Combined oral contraceptives (COCs) contain two hormones — an estrogen component (almost always ethinyl estradiol) and a progestin component that varies significantly between formulations. The type of progestin is the most important variable in determining side effect profile, non-contraceptive benefits, and suitability for individual patients. Many women who stopped the pill because of side effects could have had those side effects resolved by switching to a different progestin — without abandoning oral contraception entirely.
Non-contraceptive benefits of combined oral contraceptives are substantial and represent a significant clinical reason to prescribe them independent of contraceptive need: cycle regulation, reduction of menstrual pain and flow, acne improvement, reduced risk of ovarian and endometrial cancer with long-term use, management of PCOS and endometriosis symptoms, and treatment of perimenopausal hormonal fluctuation when combined with contraceptive need.
Androgenic Progestins — Levonorgestrel, Norgestrel, Norethindrone
Older-generation progestins with higher androgenic activity. May worsen acne and hirsutism in susceptible women. Associated with lower risk of blood clots compared to some newer progestins. Generally lower cost. Examples: Lo Loestrin Fe, Junel, Microgestin, Levlen, Seasonique.
Anti-Androgenic Progestins — Drospirenone, Dienogest, Norgestimate
Newer-generation progestins with anti-androgenic properties that make them particularly beneficial for acne, hirsutism, and PCOS-related symptoms. Drospirenone (in Yaz, Yasmin, Beyaz) also has mild anti-mineralocorticoid activity that reduces bloating and fluid retention for some women. Associated with slightly higher venous thromboembolism risk than some androgenic progestins in some studies — this is discussed at the counseling visit for women with relevant risk factors.
Low-Dose vs Standard-Dose Estrogen
Most modern combined pills contain 20 to 35 mcg of ethinyl estradiol. Ultra-low-dose formulations (10 mcg) are available but may be associated with more breakthrough bleeding. The estrogen dose affects the pill’s effect on the uterine lining and bleeding patterns, the estrogenic side effects (breast tenderness, nausea), and certain safety considerations. Choosing an appropriate estrogen dose is part of the individualized prescribing decision at Lapeer Women’s Health.
Extended Cycle and Continuous Dosing
Extended cycle formulations (Seasonique, Seasonale) and continuous dosing regimens allow women to reduce or eliminate withdrawal bleeding entirely by skipping the hormone-free interval. This is clinically appropriate and safe for most women who prefer fewer periods or who have conditions worsened by menstruation (endometriosis, migraines with menstrual trigger, severe dysmenorrhea). Extended dosing can also be achieved with any monophasic pill by skipping the placebo week.
Progestin-Only Pill (Mini-Pill)
The progestin-only pill is the appropriate oral contraceptive choice for women who cannot use estrogen: breastfeeding women, women with a history of blood clots or stroke, women with migraines with aura, and women with certain cardiovascular conditions. It requires a strict 3-hour daily window. Norethindrone (Camila, Errin, Jolivette) and norgestrel (Opill, now available over the counter) are the available options. Ovulation suppression is less consistent than with combined pills, and the cervical mucus thickening mechanism is the primary contraceptive effect.
Stop taking the pill and seek prompt medical evaluation if you experience:
- ACHES: Abdominal pain (severe), Chest pain, Headache (severe), Eye changes (blurred vision), Severe leg pain or swelling — these are the warning signs of rare but serious pill-related complications
- New onset of migraines with aura or focal neurologic symptoms in a woman taking combined pills — switch to progestin-only method is indicated
Many women who stopped oral contraceptives because of mood changes, weight gain, reduced libido, acne worsening, or other side effects were taking a formulation that was not the best fit for their hormonal profile — not experiencing side effects that are inherent to all pills. Different progestin types, different estrogen doses, and different dosing regimens produce meaningfully different side effect profiles. A formulation-specific conversation at Lapeer Women’s Health may identify a pill that provides the non-contraceptive benefits without the side effects that led to discontinuation.
Our team at Lapeer Women’s Health provides individualized pill counseling and prescribing at both offices. No referral required.
Schedule a Gynecologic VisitEducational purposes only. Not medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.