Table of ContentsView AllTable of ContentsEffectsGenerationsCombination PillsProgestin-Only Pills
Table of ContentsView All
View All
Table of Contents
Effects
Generations
Combination Pills
Progestin-Only Pills
Progestin is used incombination(estrogen plus progestin) and progestin-only birth control pills. Birth control pills are commonly used to prevent pregnancy, but they may also be prescribed for other conditions such as irregular periods and endometriosis.
This article looks at the brand and generic names for progestin and what these progestins do in your body.
The estrogen in combination birth control pills is usually ethinyl estradiol, a synthetic form of estrogen.
Progestin Effects
Progestin has a few different effects on the female body:
Different progestins may vary in these effects. For example, some may have lower progestational effects but higher androgenic effects, or vice-versa. This can have an effect on whether or not a pill causes certain side effects like acne or breakthrough bleeding.
The Role of Progestin in Birth Control
Progestin Generations
There are four generations of progestins. Different generations have different qualities.Keep in mind that newer isn’t always better. Some progestins are more likely to cause unwanted side effects, so talk to your healthcare provider about which pill might be best for you.
Some combination pills that sound very similar have different progestins. For example, Ortho-novum 1/35 and 7/7/7 contain norethindrone. Ortho-novum 1/50 contains norgestrel.
Combination Oral Contraceptives
Combination pills contain estrogen and different doses and types of progestin. The different types are listed below.
Norethindrone
Adam Hart-Davis / Getty Images
Norethindrone is a first-generation progestin. It is available in the followingformulations:
Norethindrone has low progestational activity. It also has slight estrogenic activity. It tends to be less androgenic than second-generation progestins. It may be more androgenic than newer progestins.
This progestin may improve your cholesterol in pills that contain less than 50 micrograms of ethinyl estradiol. It can help raise good cholesterol and lower bad cholesterol.
Other advantages of norethindrone include the following:
Disadvantages may include limited effects against acne.
Examples of pills that contain this progestin include:
Norethindrone Acetate
Norethindrone acetate is another first-generation progestin. It has low progestational activity and slight estrogenic effects.
This progestin tends to be less androgenic than second-generation progestin. It also tends to be more androgenic than newer progestins.
The brand of birth control pill called Estrostep was designed to mimic a woman’s natural cycle closely. This pill provides increasing levels of estrogen with a constant progestin dose. It is the only triphasic brand with this progestin.
This brand may be helpful for women who have minor estrogen-related side effects with other combination pills. These side effects may include:
Disadvantages of this progestin include limited effects against acne.
Ethynodiol Diacetate
Ethynodiol diacetate is a first-generation progestin. It has viable progestational activity but weak estrogenic effects and little androgenic activity.
Ethynodiol diacetate is made from norethindrone. This means it is easily converted to norethindrone within the body.
Birth control pills that contain this progestin may help women withendometriosis.This is a condition where the lining of the uterus grows outside the uterus.
Side effects of pills that contain this progestin include breast tenderness andbreakthrough bleeding.This is menstrual-like bleeding that happens mid-cycle.
Levonorgestrel
Levonorgestrel is a second-generation progestin. It is the most widely prescribed birth control progestin worldwide. It has progestational and androgenic effects.
Severallow-doseestrogen brands containing this progestin are available.
Levonorgestrel birth control has also been FDA-approved for emergency contraception. This type of birth control is taken after unprotected sex. Examples includePlan B One-StepandNext Choice.
The FDA says all combination pills with this progestin are safe and effective foremergency contraceptionunder the Yuzpe method.
This emergency contraception method involves taking two doses of combination birth control pills 12 hours apart.
According to a 2018 review, levonorgestrel was associated with the lowest riskofblood clotsof all combination birth control pills.
Disadvantages of this progestin include the slight chance of negatively impacting cholesterol levels.It may also increase androgenic side effects like acne.
Norgestrel
Norgestrel is a second-generation progestin. It is a mixture of dextro-norgestrel and levonorgestrel. Levonorgestrel is the active ingredient.
Norgestrel has high progestational activity. It also has strong antiestrogen effects. It is high in androgenic activity.
This progestin may help prevent endometriosis. Unwanted side effects may include acne and weight gain.
Desogestrel
Desogestrel is a third-generation progestin. It has high progestational selectivity. This means it minimizes the androgenic effects and estrogenic activity.
This progestin has a lower negative impact on things like:
Desogestrel may have a small positive effect on cholesterol. It may cause slight increases in good cholesterol.
