For some women, birth control without estrogen is the best option. This choice can be influenced by personal preference, concerns about side effects, or underlying medical conditions. Progestin-only birth control is generally a better option for women who cannot or should not increase the natural levels of estrogen in their bodies. This applies to women with a history of high blood pressure, blood clots, migraine with aura, diabetes with complications, heart attack, stroke, inflammatory bowel disease, or current or recent cancer. Additionally, estrogen-free birth control may be a better fit for women who are breastfeeding, use cigarettes or nicotine-containing products, or chronically use steroids.

Beyond pregnancy prevention, there are plenty of reasons women take birth control. In a survey, we found that 43% of Nurx patients use birth control to help manage medical concerns other than reducing the risk of pregnancy.

Hormonal birth control can help improve acne, reduce symptoms of PMS, decrease menstrual migraines, and help make periods more regular, less painful, and lighter in flow. It can also help reduce painful symptoms of endometriosis and reduce your risk of developing ovarian, uterine, and colon cancers. Everyone's body is different, and our providers can help you determine what is best for you.

Like most medications, both combination and estrogen-free birth control can cause side effects.

Most women who take combination birth control experience few or no noticeable side effects. Because combination pills contain estrogen, there is a slightly increase the risk of blood clots for some women. Women who smoke, particularly those over the age of 35, are advised not to use any birth control method that contains estrogen. The most common side effects of birth control pills include nausea, headaches, mood changes, breast tenderness, period changes (including stopped or heavier periods), slightly heightened migraine pain, irregular bleeding and spotting between periods, decreased sex drive, vaginal discharge, and weight gain (no more than 5 pounds).

Women who use estrogen-free birth control may experience side effects like irregular bleeding, breast tenderness, headaches and nausea.

It’s complicated. A change in your sex drive is rarely caused by a single factor. There’s no conclusive research proving that birth control pills increase or decrease the female sex drive. Many women who aren’t on hormonal birth control experience increased sexual urges around ovulation, and you won’t experience that on the pill since you’re not ovulating.

Despite a common belief to the contrary, the pill has not been shown to cause weight gain in women. Older birth control pills had much higher levels of hormones than modern pills, which made weight gain due to them far more common. 

Estrogen naturally promotes water retention, meaning that combination pills might slightly increase a woman’s propensity to gain water weight. Most women will not experience this, and those who do tend to only gain a few pounds and lose that weight after 2-3 months on the pill. Progestin, the other hormone found in combination pills (and the only hormone in progestin-only pills), is a natural diuretic—meaning that it tends to balance out the effects of the added estrogen. 

Most combination birth control pill packs contain both active and inactive pills. Active pills deliver a dose of hormones while inactive pills (also known as placebo or sugar pills) do not contain any hormones. The bleeding experienced while taking inactive pills isn’t really a period, it’s technically a “withdrawal bleed.” 

The estrogen and progestin in the active combination birth control pills, which suppress ovulation, also cause the growth of the endometrium (the lining of the uterus). When you stop taking these hormones during the placebo week, this lining sheds, causing bleeding that mimics a normal menstrual period. This “period” isn’t necessary for health and you can even opt to skip this withdrawal bleed.  

We often hear this question from Nurx patients. The short answer? Yes! Many believe that period blood will "build up" over time if they don't have a period every month—we know this is not true. You need to menstruate to shed the uterine lining which is in the form of period blood. Hormonal birth control safely stops the uterine lining from building up, so there isn’t anything to shed on a monthly basis.