Depending on the composition of the hormones, such agents prevent ovulation ("ovulation inhibitor"), thicken the mucus in the cervix and thus make it difficult for the sperm to penetrate or inhibit the implantation of the egg into the uterus. In recent years, in addition to the classic "contraceptive pill" used since the early sixties, a number of alternatives have been developed.
Oral contraceptives (contraceptive pill)
They are swallowed daily for 21 or 22 days in tablet form, followed by a break of 7 or 6 days. They protect immediately, but must be taken regularly, no later than 12 hours after the normal rhythm. Antibiotics and some antiepileptic drugs may affect their effects.
In this still popular form of contraception, several categories are distinguished:
- conventional pill (combination preparation): prevents ovulation by a mixture of estrogens and progestins. In single-phase preparations, the mixing ratio remains constant over the intake period, but changes in two-phase and three-phase preparations to better match the female cycle (Pearl Index: 0.1-0.9)
- Micropille: similar to a conventional pill, but has lower estrogen content (Pearl Index: 0.2-0.5)
- Minipill: It contains only low-dose progestogens and must therefore be taken on a strict schedule (Pearl Index: 0.15-3).
The new progestin drospirenone ("Yasmin®"), which has been used since 2002, counteracts the accumulation of water caused by estrogens and the associated increase in weight, has positive effects on the skin and sometimes also helps with premenstrual syndrome. Other known progestins such as chlormadinone and dienogest also work against acne, hair loss and increased body hair.
Vaginal ring (NuvaRing®)
This soft, flexible ring is made of plastic, has a diameter of 54 mm and contains in a depot an estrogen-progestin mixture. He gives these hormones constantly and acts like a mini-pill (Pearl Index: 0.65). It is introduced by the women themselves like a tampon and removed after three weeks. After a week break, the next one is used. It has been available on the German market since February 2003.
Contraceptive patches (Evra® or Lisvy®)
The 4.5 x 4.5 cm, skin-colored hormone patch Evra® has existed in Germany since 2003. It releases its estrogen-progestin mixture continuously through the skin into the body, is stuck to the buttocks, upper arm, abdomen or upper back and changed weekly. As with the conventional pill, there is a break of one week after three weeks (Pearl index: 0.88, worse for overweight women).
Since 2015, the lower-dose, transparent, approximately 11 cm² Lisvy® contraceptive patch has also been available (Pearl Index: 0.81, insufficient data are available for overweight women).
Contraceptive sticks (Implanon®)
This contraceptive method using a stick that releases hormones has been on the market in Germany since June 2000. Like the three-month syringe, it only contains progestagens that are released slowly, its contraceptive is very safe and lasts for over three years (Pearl Index: 0.1-0.9). The 3-4 centimeters long and 2 millimeters thin stick is pushed by the gynecologist under the skin, on the inside of an upper arm.
Similar to the mini-pill, this contraceptive contains only progestins, but in depot form. It is injected every three months by the gynecologist in the humerus or buttock muscle and from there slowly releases its active ingredients (Pearl Index: 0.2-0.5).
Hormone Spiral (Mirena®)
Like the copper spiral, the hormone spiral ("intrauterine system" = IUS) is inserted into the uterus by the gynecologist and can remain for up to 5 years. Instead of copper she gives continuously progestins from there. It combines the advantages of the classic spiral with the methods of mini-pill or three-month syringe and is therefore very safe (Pearl Index: 0.05-0.1).