Birth control pills are hands down our fave invention of the 20th century. (Yeah, we’re including TV and the Internet in that statement.)
Not only do they prevent unwanted pregnancy, but they regulate your menstrual cycle, ease cramps, slow a heavy flow, and help clear up acne. Damn.
However, not all birth control pills work well for everyone. Some people get gnarly side effects, especially when the hormones are at higher doses. For that reason, your healthcare provider may prescribe you what’s called low-dose birth control.
Intrigued? Let’s take a close look at low-dose birth control, what it does, and how you can decide what’s right for you.
Birth control pills contain hormones that stop ovulation (aka prevent eggs from being released every month) and thicken cervical mucus, making it more difficult for sperm to reach an egg.
Let’s quickly recap how the menstrual cycle works:
- The hormones estrogen and progesterone regulate your menstrual cycle. They’re busy all month getting an egg ready to be fertilized.
- The lining of your uterus preps itself in the possibility an egg will implant there.
- The egg is released from your ovaries.
- When the released egg is not fertilized by sperm, your uterine lining sheds. That’s called your period.
Any type of hormonal birth control will affect your menstrual cycle. But since we’re focusing on low-dose birth control here, let’s zero in on the two main types: combination and the “minipill.”
- Combination low-dose birth control has small amounts of synthetic estrogen and progesterone.
- The minipill contains only synthetic progesterone. It may be prescribed if you have risk factors that prevent you from taking estrogen (such as smoking).
In order for any low-dose birth control to work effectively, you must take each dose daily at the same time to prevent pregnancy.
As the name implies, low-dose birth control contains lower doses of hormones than traditional BC pills. Most fall between 10 and 30 micrograms of estrogen and around 35 micrograms of progesterone.
The minipill contains 35 micrograms of progesterone and no estrogen.
When birth control pills first came onto the scene in 1960, they had what we could consider today to be super high levels of hormones. The first version had 150 micrograms of estrogen and 9.85 milligrams of progesterone.
In newer versions of the pill, estrogen levels are between 20 and 50 micrograms, and progesterone levels are between .01 and 3.0 milligrams.
Those early birth control pills gave women more control of their bodies. It was a societal game changer for sure. But that freedom came with some serious side effects: heart attacks, blood clots, and stroke.
Since then, researchers have found you don’t need big doses of hormones to prevent pregnancy, leading to today’s version of the pill.
Low-dose birth control is very effective. When it’s taken correctly — that is, every single day — it has a 91 percent success rate, according to Planned Parenthood. Just set an alarm on your phone and you’re set!
To explain how, let’s go back to your menstrual cycle. Pregnancy happens when your ovaries release an egg, which is called ovulation. That egg gets fertilized by sperm and implanted in your uterus. Low-dose birth control interrupts this process in a couple of ways.
- The hormones in birth control pills tell your pituitary gland (which controls your hormones) not to release the hormones that trigger ovulation. No egg = no pregnancy.
- They also thicken the mucus on the cervix, so sperm have a harder time fighting their way through. Sorry, little buddies!
The exception to the above is the minipill, which rather than preventing ovulation, works by thinning the lining of your uterus and thickening cervical mucus to keep sperm out and prevent implantation.
And voila. That’s how you prevent pregnancy.
Reasons why low-dose birth control rocks
One of the best perks? Your chance of serious side effects is low, because of the low dose of hormones. This is especially true of the progesterone-only minipill, since estrogen is the culprit for most of the risks and side effects.
What else can low-dose birth control do for you?
- It can help reduce acne, cystic breasts and ovaries, and iron deficiency (anemia).
- It reduces PMS symptoms, likely meaning lighter cramps. (Hell yeah!)
- It can regulate irregular periods and make periods lighter.
- If you want to get pregnant, you can just stop taking the pill.
- Helps people who deal with PMDD or menstrual migraines.
- Can help those with endometriosis.
- Helps decrease risk of ovarian and endometrial cancer.
Reasons to stay clear of low-dose birth control
Alas, there are downsides to low-dose birth control, too. The biggest one is that you must take it every day for it to effectively prevent pregnancy. There’s no wiggle room on this one.
Other downsides include:
- Some people have side effects like decreased libido, headaches, bloating, nausea, or breast tenderness. The good news is these may lessen over time.
- All birth control pills come with a risk of heart attack, blood clots, or strokes. People who smoke or have certain medical conditions are more likely to have these side effects.
- The minipill can cause spotting (bleeding a bit between periods).
Additionally, certain medications decrease the effectiveness and make you vulnerable to an unwanted pregnancy. These include:
- Rifampin (an antibiotic)
- Some anti-seizure medications
- The antifungal medication griseofulvin or Gris-PEG
- Some HIV treatments
- Some pain relievers (analgesics)
- Some blood pressure medications
- St. John’s Wort (used as an herbal remedy)
If you take any of these above medications, your healthcare provider might suggest another way for you to prevent pregnancy.
You can take your low-dose birth control in different dosages. There are two types of dosing: conventional and continuous/extended cycle.
Conventional dosing most closely follows your typical 28-day menstrual cycle. You take pills that contain hormones (“active” pills) for 3 weeks, and then pills without hormones (“inactive” pills) for 1 week.
You’ll get your period during that week of inactive pills. Taking inactive pills during the week of your period keeps you in the habit of taking a pill every single day.
Continuous dosing, or extended cycle dosing, stretches out the time between periods. For some brands, like Seasonale, you take active pills for 12 weeks and then inactive pills for 1 week. That means you only get a period every 3 months!
Other brands have 365 pills, so you take one every day for a year and do not have a period.
Extended cycle dosing can be especially good for people who get unusually heavy periods or experience severe PMS. We have to admit, fewer periods sounds really great.
What are some brands of low-dose birth control?
There are oh so many options to consider! Here’s a list of low-dose birth control pills that your healthcare provider may consider:
We’re glad you asked! Here’s a few questions to ask yourself.
Is low-dose birth control safe for someone with my health history?
Hormone based birth control isn’t for everyone. Some risk factors are blood clots, breast cancer or other cancers, high blood pressure, a heart condition or diabetes.
Make sure you share your entire health history with your healthcare provider, so they can determine the best contraception for you.
What if I smoke? Or I’m not so reliable about taking pills?
Smoking while on birth control pills that contain estrogen is a big no-no, because it increases the risk of having a heart attack. The risk is especially high if you’re 35 or older. Taking oral contraception and smoking also increases your risk for having a stroke.
Taking a daily pill might not be a good lifestyle fit if you’re forgetful (it happens!) or your lifestyle is chaotic. Be honest with yourself: Will you really take the pill every single day at about the same time every day?
It’s totally OK if taking birth control wouldn’t work for you. There are plenty of other contraceptive options out there.
Do I want to get pregnant soon?
You can get down to baby-making quickly after stopping low-dose birth control pills. You simply stop taking the pills! Birth control pills are easier to stop taking than getting implants (Nexplanon) and IUDs (Kyleena, Liletta, Mirena, Skyla) removed.
Maybe you’re looking for reliable birth control. Or maybe you have irregular or very heavy periods, bad PMS, or acne. No matter your reason for wanting to go on low-dose birth control, here’s what to share with your doctor:
- your age
- a list of medications you currently take
- your health history, including whether you smoke
- your ability to take a pill at the same time every day
- any plans to get pregnant
If your healthcare provider says the pill isn’t right for you, don’t fret. There are many other options.