is implanted under the skin of the upper arm and replaced every 3 years. Brand names are Nexplanon and Implanon.
Hormonal intrauterine devices, IUDs, contain the progestin levonorgestrel. The newest version (2023) named Liletta is effective for 8 years. Earlier brands could be left in place from 3 to 8 years.
Here is a link to facts about other forms of contraception from the Department of Health and Human Services
Hormone therapy and heart disease
A 2015 Cochrane review of 40,410 postmenopausal women examined the use of oral hormone therapy (estrogen with or without progesterone) taken for at least six months, compared with placebo (no real drug), to determine the effect on death from any cause, and deaths caused by heart disease, stroke, and blood clot in a leg or lung.
The review found no benefits for preventing heart attack (fatal or nonfatal), or death due to any cause. And other studies and reviews have found no long term increased risk of death from hormone use, although the risk of cardiovascular disease is increased while taking the drugs.
Here is a link to a review of hormone therapy benefits and risks.
Menopausal Hormone Therapy
Vaginal estrogen and heart health
While oral estrogen replacement after menopause can decrease night sweats, hot flashes, and vaginal dryness, it potentially increases the risk of developing cardiovascular disease-heart attacks and stroke, and some cancers-breast and uterine. But does estrogen given vaginally carry the same risk?
No, according to the results of the Nurses Health Study. Statistics over 18 years showed no increase in these complications in women who used vaginal estrogen, suggesting this is a safe option for women who choose to use estrogen to improve quality of life after menopause. (from the journal Menopause)
Controlling fibroids that bleed
Fibroids are a non-cancerous tumor of the uterus. They often cause no symptoms but can cause heavy and/or painful periods. Now a hormone combination can stop that.
Marketed as Oriahnn, two capsules daily taken morning and evening can decrease menstrual blood loss by 50% or more. One capsule contains 3 hormones-elagolix, estradiol, and norethindrone. The other contains only elagolix. Treatment should not exceed 2 years due to a risk of bone loss, similar to that seen after menopause occurs.
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