The Inside Scoop on the Difference Between Combination Birth Control Pill and Progestin-Only Pill

There are two basic types of pills: the combination pill (estrogen + progestin) and the progestin-only pill. So really — what difference does estrogen make?

The Combination Pill

The combination pill was the first type of pill to hit the US market way back in 1960. Estrogen prevents your ovaries from releasing eggs. While progestin causes your cervical mucus to thicken (eww…), making it more difficult for sperm to make it all the way to your uterus.

Combination pills can have some major benefits: many women find that they have lighter, more regular and less painful periods. They can also reduce your risk of getting ovarian or endometrial cancer.

But they have their downsides too… Combination pills have been reported to decrease your sex drive. In the first few months women can experience symptoms such as breast tenderness and nausea too. But this usually does away — if it doesn’t you should see your physician for a different pill or birth control method.

Who shouldn’t take the combination pill?

Estrogen is an absolute no no if you have or have had any of the following conditions:

• Migraine headaches with an aura
• Uncontrolled high blood pressure
• Uncontrolled diabetes or liver disease
• Blood clots or a blood clotting disorder
• Heart problems
• Breast cancer

Not all combination pills are created equal… The different kinds of combination pills, contain different types and proportions of hormones. Monophasic pills have the same ratios of estrogen and progestin in every active pill in the pack. You could take the active pills out of order and you would still get the same protection (unless you take the placebo pills — then you are out of luck). But don’t switch the order if you are on a multiphasic pill. Each week there is a different ratio of estrogen and progestin so you will not be protected if you take them out of order.

Important tid-bit for new users: If you start your first pack of combination pills within 5 days of the first day of your period you are protected from pregnancy. If you start later — you are not protected from pregnancy for at least 7 days.

Progestin-Only Pill

The progestin-only pill, frequently known as the “mini pill”, only contains the hormone progestin, and every pill in a pack is “active”. The mini pill works by thickening the cervical mucus so sperm can’t enter the uterus, and by making it less likely that your ovaries will release an egg — though you may still ovulate on some months. Some people prefer to use the mini pill if they’re sensitive to estrogen, or if they shouldn’t take estrogen because they’re at higher risk of stroke.

Important tid-bit: The mini pill has to be taken within the same three-hour window every day, or you will not be protected from pregnancy.

OK, so I have to set and not silence by alarm… What are other downsides to the progestin only pill? Early on you may have acne, mood swings, and breast tenderness. It’s also common to have irregular periods and spotting too — that’s why this is not a popular form of birth control pill.

No matter what kind of pill you choose, there’s one thing that doesn’t change — you have to take all of the active pills in a packet on time for the pill to reliably prevent pregnancy!

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Sources:

1. https://www.plannedparenthood.org/learn/birth-control/birth-control-pill/what-are-the-disadvantages-of-the-pill
2. https://www.plannedparenthood.org/learn/teens/ask-experts/is-it-ok-take-my-pills-out-of-their-pack-and-carry-them-in-a-different-container
3. Hatcher, RA, Nelson AL, Trussell J, Cwiak C, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds, Contraceptive technology. 21st ed. New York, NY. Ayer Company Publishers, Inc, 2018, p318–325
4. Hatcher et al, 320