Birth Control Pill Hormone Comparison: A Complete Guide
Not all birth control pills are the same. They vary by estrogen type, progestin generation, hormone dosage, and dosing schedule. Understanding these differences can help you and your partner have more informed conversations with your doctor.
How birth control pills are classified
Birth control pills fall into two main categories:
- Combined oral contraceptives (COCs) -- contain both estrogen and progestin
- Progestin-only pills (POPs / mini-pills) -- contain only progestin, no estrogen
COCs are further classified by estrogen dose:
| Classification | Ethinyl Estradiol (EE) Dose | Examples |
|---|---|---|
| Ultra-Low Dose | 10-15 mcg | Lo Loestrin Fe |
| Low Dose | 20 mcg | Yaz, Mercilon, Meliane, Alesse |
| Regular Dose | 30-35 mcg | Yasmin, Diane-35, Ortho-Cyclen |
| High Dose | 50 mcg | Ogestrel (rarely prescribed today) |
Progestin generations
The progestin component determines many of a pill's side effects and characteristics. Progestins are grouped by generation:
| Generation | Progestins | Androgenic Activity | VTE Risk |
|---|---|---|---|
| 1st Gen | Norethindrone, ethynodiol diacetate | High | Baseline |
| 2nd Gen | Levonorgestrel, norgestrel | Moderate | Lowest among COCs |
| 3rd Gen | Desogestrel, gestodene, norgestimate | Low | ~1.5-2x vs 2nd gen |
| 4th Gen | Drospirenone, cyproterone acetate, dienogest | Anti-androgenic | ~1.3-2x vs 2nd gen |
What does this mean?
Androgenic activity relates to side effects like acne, oily skin, and hair growth. Lower is generally preferred for these concerns.
VTE risk (venous thromboembolism / blood clots) is slightly higher with 3rd and 4th generation progestins. The NIH considers EE 30 mcg + levonorgestrel (2nd gen) the safest COC in terms of clot risk.
Combined pills: complete comparison
Low-dose pills (EE 20 mcg)
| Brand (US) | Brand (Korea) | Progestin | Progestin Dose | Gen | Regimen |
|---|---|---|---|---|---|
| Yaz, Gianvi, Loryna | Yaz (야즈) | Drospirenone | 3 mg | 4th | 24/4 |
| Kariva, Mircette | Mercilon (머시론) | Desogestrel | 150 mcg | 3rd | 21/7 |
| Loestrin 1/20, Junel 1/20 | - | Norethindrone acetate | 1 mg | 1st | 21/7 |
| - (not available in US) | Meliane (멜리안) | Gestodene | 75 mcg | 3rd | 21/7 |
| Alesse | Alesse (에이리스) | Levonorgestrel | 100 mcg | 2nd | 21/7 |
Regular-dose pills (EE 30-35 mcg)
| Brand (US) | Brand (Korea) | Progestin | Progestin Dose | Gen | Regimen |
|---|---|---|---|---|---|
| Yasmin, Ocella | Yasmin (야스민) | Drospirenone | 3 mg | 4th | 21/7 |
| Desogen, Apri | Sensday (센스데이) | Desogestrel | 150 mcg | 3rd | 21/7 |
| Nordette, Portia | Minivlar (미니보라) | Levonorgestrel | 150 mcg | 2nd | 21/7 |
| - (not available in US) | Myvora (마이보라) | Gestodene | 75 mcg | 3rd | 21/7 |
| Ortho-Cyclen, Sprintec | - | Norgestimate | 250 mcg | 3rd | 21/7 |
| - (not available in US) | Diane-35 (다이안느35) | Cyproterone acetate | 2 mg | 4th | 21/7 |
Progestin-only pills (mini-pills)
These pills contain no estrogen and are suitable for people who cannot take estrogen, including those who smoke, are over 35, have migraines with aura, or are breastfeeding.
| Brand | Progestin | Dose | Regimen | Notes |
|---|---|---|---|---|
| Camila, Errin, Heather | Norethindrone | 0.35 mg | 28 active (no placebo) | Strict 3-hour window |
| Slynd | Drospirenone | 4 mg | 24 active + 4 placebo | 24-hour window; anti-androgenic |
| Opill (OTC) | Norgestrel | 0.075 mg | 28 active | First OTC oral contraceptive (US) |
| Cerazette | Desogestrel | 75 mcg | 28 active | 12-hour window; not available in US |
Monophasic vs. multiphasic pills
| Type | Hormone Levels | Missed Pill Forgiveness | Can Skip Periods? |
|---|---|---|---|
| Monophasic | Same dose every pill | Most forgiving | Easiest to extend |
| Biphasic | 2 different dose levels | Moderate | Possible |
| Triphasic | 3 different dose levels | Least forgiving | More complex |
Which is better?
Cochrane reviews found no significant difference in efficacy between monophasic and multiphasic pills. Monophasic pills are generally simpler to use, especially if you want to skip periods by running packs together.
