Estrogen-free birth control options may be a good fit if you can’t use birth control methods containing estrogen. They often contain artificial progesterone. Weigh the pros and cons before deciding if it is right for you.

Currently, there’s no one-size-fits-all birth control method that’s easy to use and free from side effects.

However, if you’re one of the many people who cannot use birth control methods that contain estrogen, you do have several options.

Many of the estrogen-free birth control alternatives contain progestin, which is an artificial version of the hormone progesterone.

In this article, we take a closer look at:

  • available progestin-only options
  • how they work
  • the pros and cons of each

The minipill is a type of oral contraceptive that contains pills that only have progestin.

None of the pills in the pack have any estrogen. The dose of progestin varies and depends on the formulation used in the birth control pill.

A minipill package has 28 pills, all of which contain the hormone progestin. It doesn’t contain any placebo pills.

To maximize the minipill’s effectiveness, you’ll need to take the pill at the same time every day.

If you miss a dose — even by as little as 3 hours — you’ll need to use a backup method of birth control for at least 2 days.

The newest progestin-only pill is called Slynd. The Food and Drug Administration (FDA) approved it in 2019. It can be taken within a 24-hour period and still not be considered a “missed dose,” unlike other progestin-only pills.

How does the minipill work?

In the United States, the progestin-only birth control pill is known as norethindrone. Norethindrone works by:

  • thickening the mucus in your cervix and thinning the lining of your uterus, making it harder for sperm and egg to meet
  • preventing your ovaries from releasing eggs

The progestin-only minipill may not always suppress your ovulation.

The American College of Obstetricians and Gynecologists (ACOG) estimates that around 40% of women will keep ovulating while taking progestin-only pills.

According to ACOG, the minipill is a good option for those who cannot take birth control pills containing estrogen.

This includes people who have a history of:

But progestin-only contraception isn’t the best choice for everyone. You may want to avoid the minipill if you have trouble remembering to take medications at the right time.

You may also want to avoid it if you’ve had breast cancer, as it can increase the risk of this cancer.

Some antiseizure medications break down hormones in your body, which means that a progestin-only pill might not be as effective if you take antiseizure medication.

If you’ve had bariatric surgery, talk with your doctor about the risks of taking an oral contraceptive.

Bariatric surgery may affect the way your system absorbs these medications, making them less effective.

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Before starting the minipill, talk with your doctor about what day to begin.

You can start using this pill on any day of your menstrual cycle, but depending on where you are in your cycle, you may have to use a backup birth control method for a few days.

If you start taking the minipill during the first 5 days of your period, it should fully prevent pregnancy, and you won’t need any additional contraception.

If you start on any other day, you’ll need to use an extra method of pregnancy prevention for at least 2 days.

If your period has a short cycle, you should use additional birth control until you’ve been taking the minipill for at least 2 days.

All oral contraceptives have potential side effects, and they vary in intensity from person to person.

You may experience the following side effects from the progestin-only minipill:

Minipill pros

  • You don’t have to interrupt sex to take care of birth control.
  • You can take this pill if estrogen isn’t recommended for you due to high blood pressure, deep vein thrombosis, or cardiovascular disease.
  • Your periods and cramps might lighten up.
  • You can use this method if you’re breastfeeding.

Minipill cons

  • You need to be vigilant and precise about when you take the pill.
  • You might experience spotting between periods.
  • Your sex drive might decrease.
  • Your body hair might grow differently.

If you want hormonal birth control without estrogen, the minipill is just one option. There are several other progestin-only birth control options. Each one works differently and has unique side effects and risks.

Here’s a quick rundown of your options.

Depo-Provera is an injection. It works the same way as the progestin-only pill: It thickens the mucus around your cervix to prevent sperm from reaching an egg. Additionally, it stops your ovaries from releasing eggs.

Each injection lasts around 3 months.

Progestin shot pros

  • You don’t have to think about taking a birth control pill every day.
  • Many people consider an injection less invasive than using an IUD.
  • If you get the shots at recommended intervals, it’s over 99% effective at preventing pregnancy.

Progestin shot cons

In the United States, progestin implants are marketed under the brand name Nexplanon. The implant consists of a skinny, flexible rod that your doctor inserts just under the skin on your upper arm.

Like the minipill and progestin injection, an implant releases small amounts of progestin into your system.

This causes:

  • the lining of your uterus to thin
  • your cervical mucus to thicken
  • your ovaries to stop releasing eggs

Once in place, the implant is extremely effective. According to the Centers for Disease Control and Prevention (CDC), implants are more than 99% successful at preventing pregnancy.

Progestin implant pros

  • You don’t have to think about birth control every day.
  • You don’t have to interrupt sex to take care of birth control.
  • It’s highly effective.
  • It can be used immediately after childbirth or an abortion.
  • It’s safe to use while you’re breastfeeding.
  • It’s reversible. Your doctor can remove it if you want to get pregnant.

Progestin implant cons

  • A doctor needs to insert the implant.
  • There may be a high upfront cost if insurance doesn’t cover it.
  • Your periods may become harder to predict. They could become heavier or lighter, or they could go away altogether.
  • You may experience breakthrough bleeding.
  • You could experience side effects like headaches, acne breakouts, weight changes, or tender breasts.
  • The implant can migrate or may be difficult to take out when it’s time for removal. If either situation arises, some people may need imaging tests. In rare cases, surgery is needed to remove the implant.
  • You may experience mood changes.

Another option is an intrauterine device (IUD) that your doctor inserts into your uterus. Made of plastic, this small, T-shaped device releases small amounts of progestin, preventing pregnancy for up to 8 years.

According to ACOG, an IUD doesn’t interrupt pregnancy. It prevents it.

Progestin IUD pros

  • You don’t have to think about birth control very often.
  • It’s 99% effective at preventing pregnancy.
  • Your periods may get lighter. Cramps may lessen, too.
  • An IUD is reversible and won’t affect your fertility or make it harder to get pregnant in the future.

Progestin IUD cons

  • It can be uncomfortable to have the IUD inserted.
  • Your periods may be harder to predict.
  • You could experience spotting or breakthrough bleeding, especially at the beginning.
  • Your IUD could come out.
  • In rare cases, implanting the device could puncture your uterus.
  • In rare cases, you may experience an ectopic pregnancy.

If you want to use nonhormonal birth control methods, talk with your doctor or a healthcare professional about these options:

Many of these methods are less effective at preventing pregnancy than methods that involve hormones.

Spermicide, for example, fails roughly 28% of the time, so it’s important to understand the risks as you weigh your options.

If you need a more permanent form of birth control, talk with your doctor about tubal ligation or vasectomy.

The progestin-only minipill is one of several birth control methods that doesn’t contain estrogen.

The minipill works by suppressing ovulation and changing your uterus and cervix to make it unlikely that sperm will be able to fertilize an egg.

If you want to use hormonal birth control without estrogen, you could also try progestin-only shots, implants, or IUDs.

If you want to use a hormone-free birth control method, you could explore options like condoms, a diaphragm, cervical caps, a copper IUD, sponges, tubal ligation, or vasectomy.

Since all birth control methods have side effects, talk with your doctor about the type of contraception that works best for you.

Be sure to tell your doctor about any health conditions you have as well as any supplements and medications you take, as they could reduce the effectiveness of your contraception.