Hesperian Health Guides

Hormonal methods of family planning

Every day 20,000 people visit the HealthWiki for lifesaving health information. A gift of just $5 helps make this possible!

Make a giftMake a gift to support this essential health information people depend on.


HealthWiki > A Health Handbook for Women with Disabilities > Chapter 9: Family planning > Hormonal methods of family planning


Hormones are chemicals a woman’s body normally makes. The hormones regulate many parts of a woman’s body, including your monthly bleeding and ability to become pregnant. This process is no different in a woman with or without a disability. Hormonal methods of family planning prevent pregnancy by stopping your ovaries from releasing eggs into your womb. Hormonal methods do not protect against HIV/AIDS or other STIs.

You should not use any hormonal method if:

  • you have breast cancer.
  • you may be pregnant already.
  • you have very heavy monthly bleeding or monthly bleeding that lasts for more than 8 days.


a packet of 28 pills.
a small bottle and a syringe.
2 implants.

Hormonal methods include:

  • Pills, which a woman takes every day.
  • Injections, which are given every few months
  • Implants, which are put into a woman’s arm and last for several years.


Most birth control pills and some injections contain 2 hormones similar to the hormones a woman’s body normally makes. These hormones are called estrogen (ethinyl estradiol), and progestin (levonorgestrel). Implants, some pills, and some injections contain only progestin.

New hormonal methods are still being invented. Some newer methods are a contraceptive patch, a ring (worn on the cervix), and a hormonal IUD.

Side effects
Hormonal methods sometimes have side effects. These effects are not dangerous, but they are often uncomfortable. Hormonal methods can make a woman have:

nausea headaches swelling of
the breasts
weight gain changes in
monthly
bleeding
WWD Ch9 Page 196-8.png
WWD Ch9 Page 196-4.png
WWD Ch9 Page 196-5.png
WWD Ch9 Page 196-6.png
WWD Ch9 Page 196-7.png

These effects usually lessen after a few months. If they do not,
the woman can try a different family planning method.

Birth control pills (oral contraceptives or “the Pill”)

a woman with a prosthetic arm taking a pill as the sun rises.

If you decide to take birth control pills, they should be “low-dose.” That means they should have 35 micrograms (mcg) or less of estrogen, and 1 milligram (mg) or less of progestin. Do not use pills with more than 50 mcg of estrogen. There are many different brands of birth control pills.

Taking a birth control pill at the same time every day is one of the most effective ways to avoid pregnancy. There is an increased chance of pregnancy if you forget to take even a single pill. As a rule, women who take birth control pills have lighter monthly bleeding. This may be a good thing, especially for women who have a difficult time managing their monthly bleeding. If you have trouble swallowing pills, they can be ground up in water or some other liquid, and swallowed through a straw.

Pills come in packets of 21 or 28 tablets. You should take the first pill in a packet on the first day of your monthly bleeding. If that is not possible, take the first pill any time in the first 7 days after you start your monthly bleeding. If you are using a 21-day packet, take one pill every day for 21 days. Then wait 7 days before starting a new packet. Usually, you will start your monthly bleeding after the 21st day. But even if you do not, start a new packet in 7 days. If you are using a 28-day packet, take one pill every day. As soon as you finish one packet, begin taking a new one.

If you vomit within 3 hours after taking your pill, or have severe diarrhea, your birth control pill will not stay in your body long enough to work well. Use condoms, or do not have sex, until you are well and have taken a pill each day for 7 days.

The combined pills (estrogen and progesterone) start to prevent pregnancy within 2 weeks, if you start taking them the first day of your monthly bleeding. Progestin-only pills will not prevent pregnancy for the first 4 weeks you take them. So you will need to use condoms or another method of family planning, or you may become pregnant.


WARNING! If you are taking pills and you get any of these signs, get medical advice right away:

  • chest pain and shortness of breath
  • strong headaches
  • numbness in your arms or legs
  • strong pain or swelling in one leg

These are signs that you may have a blood clot inside your body that is preventing the blood from flowing to your lungs, chest, brain or arm or leg.

Injectable contraceptives

a health worker giving a woman an injection.

With this method, a health worker gives a woman a hormone injection to keep her from getting pregnant. One injection lasts 1 to 3 months. Most injections contain only progestin. Depo Provera and Noristerat are the most common brands. These injections are safe to use while breastfeeding, and are safe for other women who should not use estrogen.

Injections are very effective. Very few women who use this method become pregnant. Another advantage to this method is that you do not have to do anything before having sex. And no one except your health worker needs to know you are using a family planning method. To use this method, you will need to see a health worker every 1 to 3 months to get another injection.

After having your first injection, you may have irregular bleeding or heavy spotting during the first few months. Then you may have no monthly bleeding at all. This is not dangerous. When you stop getting injections, it may take longer than usual (as much as a year or more) for you to get pregnant. For this reason, injections are best only if you are sure you do not want to get pregnant in the next year or more.

Women with epilepsy may have fewer seizures when they use the family planning injection. Also, if you use the injection for more than 6 months, try to eat more foods that contain calcium to keep your bones strong. Using injectable contraceptives for a long time may cause your bones to become weaker.

Implants

With this method, a trained health worker puts small, soft tubes of progestin under the skin of a woman’s arm. The implant then prevents pregnancy for 3 to 5 years, depending on the type of implant. The implants must be removed after those 3 to 5 years are over and you will need a new implant or another family planning method right away if you do not want to get pregnant. If you want to get pregnant before that time, the implant must be removed by a health worker.

WWD Ch9 Page 198-2.png

implants
WWD Ch9 Page 198-3.png

Implants are put
under the skin...
WWD Ch9 Page 198-4.png

...and can be removed
by a trained health worker.


You cannot remove implants yourself. They can be removed only by a trained health worker. If you want to use implants, first make sure you will always be able to go to a health worker who knows how to remove them.

A woman with implants does not have to do anything before sex to prevent pregnancy. Implants contain only progestin, so they are safe for women who should not take estrogen. And they can be used safely while breastfeeding.

During the first months, the implants may cause irregular bleeding (in the middle of your monthly cycle) or more days of monthly bleeding. Or you may have no bleeding at all. This does not mean you are pregnant or that something is wrong. These changes usually go away as your body becomes used to having more progestin. If irregular bleeding causes problems for you, see a health worker. She may also give you low-dose combined birth control pills to take for a few months.


WARNING! If you have an implant, get medical help if you have any of these signs:

  • arm pain near the implant
  • pus, redness, or bleeding around the implant
  • the implant comes out