Birth control pills and uterine fibroids
Examples
Generic Name Brand Name Very low-dose pills Alesse, Minestrin, Marvelon Low-dose pills Min-Ovral, Yasmin Phasic pills Ortho 7/7/7, Ortho Tri-Cyclen Lo, Triphasil High-dose pills Demulen 1/50, Norinyl 1/50, Ovral
Note: This is not a complete list of all brand-name birth control pills available.
Skin patch
Generic Name Brand Name 20 mcg estrogen, plus progestin Evra patch Vaginal ring
Generic Name Brand Name 15 mcg estrogen, plus progestin NuvaRing Very low-dose pills have 20 mcg of estrogen plus progestin.
Low-dose pills have 30 to 35 mcg estrogen plus progestin.
Phasic pills have changing levels of estrogen and progestin.
High-dose pills have about 50 mcg of estrogen plus progestin.
How It Works
Birth control pills, also called oral contraceptives, control the body's estrogen and progesterone levels (progestin is a synthetic form of the body's progesterone). Even though estrogen and progestin have a role in uterine fibroid growth, birth control pills do not affect the size of fibroids. However, birth control pill use improves heavy menstrual bleeding, which can be caused by uterine fibroids.
There are no studies that show birth control pills to be an effective fibroid treatment.1
When taking birth control pills, your hormone levels are like they would be during pregnancy. Birth control pills:
- Prevent the ovaries from releasing an egg every month (ovulation). This prevents pregnancy.
- Minimize the growth of the uterine lining, called the endometrium. This reduces or stops dysfunctional uterine bleeding (thick endometrial growth leads to heavy bleeding).
- Can stop menstrual periods if taken for a long period of time. This effect can last until several months after you stop taking them.
If you prefer to use a birth control patch or vaginal ring, see how to use the contraceptive skin patch or how to use the vaginal hormonal contraceptive ring.
Why It Is Used
Birth control pills are commonly prescribed to lighten heavy menstrual bleeding with or without uterine fibroids. This is because birth control pills can help correct menstrual problems, and they are a low-risk treatment for most women.
Generally, birth control hormonal pills, skin patches, or vaginal rings are good choices for women who have one or more of the following concerns:
- Need short- or long-term birth control that can be stopped at any time
- Prefer a form of birth control that does not interfere with sexual spontaneity
- Have heavy, painful, or irregular menstrual periods
- Have endometriosis
- Have ovarian cysts
- Have a family history of ovarian cancer. Combination pills reduce the risk of ovarian cancer after 1 year of use. This benefit seems to last for years after stopping the pill.2
How Well It Works
Birth control pill use reduces heavy, prolonged, and painful menstrual bleeding. Because the pills prevent pregnancy, they are not a choice for women who are trying to become pregnant.3
Birth control pill use does not affect the size of uterine fibroids.4
Side Effects
Birth control pills have been studied for many years and are considered very safe.
Common side effects
The most common side effects are changes in menstrual periods, including:
- Very light or skipped periods.
- Bleeding between periods (spotting), which usually decreases after using a hormonal method for 3 to 4 months.
The contraceptive skin patch may cause skin irritation at the site.
The contraceptive vaginal ring may cause:
- Vaginal discharge.
- Irritation and inflammation of the vagina (vaginitis).
Less common side effects
Less common side effects of combination hormonal methods include:
- Nausea and vomiting, especially during the first month of use. (Try taking your pill with your evening meal or at bedtime and then sleeping through the high-hormone hours that can cause nausea. Or take your pill with breakfast, if nausea bothers you at night.) This side effect is least likely with the vaginal ring. Nausea usually goes away after the first few months of use. If not, a lower dose of estrogen may help.5
- Frequent or more severe headaches. Migraine headaches may get worse. This side effect is least likely with the vaginal ring.
- Breast tenderness for the first few months.
Uncommon side effects
Side effects that are sometimes reported with hormonal birth control use include:5
- Weight gain. (Although some women report weight gain with birth control pill use, studies suggest that generally, long-term weight gain is not a common side effect.6)
- Depression or mood changes.
- Darkening of the skin on the upper lip, under the eyes, or on the forehead (chloasma). This may slowly fade after you stop using hormonal methods, but in some cases, it is permanent.
- Decreased interest in sex.
Rare but serious side effects of combination hormonal methods
The risk of a serious side effect increases with age and with smoking. Rare, but more serious, side effects include:
- High blood pressure.
- Blood clots in a vein (deep vein thrombosis) or lung (pulmonary embolism).
- Heart problems.
- Possible increased risk of cervical cancer. (See Does the Pill cause cancer?)
The following symptoms, called ACHES, are rare but serious. Report any of these to your health professional immediately.7
- Abdominal pain that is severe or persists may be a sign of blood clots (thrombophlebitis) in the pelvis, liver blood clots or tumours, or gallbladder disease.
- Chest pain may be a sign of blood clots in the lungs (pulmonary embolism), heart attack, or heart disease. Smoking increases this risk.
- Headaches that are severe may be a sign of stroke, migraine, or hypertension. Smoking increases this risk.
- Eye problems, such as blurred vision or loss of vision, may be a sign of migraine, blood clots in the eye, or a change in the shape of the cornea.
- Severe leg pain or sudden swelling of one leg may be a sign of leg blood clots (thrombophlebitis) or deep vein thrombosis (DVT).
Report any serious side effect to your health professional for immediate follow-up.
Report bothersome side effects to your health professional at your next regularly scheduled visit.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Combination hormonal pills, skin patches, and vaginal rings have similar possible side effects because they all contain a combination of estrogen and progestin. The pill causes hormone levels to peak and drop each day. Each weekly patch takes 3 days after application to reach a steady hormone level. The ring releases a steady dose every day throughout the day. This may explain why the ring is less likely than the pill or patch to cause headaches and nausea.5
Birth control hormones may not relieve your uterine fibroid symptoms. They do not shrink fibroids.4 They may, however, improve heavy menstrual bleeding.
Patch warnings
- The patch delivers more estrogen than the low-dose birth control pills do. Some research has found that women using the patch are more likely to get dangerous blood clots in the legs and lungs. The risk may be higher if you smoke or have certain health problems. Health Canada suggests that you talk to your doctor about the risks and benefits of using the patch.8
- Direct sunlight or high heat can increase, then lower, the amount of hormone released from a patch. This can give you a big dose at the time and leave less hormone for the patch to release later in the week. This increases your risk of pregnancy. Avoid direct sunlight on the hormone patch. Also avoid using a tanning bed, heating pad, electric blanket, hot tub, or sauna while you are using a hormone patch.
Do not use birth control hormones if you:
- Are older than 35 and smoke, have diabetes, or have an increased risk of heart disease.
- Have a personal or family history of breast cancer. Estrogen stimulates certain types of breast cancer.
Birth control hormones are not generally recommended if you have any of the following conditions:
- Uncontrolled high blood pressure
- Liver disease
- A history of blood clots in a vein (deep vein thrombosis) or lung (pulmonary embolism)
- A history of stroke
- Migraine headaches with aura
For women older than 35, low-dose birth control pills are recommended. If you have no risk factors, such as a history of heart problems or diabetes, you may use birth control pills until you reach menopause. This is when you have had no menstrual periods for 1 year. Birth control pills are not recommended for use after menopause.
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| Author: | Kathe Gallagher, MSW | Last Updated: October 8, 2007 |
| Medical Review: | Kathleen Romito, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine | |
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| Topic Contents | |
| Examples | |
| How It Works | |
| Why It Is Used | |
| How Well It Works | |
| Side Effects | |
| What To Think About | |
| References | |