Side effects by hormone type
Estrogen-related side effects (dose-dependent)
| Side Effect | Higher EE (35-50 mcg) | Lower EE (20 mcg) | Ultra-Low (10 mcg) |
|---|---|---|---|
| Nausea | More common | Less common | Least common |
| Breast tenderness | More common | Less common | Least common |
| Headache | More common | Less common | Least common |
| Blood clot risk | Highest | Lower | Lowest |
| Breakthrough bleeding | Less common | More common | Most common |
Progestin-related side effects (by type)
| Progestin | Acne Effect | Weight Effect | Clot Risk (vs LNG) | Special |
|---|---|---|---|---|
| Levonorgestrel 2nd | May worsen | Possible slight gain | Reference (lowest) | - |
| Norgestimate 3rd | May improve | Neutral | ~1.5-2x | FDA-approved for acne |
| Desogestrel 3rd | May improve | Neutral | ~1.5-2x | - |
| Drospirenone 4th | Improves | Possible slight loss | ~1.3-2x | Anti-water-retention |
| Cyproterone acetate 4th | Strongly improves | Variable | Higher | For severe acne/PCOS |
Pills available in Korea (한국 경구피임약)
In Korea, 2nd and 3rd generation pills are available over-the-counter (일반의약품), while 4th generation pills require a prescription (전문의약품).
Over-the-counter (일반의약품)
| 제품명 | EE 용량 | 프로게스틴 | 세대 | 구분 |
|---|---|---|---|---|
| 에이리스 (Alesse) | 20 mcg | 레보노르게스트렐 0.1 mg | 2세대 | 저용량 |
| 라니아 (Rania) | 20 mcg | 레보노르게스트렐 0.1 mg | 2세대 | 저용량 |
| 미니보라 (Minivlar) | 30 mcg | 레보노르게스트렐 0.15 mg | 2세대 | 일반용량 |
| 머시론 (Mercilon) | 20 mcg | 데소게스트렐 0.15 mg | 3세대 | 저용량 |
| 멜리안 (Meliane) | 20 mcg | 게스토덴 0.075 mg | 3세대 | 저용량 |
| 마이보라 (Myvora) | 30 mcg | 게스토덴 0.075 mg | 3세대 | 일반용량 |
| 센스리베 | 20 mcg | 데소게스트렐 0.15 mg | 3세대 | 저용량 |
| 디어미 | 20 mcg | 데소게스트렐 0.15 mg | 3세대 | 저용량 |
Prescription only (전문의약품)
| 제품명 | 에스트로겐 | 프로게스틴 | 세대 | 특징 |
|---|---|---|---|---|
| 야즈 (Yaz) | EE 20 mcg | 드로스피레논 3 mg | 4세대 | 항안드로겐, 부종 감소, 24/4 복용 |
| 야스민 (Yasmin) | EE 30 mcg | 드로스피레논 3 mg | 4세대 | 항안드로겐, 부종 감소 |
| 다이안느35 (Diane-35) | EE 35 mcg | 시프로테론 아세테이트 2 mg | 4세대 | 강력한 항안드로겐 (여드름/다모증) |
| 클래라 (Qlaira) | 에스트라디올발레레이트 1-3 mg | 디에노게스트 2-3 mg | 4세대 | 천연 에스트로겐, 다단계 복용 |
2세대 vs 3세대 vs 4세대: 어떻게 선택할까?
2세대: 혈전 위험이 가장 낮음. 안드로겐 관련 부작용(여드름 등)이 있을 수 있으나, 안전성 측면에서 가장 권장됨.
3세대: 안드로겐 부작용 감소. 처방전 없이 구매 가능. 혈전 위험은 2세대 대비 약 1.5-2배.
4세대: 여드름 개선, 부종 감소 등 추가 효과. 처방 필요. 혈전 위험으로 정기 검진 권장.
How to choose the right pill
There is no single "best" pill. The right choice depends on your individual health profile, concerns, and preferences. Here are general guidelines from medical literature:
- Lowest clot risk: EE 30 mcg + levonorgestrel (2nd gen) is considered the safest COC per NIH
- Acne or oily skin: Drospirenone (Yaz/Yasmin) or cyproterone acetate (Diane-35) pills have anti-androgenic effects
- Water retention concerns: Drospirenone has anti-mineralocorticoid activity (mild diuretic effect)
- Cannot take estrogen: Progestin-only pills (Slynd offers a more flexible missed-pill window than older mini-pills)
- Fewest side effects: Ultra-low or low-dose pills (10-20 mcg EE) reduce estrogen-related side effects but may increase breakthrough bleeding
Sources
- NIH/NCBI StatPearls - Oral Contraceptive Pills
- NIH/NCBI StatPearls - Progestins
- FDA Prescribing Information - Yaz
- FDA Prescribing Information - Slynd
- Mayo Clinic - Choosing a Birth Control Pill
- PMC - Triphasic vs Monophasic OCs (Cochrane Review)
- PMC - COCs and VTE Risk Review
- PMC - MEGA Study: VTE Risk by OC Type
- 식약처 의약품통합정보시스템 - 야즈정
- 식약처 의약품안전사용 매뉴얼 - 경구피임약
- 대한약사저널 - 경구피임약 선택가이드