OVERVIEW

Now more than 40 years since it was first approved by the U.S. Food and Drug Administration (FDA) in 1960, "the pill" continues to be the most popular and one of the most effective forms of reversible birth control ever invented. According to the Johns Hopkins School of Public Health Population Information Program, more than 100 million women worldwide and 18 million U.S. women rely on birth control pills (BCPs) today. In the U.S. alone, about 40 different brands are available.

Unlike the original oral contraceptives that women took decades ago, there are new low-dose forms of BCPs that have many fewer health risks attached to them. In fact, they have many health benefits. Despite the fact that they are safe for most women, birth control pills do carry some health risks, however. For example, if you smoke and/or have certain medical conditions (a history of blood clots or breast or endometrial cancer), you may be advised against taking them. Likewise, birth control pills cannot reduce your risk of transmitting or acquiring sexually transmitted diseases (STDs), including HIV (human immunodeficiency virus), the virus that causes AIDS.

Unlike other forms of birth control sold over-the-counter, a health care professional's prescription is needed to purchase BCPs; many health insurers are starting to cover their cost.

It is important to consult with a health care professional about the pros and cons of any form of birth control you are considering. Factors to be considered are outlined below in this article. (For more information on contraceptive devices and methods other than oral contraceptives, see the health topic at the Web site titled "Contraception.")

How Birth Control Pills Work

The pill is a synthetic form of the body's own hormones that works by suppressing ovulation – the monthly release of an egg from one of the ovaries. At the beginning of each menstrual cycle, levels of the hormone estrogen begin building. This thickens the endometrium (the lining of the uterus) in preparation for a fertilized egg. Estrogen levels peak and then, at approximately 14 days into the cycle, an egg is released from one of the ovaries. After ovulation, levels of progesterone rise for the next seven days. This further prepares the endometrium for a fertilized egg to attach itself to the endometrium, which is called implantation. If implantation does not occur, levels of both estrogen and progesterone drop to their lowest point. This drop signals the thickened uterine lining to slough off, resulting in the monthly period. When a woman is taking the pill, hormone levels are more constant. If there is never a peak of estrogen, there is no signal for the ovary to release an egg. No egg, no fertilization, no pregnancy.

Types Of Birth Control Pills
The three most common types of birth control pills are:

Progestin-only pills (POP): One type of pill contains no estrogen at all. Called the progestin-only pill, or "mini-pill," it's ideal for breast-feeding women because estrogen reduces milk production. It's also ideal for women who cannot take estrogen. However, POPs are not as effective at preventing pregnancy as pills containing both estrogen and progestin. POPs primarily work by thickening the cervical mucous, thereby preventing sperm from entering the uterus. In order to do this, POPs must be taken at a certain time every 24 hours.

Combined pills: When you hear the term "birth control pill," it most often refers to those containing two hormones. Each pill in the pack is a combination of estrogen and progestin.

* "Monophasic" pills: Each of the 21 active pills in one of these packs contains the same amount of estrogen and progestin. The other seven pills are placebos (they contain no hormones); they are meant to be taken the week a woman has her period. In September 2003, the FDA approved Seasonale, a 91-day oral contraceptive regimen. Tablets containing progestin and estrogen are taken for 12 weeks (84 days), followed by one week of placebo tablets. Therefore, the number of expected menstrual periods are reduced from once a month to about once every three months.

* "Multiphasic" pills: Multiphasic pills are those that have different hormone doses throughout the pill-taking schedule. This formulation was developed in an effort to reduce hormone levels to their lowest effective dose, in hopes of reducing side effects such as breakthrough bleeding, spotting and amenorrhea (lack of a menstrual cycle).

