The Differences Between Combination vs. Progestin-only Contraceptive Pills

Picking a birth control pill is a personal decision and can be difficult with so many options available. There isn't a one-size-fits-all. It's important to find a method that suits your lifestyle. Various factors, such as convenience, effectiveness, and cost should be taken into consideration. By being well-informed, you can make an educated decision about the right birth control method for your needs.

How Does the Menstrual Cycle Work?

The menstrual cycle is a natural process that occurs in the female reproductive system, typically lasting around 28 days. It involves a series of hormonal and physiological changes that prepare the body for potential pregnancy.

• Menstruation (the peirod)—Day 1–5 : This is marked by the shedding of the uterine lining (endometrium) and the release of blood through the vagina. This occurs alongside a drop in both estrogen and progesterone.
• Follicular Phase—Day 1–14: It begins on the first day of menstruation and lasts for 13 to 14 days, marks the start of the menstrual cycle and ends with ovulation. This is when an egg matures in the ovaries, alongside a rise in estrogen.
• Ovulatory—Day 14: A mature egg is released from the ovary (ovulation). This typically occurs on day 14 following the peak in estrogen levels.
• Luteal Phase—Day 15–28: This final stage occurs from day 15-28 as the lining of the uterus thickens to prepare for pregnancy. Progesterone peaks, then both estrogen and projesterone decrease back to baseline by the end of the phase to preprare for menstruation.

How Does Hormonal Birth Control Work?

Birth control pills are oral contraceptives that contain synthetic hormones (estrogen and/or progestin) that targets one or multiple phases of the menstrual cycle to prevent pregnancy.

Birth controll pills work by

• suppressing ovulation
• thickening of cervical mucus, making it difficult for sperm to penetrate and reach the egg
• thinning of the endometrium (the uterine lining), making it less receptive to the implantation of a fertilized egg

Differences Between Progestin-only and Combination Pills

Progestin-only pills (minipills) and combination pills (the pill) are two different types of oral contraceptives. Progestin-only pills only contain progestin, a synthetic form of progesterone. Combination pills contain both estrogen and progestin.

Progestin-only pills primarily work by thickening the cervical mucus, making it difficult for sperm to reach the egg. They also thin the lining of the uterus, making it less receptive to implantation. Combination pills prevent pregnancy through various mechanisms, including suppressing ovulation, thickening cervical mucus, and thinning the uterine lining.

The main effect in both pills comes from the progestin. The major action of progestin is thickening the mucous in the cervix. Another major effect is preventing the hormonal changes responsible for ovulation, blocking the egg’s release. Estrogen is thought to contribute to ovulation prevention, but its major role is maintaining a “normal” cycle.

How To Take It

Progestin-only pills require strict adherence and timing. You must take them every day at the same time (within a 3-hour window) to maintain their effectiveness. A progestin-only pill is considered “missed” if you tak it 3 hours or more outside of the typical timing. If you missed a pill, take it as soon as possible. This may mean you take two pills on the same day. You also require to use backup contraception like a condom.

Combination pills are typically taken orally on a daily basis. They are usually taken daily for 21 or 28 days, followed by a break or a week of placebo pills.

A combination pill is considered “late” if it is taken more than 24 hours after the scheduled time. Take the missed dose as soon as possible even if it means you're taking two pills in one day. If you've missed more than 2 pills in a row, take the most recent pill and use a backup contraceptive method for the next 7 days.

Who Should Not Use Birth Control Pills

For most individuals, both types of oral contraception are safe. However, both medications have three contraindicated conditions (meaning if you have these conditions, you should not take these medications).

You shouldn't take oral contraceptives if you:

• are pregnant
• had or have breast cancer
• have undiagnosed vaginal bleeding

Progestin-only pills (minipills) are primarily recommended for certain individuals who may have specific medical conditions or situations that make them unable to take estrogen-containing contraceptives.

POP are recommended if you

• are within 6 weeks of delivery
• are 35 years or older and smoke
• have uncontrolled high blood pressure or diabetes
• have history of a blood clot
• have heart disease
• have migraines with aura
• have active liver disease

You may notice that many of the contraindications links to heart disease and blood clots. This is because estrogen is sometimes linked to an increase in the risk of heart-related events. If any of the above apply to you or your risk is greater than a typical individual, your healthcare provider will often recommend you avoid combination pills.

Side Effects

Both medications have some possible side effects. Although not every patient will experience any or all of these effects, it’s good to know what you may experience while on either medication.

It is also important to note that the side effects tend to be worst during the first three months. After this point, symptoms typically resolve considerably or completely. Because of this, it’s often advised that you stick with one contraceptive for 3 months before switching for side effects, unless severe.

The most common side effects with contraceptive pills include:

• Nausea
• Bloating
• Spotting
• Breast tenderness
• Headaches
• Weight gain
• Irregular periods

While progestin-only contraceptives typically cause more of the menstruation-related effects such as spotting and irregular periods, combination pills commonly have more variety of effects. In general, combination pills typically cause more side effects, but this isn’t true for everyone!

Cost

In general, the prices of the two medications are comparable. At Marley Drug, you can get a 1-month supply of either medication for only $20!

Which One Is Better?

Prices mentioned in this article are based on average retail price at major box chain pharmacy in the U.S. as of May 31, 2023.