Clinical trials show a possibly higher risk of non-fatal blood clots with desogestrel pills. This is compared to pills that contain levonorgestrel.
Mircette is a low-dose estrogen/desogestrel pill. This medicine includes only two placebo days. This may be helpful for women who have side effects while taking the placebos, including:
Desogestrel appears to come with a higher risk of blood clots than other options. Desogestrel combined with 30 to 40 micrograms of ethinyl estradiol appears to have the highest blood clot risk of all combination birth control pills.
Pills containing this progestin have a few advantages, including:
The primary disadvantage is the higher risk of blood clots.
Norgestimate
Norgestimate is a third-generation progestin. It has high progestational activity. It shows slight estrogenic effects. It tends to be less androgenic.
It has minimal effect on cholesterol. It also has little impact on carbohydrate metabolism. This means it probably won’t have an effect on the way your body processes blood sugar.
Ortho Tri-Cyclen Locontains norgestimate and a mid-level dose of estrogen. This pill may help reduce side effects like nausea and vomiting. At the same time, it is less likely to cause spotting, which is a common side-effect of low-estrogen pills.
Pills containing this progestin may increase your risk for headaches. They may also cause a reduced libido or sex drive.
Drospirenone
Drospirenoneis a fourth generation progestin. It has low androgenic activity. This type of progestin may help reduce acne.
Drospirenone and estrogen seem to reduce the symptoms of mildPMS. These symptoms include:
People with kidney, liver, or adrenal disease should not take pills containing this progestin. This is because it may cause higher potassium levels.
The brandsYAZand Beyaz have 24 days of active pills and four days of placebos. This combination may cause fewer hormone fluctuations than other pills.
YAZ has also been FDA-approved to help treat the mood disorderpremenstrual dysphoric disorder(PMDD).
Drospirenone has been linked to an increased risk of blood clots in several studies.
A 2017 review looked at 17 studies on drospirenone. It found that the risk of blood clots ranged from no increase to a 3.3 times increased risk. This is compared to levonorgestrel, the birth control pill thought to have the lowest risk.
Based on the best studies the review concluded that the risk is only slightly increased.
Some of the same researchers looked at the risk of blood clots in first-time users and in people who stopped taking birth control pills and then started again. The study included over 55,000 participants.
This study found that the risk of blood clots was 3.19 times higher with drospirenone than with levonorgestrel for first-time users. The risk was 1.96 times higher in restarters.
People who have other risk factors for blood clots may wish to consider a birth control pill other than those with drospirenone or desogestrel. In some cases, an entirely different form of birth control may be preferable.
Birth Control Choices That Best Minimize Side Effects
Progestin-Only Birth Control Pills
Progestin-only birth control pills contain only progestin and do not have any estrogen in them. They may be prescribed if you experience intolerable side effects when using a combination birth control pill. They are sometimes referred to as “the mini-pill.”
Progestin-only birth control pills are made with the first-generation progestin norethindrone. Brand names include:
In July 2023, the Food and Drug Administration (FDA) approvedOpill (norgestrel), aprogestin-only oral contraceptive, to be sold OTC. Opill is the first and only birth control pill available without a prescription. Before starting a birth control method, it’s a good idea to speak with your healthcare provider, even if your method of choice doesn’t require a prescription.
Summary
Progestin is the synthetic form of the hormone progesterone. It is used in combination birth control pills and in progestin-only birth controls. Progestin helps prevent ovulation and may reduce monthly bleeding. It may also have unwanted side effects like acne.
Progestin types are grouped according to generation, or the time they became available. First-generation progestins have been around longer and have more data associated with their use. Second-generation progestins like levonorgestrel have also been well-studied and widely used. Newer third and fourth-generation progestins have advantages, too.