Emergency contraceptive pills (ECP): ECPs are not intended for conventional birth control use, but rather they can be helpful in preventing pregnancy after unprotected sex (when standard contraceptives fail or no method was used at all). ECPs are taken in two doses. The first must be taken within 72 hours of unprotected sex, and the second dose 12 hours later. Two products have been approved by the FDA specifically for emergency contraception. One contains both estrogen and progestin (brand name, Preven), and one contains only progestin (brand name, Plan B). Some ordinary pill packs can be used for emergency contraception by taking several pills at the same time (the exact number depends on the brand); ask your health care professional for more information. Or, visit the Internet site for emergency contraception operated by Association of Reproductive Health Professionals or ARHP (http://www.arhp.org).

How birth control pills work and failure rates

Type of Pill	How it works	Failure rates*
Progestin-only pill (POP), known as the "mini-pill"	1. Thickens cervical mucus, making it hard for sperm to enter the upper genital tract. 2. Endometrium remains thin, hindering implantation of a fertilized egg. 3. Ovulation is suppressed in 50 percent of cycles.	Perfect use: 0.5 percent Typical use: 5 percent
Combined oral contraceptives (COC)	1. Ovulation is suppressed in 90 to 95 percent of cycles. 2. Thickens cervical mucus, making it hard for sperm to enter the upper genital tract. 3. Endometrium remains thin, hindering implantation of a fertilized egg.	Perfect use: 0.5 pecent Typical use: 5 percent
Emergency contraceptive pills (ECP), a.k.a. "morning after pill"	1. Ovulation is inhibited or delayed. 2. A fertilized egg is blocked from implantation.	If taken at least 72 hours after unprotected sex, chance of pregnancy is reduced by 75 percent. (2% failure rate)Progestin only ECPs reduce risk by 88% (1% failure rate). (FDA, 2000).

* Failure rates from Contraceptive Technology, 1998.

Are birth control pills right for you?
To determine if birth control pills are right for you, it's important to understand the advantages, disadvantages and side effects of each type. As with any medication, it's also important to consider your existing health and any other medications you're taking before starting a new one.

To help you decide if it's right for you, in this section you'll find the following information about each type of pill:
*Advantages
*Disadvantages
*Possible side effects
*A list of questions to ask yourself
*A list of recommendations for women with coexisting medical conditions made by the American College of Obstetricians and Gynecologists (ACOG), a national medical organization representing over 40,000 physicians who provide health care for women.

Progestin-only pills (POPs)
The advantages of POPs include:
- decreased menstrual blood loss
- decreased menstrual cramps and pain
- they can be used by breast-feeding women immediately postpartum (after delivery)
- they are an option for women who cannot use estrogen

The disadvantages of POPs are:
- irregular bleeding patterns, spotting or breakthrough bleeding
- they must be taken at the same time every day
- they do not protect against sexually transmitted infections; women at risk must use condoms
- they are less effective

Possible side effects are:
-amenorrhea (absence of a monthly period)
-irregular bleeding
-heavy bleeding
-abdominal pain
-headaches

Are you a good candidate for POPs? Ask yourself the following questions:
1. Are you the type of person who can remember to take a pill at exactly the same time every day?
2. Will irregular bleeding or spotting bother you?
3. Are you breast-feeding, but feel that you need contraception?
4. If you are at risk for sexually transmitted infections, will you use condoms for protection?
5.Do you have a need to avoid taking estrogen?
6.Are you willing to take a higher chance of getting pregnant?

Combined pills
The advantages of combined pills are:
- a reduced risk of ovarian cancer and endometrial cancer
- prevention of ectopic pregnancy
- decreased menstrual blood loss
- less severe premenstrual symptoms, more regular cycles
- decreased acne
- prevention of bone density loss
- less risk of ovarian cysts
- improvements in hirsutism (male pattern hair growth)
- improvements in endometriosis
- improvement in rheumatoid arthritis
- desirable affects on cholesterol ( HDL and LDL)
- decrease in benign breast disease
- reversibility and quick return to fertility

The disadvantages of combined pills are:
- no protection from sexually transmitted infections
- can cause nausea, vomiting, headaches and/or spotting, particularly with the first few cycles
- can lead to hypertension (less than one in 200 women)
- can cause blood clots in the veins in a small percentage of users
- can contribute to formation of gallstones and rare benign liver tumors

