Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team
When people talk about the dose of birth control, they mean the amount of hormones or active ingredients it has. Back in the day, “low dose” birth control had a higher amount of hormones (50 to 110 micrograms of estrogen!). So, if you’re asking specifically for low dose birth control, you should know that most pills today are considered low dose.
If you need a birth control prescription today and are in CA, FL, WY or TX you can consult one of Pandia Health’s expert birth control doctors to make sure you’re getting the best birth control for you.
The pills prescribed today are all low dose with around 30-35 micrograms of hormones. Although pills with doses lower than 30 micrograms do exist, these ultra-low dose birth control pills come with their risks. These usually are 20 or 10 micrograms and pose a risk to your bone density if you are under the age of 30 years old.
Estrogen and Bones
Your bones continue gaining density until you reach your 30s and estrogen can help with that process. Studies have shown that young adult females who had continued use of birth control pills with estrogen levels less than 30 micrograms had lower bone mass density when measured at the spine. Hormone therapy with estrogen is even used by menopausal females to prevent bone density loss.
Who gets low dose birth control?
Most people today are on pills that have 30-35 micrograms of estrogen; the pill with 10 or 20 micrograms is not usually recommended but this may be prescribed to you if you are experiencing nausea on the regular 30-35 microgram dose or if you’re under 100 pounds.
If you ask your provider for a low dose, they might prescribed you one of these very low dose pills. However, doctors who are not specialists in adolescent and young adult health or bone health may prescribe these ultra-low dose pills because they don’t know about the research showing that <30 mcg of estrogen in pills can result in lower bone mass density.
Adolescent Medicine, bone, and pediatric gynecology specialists at Stanford Medical School agree that if you are under 30 years old, you should have a birth control pill that has at least 30 mcg of estrogen.
How is Low-dose Birth Control Different from Other Hormonal Contraceptives?
Hormonal birth control products are some of the most popular and effective contraceptive methods used in the U.S. Since the birth control pill was invented and marketed in 1960, new hormonal birth control methods have become more accessible and inexpensive for women. Not only can they protect women from an unwanted pregnancy, but they can also improve their quality of life, regulate hormonal imbalances, and give women freedom and choices that their female ancestors never had.
Generally, hormonal birth control products are considered safe for most women. But they do come with risks. Fortunately, there are many different kinds of hormonal and non-hormonal contraceptives that women can try before choosing one that’s right for their needs and lifestyle.
How does the birth control pill work?
Before one can fully appreciate what makes low-dose contraceptives different than other forms of birth control, it’s crucial to understand how the birth control pill works in the first place.
The female reproductive system operates under a cycle of rising and falling estrogen, progesterone, and androgen hormones. At the beginning of the cycle, hormones steadily increase until the ovary is triggered to release an egg. Once this happens, hormones influence the uterus to grow an endometrial lining in preparation of a fertilized egg. If an egg is not fertilized within about 10 to 14 days after ovulation, the endometrium is shed, resulting in a menstrual period.
The pill disrupts the rising and falling of reproductive hormones, preventing the ovary from releasing an egg. Instead of a rise and fall of hormones, the pill introduces a steady dose of synthetic estrogen and progesterone hormones. The endometrium is not signaled to grow to prepare a fertilized egg, and when women who take the pill have a menstrual period, it’s not really a period because ovulation did not occur. Monthly bleeding on the pill is referred to as withdrawal bleeding.
Naturally occurring estrogen in the female reproductive cycle is produced in the ovaries. Estrogen helps the uterus grow the lining that is responsible for the implantation of a fertilized egg.
Changes through birth control history
When the pill was first introduced, it contained around 100 micrograms of synthetic estrogen, called ethinyl estradiol; this level of estrogen has since decreased. High doses of synthetic estrogen can cause many side effects, including a significantly increased risk of blood clot formation and other issues.
Most birth control pills in 2019 contain a mix of synthetic estrogens and progesterone hormones. Some higher dose pills on the market even contain approximately 50 micrograms of estrogen while lower dose pills, like Lo Loestrin Fe, have only 10 micrograms of synthetic estrogen.
While there is still a risk of blood clots when taking combination birth control pills, the risk is substantially lower with pills that contain 30 micrograms of estrogen or lower.
Hormone Dose in Other Forms of Birth Control
Today, most birth control pills are considered low dose, whether they contain a combination of synthetic estrogen and progesterone, or are progesterone-only pills. The birth control ring and the birth control patch contain similar amounts of estrogen as low-dose combination pills.
The one-month vaginal contraceptive ring (such as Nuvaring or EluRyng) releases 15 mcg of ethinyl estradiol per day, which may be equivalent to 20 mcg of estrogen level in blood. In a 2005 study focusing on women who used the ring for two years, it was reported that these women did not gain bone density while those who did not use the ring did increase their bone density.
Annovera releases 13 mcg of ethinyl estradiol per day, which is “one of the lowest doses” out there. But this might not be good for your bone mineral density if you are under the age of 30 years old.
The birth control patch delivers 20 micrograms of synthetic estrogen every day for seven days before the patch is changed. However, the body absorbs a higher dose of estrogen from the patch than the pill because when using the patch, the hormones are directly absorbed into the bloodstream and able to bypass the liver’s filtering functions. Therefore, women who have increased risk factors for blood clots should not use the birth control patch.
Pandia Health has FREE delivery on your birth control pill, patch, or ring so make sure to sign up today to get automatic refills and your birth control straight to your mailbox.
Are low-dose birth control pills still effective?
Yes, with typical use, low-dose birth control pills are still 92% effective against preventing unintended pregnancy. Combination pills which contain a low dose of estrogen and progesterone hormones can be taken as generics or name brand. Both types have the same amount of effectiveness. The most popular brand name, low-dose combination pills are:
In most cases, women will take 21 days of active pills followed by a seven-day break where only placebo pills are taken. It is during this seven-day break that a withdrawal bleed will occur. However, it is safe for women to take birth control pills to prevent monthly bleeding for months or years if needed.
Low-dose progesterone-only pills are also 92% effective with typical use. Brand names of synthetic progesterone-only pills include:
Low-dose progesterone-only pills are also called minipills, and each monthly pack contains 28 active pills. It is critical for women who are on the minipill to take it at the exact same time every day in order for it be effective. Combination pills give women slightly more leeway as far as what time of day she must take the pill for it to be effective.
Doctors often prescribe the minipill for women who are breastfeeding or are in perimenopause; it is also safe for women who cannot tolerate synthetic estrogens. In addition, up to 40% of women who take the minipill will continue to ovulate and it prevents pregnancy by making the uterus inhospitable to implantation.
Women who are over 35, who smoke, or who have a family or personal history of blood clots should steer clear of synthetic estrogens. The minipill may be safe for women with these risk factors to use to prevent pregnancy and regulate hormones
If you’re curious about what type of hormonal birth control can work for you, sign up with Pandia Health today. Our expert doctors are standing by to assist you with all your birth control needs.
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