Combined Oral Contraceptives

Reviewed by: HU Medical Review Board | Last reviewed: March 2023

Combination contraceptives are drugs used by people who are sexually active but who do not wish to become pregnant. Combination contraceptives are often used off-label to treat other female reproductive system-related issues such as:

Combination contraceptives may also be used to improve bone mineral density or to treat acne. These drugs contain synthetic estrogen and progesterone. These are 2 hormones that impact the female reproductive system and suppress ovarian function. In turn, this may potentially impact the growth of endometriosis lesions. 1-4

A laparoscopy is the only method of definitively diagnosing endometriosis. Because of this, some doctors may treat endometriosis-related symptoms empirically. This means they base their treatment decisions on past experiences and other cases they have seen. If a person has clear signs of endometriosis, their doctor may first recommend combination contraceptives for their pain to see if this provides relief instead of pursuing diagnostic surgery. This may reduce symptoms and pain without the need for surgery.5

In some cases, a person may have signs of endometriosis while also wanting to try birth control. Their doctor may suggest combination contraceptives to address both issues.5

Combination contraceptives include:3

  • Birth control pills
  • Vaginal ring (NuvaRing)
  • Skin patch (Ortho Evra, Xulane) contraceptives

What are the ingredients in combination contraceptives?

Each combination contraceptive contains synthetically created estrogen and progesterone hormones. The exact synthetic version may vary between types, but they are all fairly similar and behave like estrogen and progesterone naturally produced in the body.3,4

How do combination contraceptives work?

These drugs affect the levels of estrogen and progesterone in the body. While these hormones are synthetically created in these drugs, the body recognizes them in the same manner.

Combination contraceptives stop the body from ovulating. This is the process by which the ovaries release an egg each month. Suppressing ovulation helps stabilize natural hormone levels in the body. In turn, this suppresses endometriosis lesion growth.1,3,4

Specifically, the estrogen component reduces or halts the production of FSH (follicle-stimulating hormone) and LH (luteinizing hormone). These hormones lead to ovulation. The progesterone component also reduces the production of LH. It also limits sperm movement and ability to reach any eggs that may be released. Both estrogen and progesterone affect the endometrium (lining of the uterus) and lighten menstrual flow.1,3,4

All of these methods also suppress the growth of endometriosis lesions shedding in other parts of the body. This reduces endometriosis-related pain.1,3,4

What are the possible side effects of combination contraceptives?

The most common side effects include:2,4,6

  • Nausea
  • Vomiting
  • Irregular uterine bleeding
  • Abdominal pain
  • Headache
  • Acne
  • Breast tenderness or pain
  • Anxiety and depression

These are not all the possible side effects of combination contraceptives. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with combination contraceptives.

Things to know about combination contraceptives

Combination contraceptives may increase a person's risk of developing blot clots. They should not be used before or immediately after major surgery, or by anyone with a history of blot clots. Combination contraceptives should not be used by those who have a condition that makes them prone to blood clots, such as lupus or hereditary thrombophilia.2,6

Combination contraceptives may affect the growth of estrogen-related cancers, such as breast cancer. People with breast cancer or other estrogen-dependent cancers should not take combination contraceptives.2,6

Combination contraceptives may also lead to an increase in blood pressure or liver problems. Tell your doctor if you notice any of the following:2,6

  • Breast lumps or discharge from the nipple
  • Severe nausea and vomiting
  • Pain in the calf, leg, groin, or chest
  • Pain in the side, abdomen, or stomach
  • Sudden slurring of speech
  • Sudden vision changes
  • Sudden loss of coordination or numbness of the limbs
  • Yellowing of the eyes or skin
  • Sudden shortness of breath

Before starting a combination contraceptive, tell your doctor if you:2,6

  • Are over the age of 35
  • Have a personal or family history of blood clots
  • Have any liver conditions
  • Have any heart conditions
  • Have any conditions that could make you prone to developing blood clots
  • Have any mental health-related conditions
  • Are a smoker
  • Are allergic to any drugs or drug ingredients
  • Could be pregnant
  • Are planning to breastfeed or are currently breastfeeding
  • Have high blood pressure
  • Have diabetes or are pre-diabetic

Before beginning treatment for endometriosis, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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