Possible side effects of combined pills include:
-nausea and vomiting
-headaches
-irregular bleeding
-weight gain or weight loss due to changes in eating habits
-breast tenderness
-increased breast size

Are you a good candidate for combined birth control pills? Ask yourself the following questions:
1. Are you the type of person who can remember to take a pill every day?
2. If you are at risk for sexually transmitted infections, will you use condoms?
3. Do you need relief from endometriosis, severe menstrual pain or anemia?
4. Are you a nonsmoker over the age of 35?
5. Are you breast-feeding a baby less than six months old?
6. Do you have high blood pressure?

Emergency Contraceptive Pills (ECPs)
The advantages of ECPs are:
- they reduce the chance of unintended pregnancy
- can be used by all women, even those who can't take regular birth control pills
- can be obtained in advance and kept handy in case of an emergency such as condom breakage, missed oral contraceptives, late contraceptive injections or forced sex

The disadvantages of ECPs are:
- accessibility: many women don't know where to get a prescription for ECPs
- dosing: many women don't know they can use some types of regular birth control pills
- the 72-hour window in which to start the first dose should not be missed in order to be most effective

Possible side effects of ECPs include nausea and vomiting, dizziness, fatigue, headache, heavier or lighter menstrual bleeding, breast tenderness and abdominal pain.

Are you a good candidate for ECPs?
ECPs are safe for all women. You may want to consider having some in your medicine cabinet if you have ever:
- made love unexpectedly
- been forced to have sex
- had a condom break, slip or come off
- forgotten to take several birth control pills
- expected your partner to pull out ... but he didn't
- found out after sex your diaphragm had slipped
- been late for your Depo-provera or Lunelle shot and had unprotected sex

Important note: In early October 2002, Pharmacia Corporation, manufacturer of Lunelle, announced a voluntary recall of all prefilled syringe applications of Lunelle because of concerns that the applications may not be fully potent and could pose a risk for contraceptive failure. Lunelle packaged in vials is not affected by this recall, nor is any other Pharmacia contraceptive product.

The American College of Obstetricians and Gynecologists issued the following recommendations for women who are considering birth control pill use who also have certain medical conditions:

Hypertension: Women age 35 and younger with well-controlled and monitored hypertension are appropriate candidates for a trial of birth control pills formulated with 35 mcg or less of estrogen, provided they are otherwise healthy and nonsmokers. If blood pressure remains well controlled several months after beginning the pills, use can continue.

Diabetes: Use of birth control pills by diabetic women should be limited to those who do not smoke, are younger than 35 and are otherwise healthy with no evidence of hypertension, nephropathy, retinopathy or other vascular disease. Birth control injections or implants are safer alternatives than birth control pills in women with Diabetes with vascular disease or older than 35.

Migraine headaches: Birth control injections or implants are safer alternatives than pills in women with migraine headaches.

Fibrocystic breast changes and/or a history of breast cancer: Women with fibroadenoma (benign breast disease) or a family history of breast cancer are at little or no additional risk of breast cancer from using BCPs.

Heart disease: POPs may be appropriate for women with coronary artery disease, congestive heart failure, or cerebrovascular disease. However, combined pills are not recommended for these women.

Lupus/Sickle cell anemia: Birth control injections or implants are safer alternatives than birth control pills in women with lupus or sickle cell anemia.

Health benefits of birth control pills

As with any medication, there are benefits and risks to using the pill. But, many women know more about the health risks – or the health myths -- associated with BCPs and don't know about benefits. Here's the scoop…

Pregnancy Prevention. Birth control pills are one of the most effective forms of reversible birth control. If used correctly, the odds are that only one in 1,000 women is likely to get pregnant in the first year of use. It is also important to realize that birth control pills prevent not only normal pregnancies, but also those that begin outside the uterus (ectopic pregnancies).

