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Progestin-Only Hormonal Methods (Mini-Pills, Implants, and Shots)

Examples

Oral contraception

Generic NameBrand Name
norethindroneMicronor, Nor-QD

Implant

Generic NameBrand Name
etonogestrelImplanon, Nexplanon

Shot

Generic NameBrand Name
medroxyprogesteroneDepo-Provera

For information on combination birth control pills, see Birth control pills, patch, or ring.

How It Works

Progestin-only birth control methods, including pills (called "mini-pills"), implants, and shots, prevent the ovaries from releasing an egg (ovulation), thicken mucus at the cervix so sperm cannot enter the uterus, and in rare cases, prevent a fertilized egg from implanting in the uterus.

Birth control mini-pills

Progestin-only mini-pills come in a monthly pack. To be effective, the pills must be taken at the same time each day. If you take a pill more than 3 hours late:

  • Take it as soon as you remember even if that means you will take 2 pills in one day. Use another method of birth control for the next 48 hours to prevent pregnancy.1
  • Consider using emergency contraception if you have had sex in the past 3 to 5 days.

Implant

The progestin-only implant releases hormones that prevent pregnancy for 3 years. The actual implant is a thin rod about the size of a matchstick. This is inserted under the skin on the inside of the upper arm.

  • The implant is a highly effective method of birth control.
  • The implant must be inserted and removed by a trained health professional.

Shots

The birth control shot, such as Depo-Provera, is effective for 12 to 13 weeks.

Why It Is Used

Progestin-only mini-pills, implants, and shots are good choices for women who:

  • Are breast-feeding. The mini-pill is a good choice for breast-feeding mothers. It is very low-dose and does not affect the milk supply. Breast-feeding further reduces the chance of pregnancy.
  • Need short- or long-term birth control that can be stopped at any time. (But it may take from 12 weeks to 18 months to become pregnant after stopping the birth control shot.)
  • Prefer a form of birth control that does not interfere with sexual spontaneity.
  • Cannot take estrogen, including those who smoke and are older than 35; have long-standing, poorly controlled diabetes; have heart disease; have problems with blood clots; or have high blood pressure.
  • Have migraine headaches with auras, or women whose migraines get worse when taking the estrogen in combination birth control pills.
  • Have heavy, painful menstrual periods. Progestin reduces heavy bleeding and cramping.
  • Have anemia from heavy menstrual bleeding.
  • Have sickle cell disease. Women with sickle cell disease may have fewer problems from their disease when using the birth control shot.

How Well It Works

Shots and implants are highly effective methods of birth control.

Progestin-only mini-pills are very effective, but combination hormone pills are even more effective. Also, the mini-pill has to be taken at the same time every day to work correctly.

The shot

This method is highly effective, unless you fail to get a shot after 3 months.2

  • Typical use: Among all Depo-Provera users, 3 women out of 100 become pregnant each year.
  • Perfect use: Of women who get their shots on schedule, only 3 out of 1,000 become pregnant each year.

Progestin mini-pill

This method is very effective, but you must take the mini-pill at the same time every day.2

  • Typical use: Among all mini-pill users, 8 women out of 100 become pregnant each year.
  • Perfect use: Of women who take every mini-pill on schedule, only 3 out of 1,000 become pregnant each year.

Implant

This method is extremely effective and lasts for 3 years.2

  • Typical use and perfect use are the same for this method, with no reported pregnancies from studies.

Medicines that can interfere with hormonal birth control

Some combinations of medicine may affect the birth control hormones in your body, making them too strong or too weak. This may increase your chance of becoming pregnant. Or a new medicine may be less likely to work because you have birth control hormones in your body. Talk with your doctor or pharmacist to make sure that the medicines you take are not causing problems when you are using hormonal birth control.

Side Effects

Most side effects of the progestin-only birth control methods go away after the first few months of use. Side effects include:

  • Irregular menstrual cycles.
  • Spotting or bleeding between menstrual periods.
  • Sore breasts.
  • Headache.
  • Nausea.
  • Dizziness.
  • Bloating or weight gain, especially with the birth control shot.
  • No menstrual periods. Although mini-pill use can stop periods, the shot is most likely to do so.

Less common progestin side effects include depression and darkening of the skin on the upper lip, under the eyes, or on the forehead (chloasma).

Risks of the shot

Bone thinning. Use of the shot for 2 or more years can cause bone loss, which may not be fully reversible after stopping the medicine.3

For teens, bone loss from the shot is a concern. Teens are normally building bone mass as they grow. This is why it is very important for teens to get enough calcium and vitamin D when using the shot. A small study among teens showed that bone loss from the shot was reversed after the teens stopped getting the shots.4 Talk to your doctor about your risk if you have been using the shot for longer than 2 years.

Progestin risk after having gestational diabetes

Breast-feeding women can use the mini-pill or shot without worrying about effects on their milk supply or the baby. But using progestin-only birth control after having gestational diabetes appears to make it more likely that you will develop diabetes.1

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Progestin-only mini-pills may not be as effective if you are vomiting or have diarrhea. Use another method of birth control for 7 days after vomiting or diarrhea, even if you have not missed any pills.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

  1. Raymond EG (2007). Progestin-only pills. In RA Hatcher et al., eds., Contraceptive Technology, 19th ed., pp. 181–191. New York: Ardent Media.
  2. Trussell J (2007). Choosing a contraceptive: Efficacy, safety, and personal considerations. In RA Hatcher et al., eds., Contraceptive Technology, 19th ed., pp. 19–47. New York: Ardent Media.
  3. U.S. Food and Drug Administration (2004). Depo-Provera contraceptive injection (medroxyprogesterone acetate injectable suspension). Safety Alerts for Human Medical Products. Available online: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm154784.htm.
  4. Scholes D, et al. (2005). Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception. Archives of Pediatrics and Adolescent Medicine, 159(2): 139–144.

Credits

By Healthwise Staff
Sarah Marshall, MD - Family Medicine
Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
Last Revised May 3, 2012

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