All progestins come with potential side effects. Make sure you discuss these with your healthcare provider before deciding which combination birth control pill is right for you.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Casper RF.Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills.Fertil Steril. 2017;107(3):533-536. doi:10.1016/j.fertnstert.2017.01.003Sims ST, Heather AK.Myths and methodologies: reducing scientific design ambiguity in studies comparing sexes and/or menstrual cycle phases.Exp Physiol. 2018;103(10):1309-1317. doi:10.1113/EP086797Shoupe D.The progestin revolution 2: progestins are now a dominant player in the tight interlink between contraceptive protection and bleeding control-plus more.Contracept Reprod Med. 2023;8(1):48. doi:10.1186/s40834-023-00249-5National Center for Biotechnology Information.PubChem compound summary for CID 9270, ethynodiol diacetate.Memorial Sloan Kettering Cancer Center.Eithinyl estradiol and ethynodiol diacetate.National Center for Biotechnology Information.PubChem compound summary for CID 13109, levonorgestrel.World Health Organization.Emergency contraception.Oedingen C, Scholz S, Razum O.Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: the role of the progestogen type and estrogen dose.Thromb Res. 2018;165:68-78. doi: 10.1016/j.thromres.2018.03.005Gunardi ER, Surya R, Syafitri I, Pasidri Y.Impact of one-rod levonorgestrel implant on the blood chemistry profile.Sci Rep. 2021;11(1):20141. doi:10.1038/s41598-021-99801-zBosanac SS, Trivedi M, Clark AK, Sivamani RK, Larsen LN.Progestins and acne vulgaris: a review.Dermatol Online J. 2018;24(5):13030/qt6wm945xf. doi:10.5070/D3245040035Larivée N, Suissa S, Khosrow‐Khavar F, Tagalakis V, Filion KB.Drospirenone‐containing oral contraceptive pills and the risk of venous thromboembolism: a systematic review of observational studies.BJOG. 2017;124(10):1490-9. doi:10.1111/1471-0528.14623Larivée N, Suissa S, Coulombe J, Tagalakis V, Filion KB.Drospirenone-containing oral contraceptive pills and the risk of venous thromboembolism: an assessment of risk in first-time users and restarters.Drug Saf. 2017;40(7):583-96. doi:10.1007/s40264-017-0525-2The American College of Obstetricians and Gynecologists.Progestin-only hormonal birth control: pill and injection.Additional ReadingMayo Clinic.Progestin (oral route, parenteral route, vaginal route).
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Casper RF.Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills.Fertil Steril. 2017;107(3):533-536. doi:10.1016/j.fertnstert.2017.01.003Sims ST, Heather AK.Myths and methodologies: reducing scientific design ambiguity in studies comparing sexes and/or menstrual cycle phases.Exp Physiol. 2018;103(10):1309-1317. doi:10.1113/EP086797Shoupe D.The progestin revolution 2: progestins are now a dominant player in the tight interlink between contraceptive protection and bleeding control-plus more.Contracept Reprod Med. 2023;8(1):48. doi:10.1186/s40834-023-00249-5National Center for Biotechnology Information.PubChem compound summary for CID 9270, ethynodiol diacetate.Memorial Sloan Kettering Cancer Center.Eithinyl estradiol and ethynodiol diacetate.National Center for Biotechnology Information.PubChem compound summary for CID 13109, levonorgestrel.World Health Organization.Emergency contraception.Oedingen C, Scholz S, Razum O.Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: the role of the progestogen type and estrogen dose.Thromb Res. 2018;165:68-78. doi: 10.1016/j.thromres.2018.03.005Gunardi ER, Surya R, Syafitri I, Pasidri Y.Impact of one-rod levonorgestrel implant on the blood chemistry profile.Sci Rep. 2021;11(1):20141. doi:10.1038/s41598-021-99801-zBosanac SS, Trivedi M, Clark AK, Sivamani RK, Larsen LN.Progestins and acne vulgaris: a review.Dermatol Online J. 2018;24(5):13030/qt6wm945xf. doi:10.5070/D3245040035Larivée N, Suissa S, Khosrow‐Khavar F, Tagalakis V, Filion KB.Drospirenone‐containing oral contraceptive pills and the risk of venous thromboembolism: a systematic review of observational studies.BJOG. 2017;124(10):1490-9. doi:10.1111/1471-0528.14623Larivée N, Suissa S, Coulombe J, Tagalakis V, Filion KB.Drospirenone-containing oral contraceptive pills and the risk of venous thromboembolism: an assessment of risk in first-time users and restarters.Drug Saf. 2017;40(7):583-96. doi:10.1007/s40264-017-0525-2The American College of Obstetricians and Gynecologists.Progestin-only hormonal birth control: pill and injection.Additional ReadingMayo Clinic.Progestin (oral route, parenteral route, vaginal route).