Menstrual benefits. Birth control pills provide at least four benefits related to a woman's period. - They reduce menstrual flow. - Generally, pill users find improvement in their menstrual patterns because the timing is controlled by the pills. - Birth control pills are effective at relieving pelvic pain during menstruation. - They can be considered for PMS treatment if symptoms are mostly physical, but they may not be effective if mood changes are the primary symptom.

Protection from cancer. Birth control pills have been shown to protect women from ovarian and endometrial cancer, and possibly from colorectal cancer.

Prevention of bone density loss. A study published in the Archives of Internal Medicine in 1991 found that, of nearly 2,300 women, those with high bone density were more likely to have been pill users. Another study, published in the American Journal of Obstetrics and Gynecology, showed that the pills need to have at least 25 mcg of estrogen to produce that effect. It has not been demonstrated that the effect of BCPs on bone density makes a practical difference in terms of bone fracture reduction.

Protection from ovarian cysts. The Oxford University/Family Planning Association cohort study found that pill users have about one-fifth of the risk for developing ovarian cysts than do women using nonhormonal methods of contraception. Women using low dose pills (20 mcg of estrogen) or multiphasic pills may not get the same benefit.

Health risks of birth control pills

Heart Attack. While some studies find no association between heart attack and use of the pill, one U.S. study, published in the American Journal Obstetrics and Gynecology in 1996, found a small correlation: Less than three additional heart attacks per million American women in one year of pill use.

Studies have shown that smoking dramatically increases the risk of heart attack in women at the ages when the overall risk of this event begins to rise steeply (over 35 years of age). The combination of oral contraceptive pill use and smoking has a greater effect on risk than the simple addition of the two factors. Therefore, oral contraceptive pills generally are not prescribed to smokers over 35 years of age.

In another study that appeared in the January 1999 issue of the American Journal of Obstetrics and Gynecology, an estimate of the annual risk of death in the U.S. from cardiovascular disease, attributable to low-dose combination oral contraceptives among smokers versus non-smokers of defined age groups, was undertaken. Results of the study found 0.06 and 3.0 deaths per 100,000 nonsmokers 15 to 34 years of age and 35 to 44 years of age, respectively. In smokers this risk increases, respectively, to 1.73 and 19.4 deaths per 100,000 users in these two age groups; however, 97 percent and 85 percent of this risk is due to the combined effects of smoking and using oral contraceptives. The attributable risk of death from cardiovascular disease in nonsmoking oral contraceptive users is lower than the risk of death from pregnancy in nonusers of oral contraceptives at all ages; however, among smoking oral contraceptive users more than 35 years of age, the excess risk of death from oral contraceptives is higher than the risk of death from pregnancy.

ischemic stroke. The most comprehensive information on the issue of birth control pills and stroke comes from a large World Health Organization (WHO) study. According to its researchers, having an ischemic stroke (a type of stroke caused by blood clots) is three times more likely in pill users than in nonusers. If you look at specific groups, though, the risk changes greatly. For women who don't smoke and don't have high blood pressure, the risk for stroke is lower, only 1.5 times that of nonusers. Oral contraceptive users who smoked faced a higher risk--about two times greater than among nonsmoking pill users in the developing countries studied and about 3.5 times greater in Europe. Current pill users with hypertension face the greatest risk -- about four to five times that of nonusers.

Hemorrhagic stroke. The WHO study found that in both developing and European countries, current oral contraceptive users age 35 or older had a significantly increased risk of hemorrhagic stroke (a type of stroke that occurs when a blood vessel breaks in the brain), with relative risks of 2.5 and 2.2, respectively, compared with nonusers of oral contraceptives. The relative risk among current users who smoked was three to four times that of nonusers who did not smoke. Also, current users with a history of hypertension faced a substantially higher relative risk than nonusers with no such history.

