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:

• combined oral contraceptive pill ('the pill')
• progesterone-only pill ('mini-pill')

What is menopausal hormone therapy (MHT)?

Menopausal hormone therapy (MHT) is medicine that uses oestrogen and/or progesterone hormones to relieve some menopausal symptoms and improve your quality of life.

MHT can help relieve these menopause symptoms:

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

MHT may also help prevent osteoporosis.

MHT is also called hormone replacement therapy (HRT).

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

Read more about how the pill works.

MHT

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

How MHT helps:

• 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. For example:

• you need to take pills every day
• vaginal rings need to be changed once a month

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

Different types of MHT

The different forms of MHT include:

• gel
• pills
• vaginal pessary, tablet, cream or ring

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 and nausea
• reduced libido
• irregular bleeding

If you are taking hormonal contraceptive or MHT with oestrogen, you are at a slightly higher risk of a blood clot, stroke, heart attack, some cancers and high blood pressure.

Read more about MHT and contraception side effects.

Your doctor will prescribe you the lowest dose possible to minimise side effects. Ask your doctor how long you should continue taking hormonal medicines.

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

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

Alternatives to manage your menopause symptoms include:

• hypnosis
• cognitive behaviour therapy
• selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)

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.

Read more about managing menopausal symptoms without medication.

Resources and support

• The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has information on contraception and menopause.
• Jean Hailes for Women's Health has information about female health, including factsheets in languages other than English and resources for Aboriginal and/or Torres Strait Islander people.

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