What are hormonal contraceptives?

Hormonal contraceptives are birth control methods that use hormones to prevent pregnancy. There are different types — most contain oestrogen or progesterone hormones, or both.

The most common hormonal contraceptives are:

• the combined oral contraceptive pill ('the pill')
• the progesterone-only pill ('mini-pill')
• an injection, implant or vaginal ring that contains the hormone

What is menopausal hormone therapy (MHT)?

Menopausal hormone therapy (MHT) is medicine that uses oestrogen hormones or progesterone hormones to relieve some menopausal symptoms. Some MHT combine both hormones. Reducing symptoms of menopause can improve your quality of life.

MHT is also called hormone replacement therapy (HRT).

MHT can help with these menopause symptoms:

• hot flushes
• night sweats
• vaginal irritation, burning or dryness
• frequent or urgent urination (weeing)
• recurring urinary tract infections (UTIs)
• painful sex

Some types of MHT can also help reduce your chance of:

• bone fracture or osteoporosis
• endometrial cancer
• heart disease

How do these medicines work?

Hormonal contraceptives and MHT work by adjusting oestrogen and progesterone levels in your body.

Hormonal contraception

Hormonal contraception prevents pregnancy by:

• preventing ovulation
• thickening your cervical mucus to block sperm from getting into your uterus
• thinning your uterus lining to prevent implantation of a fertilised egg

Read more about how the pill works.

MHT

As you go through menopause, changes in hormone levels can cause symptoms.

Using MHT adds back some of these hormones:

• Oestrogen — relieves some menopause symptoms and maintains bone density.
• Progesterone — protects against endometrial cancer (if you haven't had a hysterectomy).

Other MHT options:

• Testosterone — may improve low libido and orgasm after menopause.
• Tibolone — a synthetic steroid that improves symptoms. Tibolone can cause irregular bleeding. It is only recommended if your period stopped at least a year ago.

Read more about the different types of MHT.

What types of medicines might I be prescribed?

There are different types of hormonal medicines. They come in different doses, types and combinations. There are advantages, disadvantages and side effects to each type.

Different types of hormonal contraception

The different ways you can take hormonal contraceptives include:

• pills — the pill (combined oral contraceptive pill), mini-pill (progesterone-only pill) and the morning after pill (emergency contraception pill)
• contraceptive injection
• contraceptive implant under your skin
• intrauterine device (IUD)
• vaginal ring

Some are short acting. You need to take contraceptive pills every day. Vaginal rings need to be changed once a month.

Some are long-acting. IUDs and implants can stay in place for up to 5 years.

Different types of MHT

MHT may contain:

• Oestrogen only — used after a hysterectomy (removal of the uterus)
• Combined MHT containing both oestrogen and progestogen — the progestogen can be taken all the time (continuous) or for a certain number of days each month (cyclical)
• Tibolone — used if you have side effects with progestogen treatment

MHT can be taken:

• by mouth as a pill or tablet
• by applying a gel, patch or cream to your skin
• by applying a vaginal cream
• by inserting a pessary (vaginal tablet) or using cream

Sometimes, an intrauterine device (IUD) is used to give you progestogen.

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What are the side effects or risks of these medicines?

Hormonal contraceptives and MHT can cause some of these side effects:

• acne
• breast tenderness
• headaches
• mood changes
• weight gain, bloating, nausea, diarrhoea
• reduced libido
• irregular bleeding

If you take hormonal contraceptive or MHT containing oestrogen, you have a slightly higher chance of:

• a blood clot
• stroke
• heart attack
• some cancers
• high blood pressure

Your chance of side effects also depends on the dose, duration and how you take MHT, as well as your own and family medical history.

Tell your doctor about any heart disease or cancer history before starting MHT.

Read more about MHT and contraception side effects.

Your doctor will prescribe you the lowest dose possible to minimise side effects. You may need to try more than one pill or MHT to find one that suits you.

When should I see my doctor?

You should see your doctor:

• to discuss which type of contraception or MHT is best for you
• within 6 months of starting MHT
• once a year, to check your risks and if you need to continue MHT
• if you are experiencing side effects
• if you are planning a pregnancy
• if you want to have your IUD or implant removed

See your doctor straight away if you notice:

• signs of a blood clot such as redness or pain in your leg
• difficulty breathing or chest pain
• breast changes
• heavy or irregular periods or bleeding after sex

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Are there any alternatives to these medicines?

There are other options if you do not want to take hormonal medicines.

Alternatives to hormonal contraception

Alternative contraception options include:

• barrier method — male and female condom, diaphragm
• fertility awareness method
• lactation amenorrhoea (breastfeeding) method
• sterilisation — vasectomy and tubal sterilisation
• withdrawal method

Some of these types of birth control are not as effective as hormonal contraception.

Alternatives to MHT

Alternative ways to manage your menopause symptoms include:

• hypnosis
• cognitive behaviour therapy
• non-hormonal medicines developed for vasomotor symptoms (hot flushes and night sweats)
• selective oestrogen receptor modulators for osteoporosis
• antidepressant medicines

These are effective for some people.

Yoga, exercise, diet, supplements, weight loss and alternative medicines have not been found to reduce hot flushes or night sweats.

There is little evidence to support using vaginal moisturisers, lubricants and vaginal laser to improve vaginal dryness and other vaginal symptoms.

Talk with your doctor or pharmacist about alternatives.

Read more about managing menopausal symptoms without medication.

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Resources and support

There are lots of ways to learn more about hormone medicines.

• Easy Read information about types of contraception has been shared by Women with Disabilities Australia.
• The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has information on menopause.
• Family Planning Australia has a factsheet on contraception options.
• Jean Hailes for Women's Health has information about female health topics including treatments for menopause symptoms.

Languages other than English

Jean Hailes for Women's Health has health information in a range of languages.

Information for Aboriginal and/or Torres Strait Islander people.

Family Planning Australia has a yarning about contraception booklet.

Jean Hailes for Women's Health has menopause information for First Nations communities.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.