Migraines and stroke. In 2002, a World Health Organization (WHO) panel examined all recent published data on the risk of stroke in combined oral contraceptive users. The authors concluded that combined oral contraceptive users with a history of migraine may have a two- to four-fold increased risk of stroke over that of nonusers with a history of migraine. The report stated that women at greatest risk are those who have migraine with "aura" -- neurologic symptoms related to focus, such as blurred vision, temporary loss of vision, seeing flashing lights or zigzag lines. In addition, their findings indicated an increased risk of stroke with age: 10 per 100,000 in women aged 20 years and 100 per 100,000 in women aged 40 years who have migraine and use oral contraceptives.

Venous thromboembolism (VTE). Many studies have linked pill use to the formation of blood clots in the veins of the legs. American researchers studying data on nearly 100,000 women taking oral contraceptives found that while blood clots were rare, cyproterone-containing pills carried a four-times higher risk compared with pills containing the progestin levonorgestrel. Levonorgestrel is found in older contraceptives known as second-generation birth control pills. Their findings were reported in the 2001 issue of the Lancet. Several recent studies indicate that lower dose pills now available have cut the risk substantially.

Worsening of severe diabetes. The estrogen in birth control pills may increase glucose levels while decreasing the body's insulin response, and the progestin in the pills may encourage overproduction of insulin. Women with normal blood sugar levels won't develop Diabetes but diabetic women who should avoid the pill include those who have experienced vascular damage or have had the disease for longer than 20 years. Diabetic women who wish to use BCPs should discuss their health history with their health care professionals.

Possible acceleration of gallbladder disease. Estrogen may cause bile to become over-saturated with cholesterol, which can lead to gallstone development. However, an analysis of 25 studies on the subject found that the increased risk for gallbladder disease among birth control pill users was not statistically significant.

Possible sexually transmitted infections. Studies have been conducted over the years to determine if there is a relationship between birth control pill use and sexually transmitted diseases (STD). Researchers find it difficult to decide which risks are real and which ones are caused by something other than the pill. For example, it is possible that pill users, confident that they are protected from pregnancy, use condoms less often than non-pill users. Pill users may contract STDs because of a false sense that the pill protects them from contracting sexually transmitted diseases. But women who do use the pill are less likely to develop pelvic inflammatory disease (PID) as a result of an STD because the thickened cervical mucus produced while on the pill prevents STDs from developing into PID. Compared with pills, condoms offer inferior protection from pregnancy, but superior protection from STDs such as human immunodeficiency virus (HIV) or chlamydia. The two methods should always be used together by women who are at risk for STDs.

Drug interactions with birth control pills
Do you know of a woman who claimed to use birth control pills correctly but got pregnant anyway? Oftentimes the blame is placed on a short stint of antibiotic use. Reports abound regarding the reduction in pill effectiveness caused by antibiotics such as ampicillin and tetracycline, but no studies have been able to prove these claims.

It is clear, however, that some drugs can reduce pill effectiveness and that pills can modify the effects of some drugs. If you are taking any of the following drugs on a short-term basis, you can use a backup method (such as condoms) or you can use high-dose pills; if you are taking any of the following drugs on a long-term basis, you could take high-dose pills and skip the pill-free interval or consider a different method:

Seizure medications: phenytoin, carbamazepine, primidone, ethosuximide, methylphenobarbital, paramethadione, phenobarbital, topiramate

Tuberculosis medications: rifampin, griseofulvin

Pill users may need a lower dose of the following medications, because birth control pills can speed up metabolism: anti-anxiety benzodiazepine drugs, corticosteroids and theophylline.

There are also new studies that demonstrate that women who take St John's wort have a higher risk of pregnancy because of the pathway through which the herb is metabolized.

Cancer and birth control pills
Many fear that using the pill will cause cancer. The truth is that the pill definitely helps prevent uterine and ovarian cancer. Birth control pill use causes several changes in the body's normal monthly cycle. These changes account for the pill's protective effects against uterine and ovarian cancer, and possibly colorectal cancer. The levels of estrogen and/or progestin provided by the pill interferes with the body's hormonal signaling process; lower levels of other chemicals (or none at all) are released by the body because there has been no signal for them to become active, and this results in less activity for the endometrium (the uterine lining) and ovaries. Ultimately, cell division in the endometrium and ovaries is reduced and cancer cells are prevented from occurring.