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Casper RF.Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills.Fertil Steril. 2017;107(3):533-536. doi:10.1016/j.fertnstert.2017.01.003Sims ST, Heather AK.Myths and methodologies: reducing scientific design ambiguity in studies comparing sexes and/or menstrual cycle phases.Exp Physiol. 2018;103(10):1309-1317. doi:10.1113/EP086797Shoupe D.The progestin revolution 2: progestins are now a dominant player in the tight interlink between contraceptive protection and bleeding control-plus more.Contracept Reprod Med. 2023;8(1):48. doi:10.1186/s40834-023-00249-5National Center for Biotechnology Information.PubChem compound summary for CID 9270, ethynodiol diacetate.Memorial Sloan Kettering Cancer Center.Eithinyl estradiol and ethynodiol diacetate.National Center for Biotechnology Information.PubChem compound summary for CID 13109, levonorgestrel.World Health Organization.Emergency contraception.Oedingen C, Scholz S, Razum O.Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: the role of the progestogen type and estrogen dose.Thromb Res. 2018;165:68-78. doi: 10.1016/j.thromres.2018.03.005Gunardi ER, Surya R, Syafitri I, Pasidri Y.Impact of one-rod levonorgestrel implant on the blood chemistry profile.Sci Rep. 2021;11(1):20141. doi:10.1038/s41598-021-99801-zBosanac SS, Trivedi M, Clark AK, Sivamani RK, Larsen LN.Progestins and acne vulgaris: a review.Dermatol Online J. 2018;24(5):13030/qt6wm945xf. doi:10.5070/D3245040035Larivée N, Suissa S, Khosrow‐Khavar F, Tagalakis V, Filion KB.Drospirenone‐containing oral contraceptive pills and the risk of venous thromboembolism: a systematic review of observational studies.BJOG. 2017;124(10):1490-9. doi:10.1111/1471-0528.14623Larivée N, Suissa S, Coulombe J, Tagalakis V, Filion KB.Drospirenone-containing oral contraceptive pills and the risk of venous thromboembolism: an assessment of risk in first-time users and restarters.Drug Saf. 2017;40(7):583-96. doi:10.1007/s40264-017-0525-2The American College of Obstetricians and Gynecologists.Progestin-only hormonal birth control: pill and injection.
Casper RF.Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills.Fertil Steril. 2017;107(3):533-536. doi:10.1016/j.fertnstert.2017.01.003
Sims ST, Heather AK.Myths and methodologies: reducing scientific design ambiguity in studies comparing sexes and/or menstrual cycle phases.Exp Physiol. 2018;103(10):1309-1317. doi:10.1113/EP086797
Shoupe D.The progestin revolution 2: progestins are now a dominant player in the tight interlink between contraceptive protection and bleeding control-plus more.Contracept Reprod Med. 2023;8(1):48. doi:10.1186/s40834-023-00249-5
National Center for Biotechnology Information.PubChem compound summary for CID 9270, ethynodiol diacetate.
Memorial Sloan Kettering Cancer Center.Eithinyl estradiol and ethynodiol diacetate.
National Center for Biotechnology Information.PubChem compound summary for CID 13109, levonorgestrel.
World Health Organization.Emergency contraception.
Oedingen C, Scholz S, Razum O.Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: the role of the progestogen type and estrogen dose.Thromb Res. 2018;165:68-78. doi: 10.1016/j.thromres.2018.03.005
Gunardi ER, Surya R, Syafitri I, Pasidri Y.Impact of one-rod levonorgestrel implant on the blood chemistry profile.Sci Rep. 2021;11(1):20141. doi:10.1038/s41598-021-99801-z
Bosanac SS, Trivedi M, Clark AK, Sivamani RK, Larsen LN.Progestins and acne vulgaris: a review.Dermatol Online J. 2018;24(5):13030/qt6wm945xf. doi:10.5070/D3245040035
Larivée N, Suissa S, Khosrow‐Khavar F, Tagalakis V, Filion KB.Drospirenone‐containing oral contraceptive pills and the risk of venous thromboembolism: a systematic review of observational studies.BJOG. 2017;124(10):1490-9. doi:10.1111/1471-0528.14623
Larivée N, Suissa S, Coulombe J, Tagalakis V, Filion KB.Drospirenone-containing oral contraceptive pills and the risk of venous thromboembolism: an assessment of risk in first-time users and restarters.Drug Saf. 2017;40(7):583-96. doi:10.1007/s40264-017-0525-2
The American College of Obstetricians and Gynecologists.Progestin-only hormonal birth control: pill and injection.
Mayo Clinic.Progestin (oral route, parenteral route, vaginal route).
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