Low-Dose and Ultra-Low-Dose Birth Control Pills

You probably know that the pill has hormones in it to keep you from getting pregnant. Most versions have a combination of estrogen and progesterone. Some have more estrogen in them than others. While fewer hormones sounds like a good thing — and it mostly is — you should know the drawbacks when you’re weighing your choices.



What’s Low?

Birth control pills (also called oral contraceptives) work well. The catch is that the more estrogen you take, the more likely you are to have side effects such as headaches, nausea, breast tenderness, and rare but potentially fatal blood clots.

When the pill first came out in the 1960s, it had 150 micrograms of estrogen. Side effects were common, and that formula was soon taken off the market. Nowadays, the highest dose available is 50 micrograms of estrogen, but even that is rarely prescribed anymore.



Low-Dose Pill Options

Today, most pills have 35 micrograms or less of estrogen, an amount that’s generally called “low dose." These pills are both safe and effective for most women. But some people shouldn’t use them, so you should talk with your doctor about your health and habits (such as smoking).

Some examples of low-dose pills are:

  • Drospirenone and ethinyl estradiol (Yasmin)
  • Levonorgestrel and ethinyl estradiol (Levora)
  • Norethindrone and ethinyl estradiol (Estrostep or Ortho-Novum)
  • Norgestimate and ethinyl estradiol (Ortho-Tri-Cyclen Lo)
  • Norgestrel and ethinyl estradiol (Lo/Ovral-28)


Ultra-Low Dose Choices

In recent years there’s been a trend toward even lower levels of hormones. “Ultra-low-dose" pills have 20 micrograms of estrogen or less. Some examples are:

  • Desogestrel/ethinyl estradiol and ethinyl estradiol (Mircette)
  • Drospirenone and ethinyl estradiol (Yaz)
  • Levonorgestrel and ethinyl estradiol (Alesse)
  • Norethindrone and ethinyl estradiol (Lo Loestrin Fe)

Ultra-low-dose pills seem to be just as good at preventing pregnancy as higher dose options. They also come with a lower risk of side effects such as headaches and fluid retention.

They tend to work especially well in perimenopausal women. These are women who are still getting periods but are having menopausal symptoms like hot flashes and irregular periods.



Side Effects

Ultra-low-dose pills can cause side effects, too. Many women who take them have breakthrough bleeding, which can lead women to stop taking them. Taking your pill at exactly the same time every day may help reduce this problem, but there are no guarantees.

Another issue is that women who take ultra-low-dose pills may get vaginal dryness and chronic pelvic pain. Those can make sex uncomfortable.



Other Possible Benefits of Birth Control

Birth control pills have benefits besides contraception. They lower your risk of ovarian and endometrial cancer and can help with acne. But it’s not clear if ultra-low-dose formulas do as good a job of providing these perks.

Birth control isn’t one-size-fits-all, so you should weigh the pros and cons of going extra-low with your doctor.



Referenced on 2/7/2021

  1. https://www.webmd.com/sex/birth-control/low-dose-birth-control-pills
  2. Aponte, M. American Urological Association 2013 Annual Scientific Meeting: Abstract 1515. Presented May 2013.
  3. Association of Reproductive Health Professionals: “Choosing a Birth Control Method: Combined Oral Contraceptive Pills."
  4. Cianci, A. Minerva Ginecologica, August 2007.
  5. Cleveland Clinic Center for Continuing Education: “Female Contraception."
  6. International Pelvic Pain Society: “Do Oral Contraceptive Pills Cause Vulvodynia? Time to Finally End the Controversy."
  7. Kripke, C. American Family Physician, October 2005.
  8. Liao, P.V. Canadian Family Physician, December 2012.
  9. Mary Jane Minkin, MD, clinical professor, obstetrics, gynecology, and reproductive sciences, Yale School of Medicine.
  10. Planned Parenthood: “Birth Control Pills."
  11. Vanessa Cullins, MD, obstetrician/gynecologist; vice president of external affairs, Planned Parenthood Federation of America.
  12. Womenshealth.gov: “Menopause Symptom Relief and Treatments."

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