The pill's possible cause and effect relationship with other types of cancer, specifically cervical cancer, breast cancer and liver cancer, are not so easy to understand. Even with the most recent scientific findings, researchers still characterize the possible link between cancer and the pill as "unresolved."

According to the National Cancer Institute, studies examining the use of BCPs as a risk factor for breast cancer have produced inconsistent results. Most studies have not found an overall increased risk for breast cancer associated with oral contraceptive use. For example, in 2002, results from the Women's Contraceptive and Reproductive Experience (Women's CARE) study indicated that present or past use among both Caucasian and African-American women ages 36 to 64 did not significantly increase the risk of breast cancer.

Protective effects of birth control pill use ( s)
Uterine cancer: Findings from the Cancer and Steroid Hormone Study (CASH), which was conducted by the U.S. Centers for Disease Control and Prevention, and other studies show that combination OC use can protect against the development of endometrial cancer. It is believed that OCs provide the progestins needed to oppose estrogen's stimulating effects on the uterine lining. The level of risk reduction is greater in women who have used OCs for a longer time, and, long after a woman discontinues OC use, she will be protected from endometrial cancer.

Ovarian cancer: Protection occurs long after a woman stops taking the pill. The Centers for Disease Control and Prevention's (CDC) large Cancer and Steroid Hormone (CASH) study found that, even if it had been 15 years since a woman stopped taking the pill, she is still half as likely to get ovarian cancer as a woman who hasn't use BCPs. Authors of the CASH study estimate that pill use prevents more than 1,700 cases of ovarian cancer in the United States each year. Ovarian cancer protection, however, may be confined only to women who are NOT genetically predisposed to this type of disease (those who carry the BRCA1 and BRCA2 genetic mutations), according to a recent study appearing in the July 2001 issue of the New England Journal of Medicine.

Colorectal cancer: The International Journal of Cancer stated in 1999 that colorectal cancer is the fifth most common cancer among women. The largest study conducted so far on this subject found that women who were pill users for at least two years have half the risk for colorectal cancer that non-pill users have.

Birth control pills and possible disease associations
Cervical cancer: There is some evidence that long-term pill use may increase the risk of cancer of the cervix (the narrow, lower portion of the uterus). The results of studies conducted by NCI scientists and other researchers support a relationship between extended use of the pill (five or more years) and a slightly increased risk of cervical cancer, but it is difficult for researchers to determine the exact role that the pill may play in the development of this cancer.

Breast cancer: A woman's normal production of reproductive hormones can put her at risk for breast cancer. According to the National Cancer Institute (NCI), hormonal risk factors include conditions that allow high levels of estrogen to persist for long periods of time, such as early age at first menstruation (before age 12), late age at menopause (after age 55), having children after age 30 and not having children at all. Because pill use allows for higher levels of estrogen in the body, it has been scrutinized as a possible cause for breast cancer. The largest analysis to date summed up the findings of 54 studies and covered 53,000 women with breast cancer. The findings of this analysis, published in 1996 by the Collaborative Group on Hormonal Factors in Breast Cancer, are as follows: You will be slightly more likely to be diagnosed with localized breast cancer if you are a current pill user or if you quit using them within the last 10 years. Today's pills, with much lower doses of estrogen, do not increase risk for breast cancer.

In 2002, results became available from the Women's Contraceptive and Reproductive Experience (Women's CARE) study. The study examined the use of BCPs as a risk factor for breast cancer in women ages 35 to 64. Researchers interviewed 4,575 women who were diagnosed with breast cancer between 1994 and 1998, and 4,682 women who did not have breast cancer. Findings indicated that present or past use among both Caucasian and African-American women in this age group did not significantly increase the risk of breast cancer. Factors such as longer periods of use, higher doses of estrogen, beginning pill use before age 20, and use by women with a family history of breast cancer were not associated with an increased risk of the disease. The data also provided evidence that former BCP use does not increase the risk of breast cancer later in life.

