Combined Hormonal Birth Control

Combined hormonal birth control comes in the form of pills, a patch, or a vaginal ring. These birth control methods contain 2 hormones: estrogen and progestin. You will need a prescription from your health care provider for any of the combined hormonal birth control methods.

The hormones in combined hormonal birth control stop your body from releasing an egg from your ovaries. These hormones also cause the mucus in your cervix (opening from your vagina to your uterus) to get thicker. This makes it harder for the sperm to reach the egg.

When combined hormonal birth control is used perfectly, less than 1 of every 100 people will get pregnant each year. In the United States, about 9 of every 100 people using combined hormonal birth control get pregnant every year because not everyone uses the method perfectly every time.

These methods are simple and easy to use. You may stop them on your own whenever you want. Most people are able to get pregnant as soon as they stop using a combined hormonal method. Many people will have shorter, lighter periods with less cramping when using this type of birth control. You may also have less acne, less unwanted hair growth, fewer premenstrual symptoms (PMS), and fewer migraines, especially if your headaches usually happen near the time of your period. You will have a lower risk of cancer in your uterus, ovaries, and colon for many years after using these methods.

If you use combined hormonal birth control, you have a slightly increased chance of having a blood clot in one of your legs or lungs, heart attack, or stroke. These problems are more likely for people who already have medical problems that increase the chance of these complications. Because of these risks, it is important to talk with your health care provider about your personal and family health history and if this method is right for you.

You may have nausea, headaches, breast tenderness, mild changes in mood and breakthrough bleeding (bleeding between your periods) while you use combined hormonal birth control. If you use the vaginal ring, you may have an increase in vaginal discharge or vaginal irritation. If you use the patch, you may have skin irritation where you place the patch. Side effects are most common during the first 3 months and then often go away.

Yes, some people with high blood pressure, diabetes, risk factors for blood clots, and other conditions should not use combined hormonal birth control methods, which is why you need to talk to your health care provider. Your provider will review your medical history before prescribing combined hormonal birth control or recommending a different method.

You take a combined birth control pill every day. You should take the pill at the same time every day to be most effective.

The hormonal patch is a small, sticky patch that is placed on your skin. You may put it on your upper arm, back, stomach, or buttock. You will wear your patch for 1 week and put on a new patch on the same day of the week for 3 weeks in a row. During the fourth week, you will take off your patch and have a period.

The vaginal ring is a flexible, plastic ring that you place in your vagina. You fold the ring and insert it as high in your vagina as it will go. It doesn't matter exactly where the ring is in your vagina. You will leave the ring in place for 3 weeks then remove it for 1 week. During the week without the ring, you will have your period.

You can choose how often you have periods with combined hormonal birth control. Talk with your health care provider about how to do this.

It is ideal to start your birth control the first day of your period to ensure you are not pregnant. If you start in the first five days after your period, you also will not have to use another method of birth control to protect you from pregnancy. If you know you could not be pregnant, you can start using combined hormonal birth control as soon as you get your prescription. If you start after your period after the 5th day of your period, you should use backup birth control or not have sex for at least one week after you start the method unless you are changing from one hormonal method of birth control to another without a break.

Flesch-Kincaid reading level 7.7

Approved October 2023. This handout replaces “Combined Hormonal Birth Control” published in Volume 61, Number 3, May/June 2016.

This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handout are not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health care provider for information specific to you and your health.