The NCI recommends that all women in their 40s or older who are at average risk for breast cancer get screening mammograms every one to two years. Women who are at higher risk of breast cancer should seek expert medical advice about whether to begin screening before age 40 and to determine their mammography schedule in their 40s.

Liver Tumors: According to the NCI, some evidence exists that pill use may increase the risk of certain malignant liver tumors. However, the risk is difficult to evaluate because of different patterns of pill use and because these tumors are rare in American women (about two cases per 100,000 women).

Birth Control Pills: A Comparison of Brands

Brand name	Dosage	Appropriate candidates
* indicates pills that can be used for emergency contraception.
Progestin-only pills
Micronor	0.35 mg norethindrone	* Women who are breast-feeding * Smokers older than 35 years of age * Women with thrombophlebitis * Women who experienced side effects while taking higher dose pills * Women who can take a pill at exactly the same time every day * Women with coronary artery disease, congestive heart failure, or cerebrovascular disease * Women with high triglycerides (350-400+)
Nor-QD	0.35 mg norethindrone
* Ovrette	0.075 mg norgestrel
20 mcg Combined Birth Control Pills (Low-dose pills)
* Alesse	0.1 mg levonorgestrel/20 mcg ethinyl estradiol	* Women in their late 40s or early 50s to help regulate irregular menstrual periods – a common change associated with the transition to menopause * Women who experience nausea or breast tenderness while taking higher dose pills * Women at risk for deep vein thrombosis * Mircette could be used if breakthrough bleeding follows menses * Mircette could be used for women with high cholesterol
* Levlite	0.1 mg levonorgestrel/20 mcg ethinyl estradiol
Loestrin Fe	1 mg norethindrone acetate/20 mcg ethinyl estradiol/75 mg ferrous fumarate
Mircette	0.15 mg desogestrel/20 mcg ethinyl estradiol for 21 days; 10 mcg ethinyl estradiol for 5 days
30 mcg Combined Birth Control Pills
Desogen	0.15 mg desogestrel/30 mcg ethinyl estradiol
* Levlen	0.15 mg levonorgestrel/30 mcg ethinyl estradiol
Loestrin 21	1.5 mg norethindrone acetate/30 mcg ethinyl estradiol
* Lo/Ovral	0.3 mg norgestrel/30 mcg ethinyl estradiol
* Nordette	0.15 mg levonorgestrel/30 mcg ethinyl estradiol
* Levora	0.15 mg levonorgestrel/30 mcg ethinyl estradiol
Ortho-Cept	0.15 mg desogestrel/30 mcg ethinyl estradiol
Yasmin	3 mg drospirenone/30 mcg ethinyl estradiol	Unique progestin, improves acne and hirsutism
35 mcg Combined Birth Control Pills
Brevicon	0.5 mg norethindrone acetate/35 mcg ethinyl estradiol	* Brevicon, Modicon, Ortho-Cyclen or Ovcon could be used for women with high cholesterol because these pills improve HDL/LDL ratio
Demulen	1 mg ethynodiol diacetate/35 mcg ethinyl estradiol
Modicon	0.5 mg norethindrone acetate/35 mcg ethinyl estradiol
Necon	1 mg norethindrone/35 mcg ethinyl estradiol
Norethin	1 mg norethindrone/35 mcg ethinyl estradiol
Norinyl	1 mg norethindrone/35 mcg ethinyl estradiol
Ortho-Cyclen	0.25 mg norgestimate/35 mcg ethinyl estradiol
Ortho-Novum 1/35	1 mg norethindrone/35 mcg ethinyl estradiol
Ovcon	0.4 mg norethindrone/35 mcg ethinyl estradiol
Zovia	1 mg ethynodiol diacetate/35 mcg ethinyl estradiol
Combined Phasic Pills
Estrostep Fe	Norethindrone acetate/ ethinyl estradiol: 1 mg/20 mcg; 1 mg/30 mcg; 1 mg/35 mcg, 75 mg ferrous fumarate	* Multiphasics were developed in an effort to reduce hormone levels to their lowest effective dose, in hopes of reducing side effects such as breakthrough bleeding, spotting, and amenorrhea (the lack of a menstrual cycle) * Estrostep could be used to treat breakthrough bleeding or spotting that occurs before menses * Ortho-TriCyclen could be used for women with high cholesterol because these pills improve HDL/LDL ratio
Jenest	norethindrone/ethinyl estradiol: 0.5 mg/35 mcg; 1 mg/35 mcg
Ortho-Novum 7/7/7	norethindrone/ethinyl estradiol: 0.5 mg/35 mcg; .75 mg/35 mcg; 1 mg/35 mcg
Ortho-Novum 10/11	norethindrone/ethinyl estradiol: 0.5 mg/35 mcg; .75 mg/35 mcg; 1 mg/35 mcg
Ortho Tri-Cyclen	norgestimate/ethinyl estradiol: 0.18 mg/35 mcg; 0.215 mg/35 mcg; 0.25 mg/35
* Tri-Levlen	levonorgestrel/ ethinyl estradiol: 0.050 mg/30 mcg; 0.075 mg/40 mcg; 0.125 mg/30 mcg
Tri-Norinyl	norethindrone/ethinyl estradiol: 0.5 mg/35 mcg; 1 mg/35 mcg; .5 mg/35 mcg
* Triphasil	levonorgestrel/ ethinyl estradiol: 0.050 mg/30 mcg; 0.075 mg/40 mcg; 0.125 mg/30 mcg
* Trivora	levonorgestrel/ ethinyl estradiol: 0.050 mg/30 mcg; 0.075 mg/40 mcg; 0.125 mg/30 mcg
50 mcg Combined Birth Control Pills (High-dose pills)
Demulen	1 mg ethynodiol diacetate/50 mcg ethinyl estradiol	* Women who take short-term medication for seizures or tuberculosis
Necon	1 mg norethindrone/50 mcg mestranol
Norinyl 1+50	1 mg norethindrone/50 mcg mestranol
Ortho-Novum 1/50	mestranol
Ovcon	1 mg norethindrone/50 mcg ethinyl estradiol
* Ovral	0.5 mg norgestrel/50 mcg ethinyl estradiol
Zovia	1 mg ethynodiol diacetate/50 mcg ethinyl estradiol
Emergency Contraceptive Pills
* Plan B	0.75 mg levonorgestrel per dose	* Women who have any reason to suspect they could have become pregnant in the last 72 hours * Women who have: -- made love unexpectedly -- been forced to have sex -- had a condom break, slip or come off; or found out after sex their diaphragm had slipped -- forgotten to take several birth control pills in a row
* Preven	0.50 mg levonorgestrel/100 mcg ethinyl estradiol per dose

NEW FDA APPROVALS Cyclessa (TM) (desogestrel/ethinyl estradiol) is a new, low hormone dose, oral contraceptive. Recently approved by the U.S. Food and Drug Administration, Cyclessa (TM) has just 25 micrograms of estrogen (ethinyl estradiol), making it the lowest estrogen dose triphasic birth control pill approved by the FDA and available across the U.S. Another type of oral contraceptive, Seasonale, was approved by the FDA in September 2003. Tablets containing progestin and estrogen are taken for 12 weeks (84 days), followed by one week of placebo tablets. Women only have four menstrual cycles a year, thus further reducing chances of unintended pregnancy.

RESEARCH

Oral contraception for men reduces sperm counts to levels that are unlikely to cause pregnancy. In Italy, a contraceptive pill containing synthetic hormones is being used by men in a clinical study. The men also receive testosterone injections to boost the effectiveness of the pill. French researchers have hopes for a different version of Mifepristone (more widely known as RU 486), which blocks sperm's use of calcium and thus prevents it from moving. One problem with finding effective oral contraceptives for me is that since men don't get pregnant, their motivation to use contraception is generally lower than a woman's.