Gillian Goddard

3 minute read Gillian Goddard

Gillian Goddard

Does the Type of Progesterone in Birth Control Matter?

Q&A on how to select the right one

Gillian Goddard

3 minute read

You’ve written about progesterone and weight gain before. What about choosing the type of progesterone in your combined oral birth control? Do some progesterones have more desirable effects, like improving acne (e.g. Yaz)?


—Anonymous

This question makes my endocrinologist heart so happy! The short answer is yes, the type of progestin in a combined birth control pill can have impacts on that pill’s side-effect profile. But  how and why are worth understanding.

First, a quick review. Combination birth control pills typically contain ethinyl estradiol, but in different amounts — modern pills vary from just 10 micrograms of estradiol to as much as 35 mcg. They also contain a synthetic progestin, of which there are several, in various doses. 

two adults sitting on a bed earing bathing suits
No Revisions / Unsplash

Estrogen, progesterone, and testosterone are all part of a group of hormones called steroid hormones. Both the hormones and their receptors are somewhat similar. So progesterone or a synthetic progesterone-like molecule can bind to the testosterone receptor and act like testosterone. Some progestins in birth control pills are more or less likely to do this. Both the affinity of the progestin for the testosterone receptor and the amount of estradiol in a pill will change how androgenic a pill is — that is, how much that pill will cause testosterone-like side effects. 

In general, progestins that were developed earlier had higher androgenic effects than those developed later. The most androgenic progestins are norgestrel and levonorgestrel. Norethindrone is in the middle, and desogestrel and norgestimate are the least androgenic progestins. 

Some of the most recently developed progestins, like drospirenone — the progesterone in Yasmin and Yaz — have anti-androgenic effects. This means that they sit in the testosterone receptor but do not act like testosterone, and they block testosterone from acting on the receptor too. This should make pills that contain anti-androgenic progestins especially good at treating androgenic symptoms like acne, body hair growth, and scalp hair loss. However, the amount of progestin and the amount of estrogen will also affect how effective a given birth control pill is at treating symptoms like acne and minimizing side effects. 

When I am choosing a birth control pill for a patient, I consider what birth control pills they have taken in the past, the indication for which we are starting the pill (i.e. contraception, PCOS, acne, perimenopause), and the patient’s age (typically I prefer lower-estrogen pills when women are in their 40s). I also recommend that my patients try a pill for three months, and then we can reassess and switch pills — or contraceptive methods altogether — if needed. 

The upshot: Some progestins are more androgenic than others, and some are even anti-androgenic. This is one factor I consider when helping a patient choose a birth control pill.

Community Guidelines
1 Comment
Inline Feedbacks
View all comments
Dr. Mom
Dr. Mom
4 months ago

Is there data to back up the idea that different progesterones have different side effect profile or is it just based on their biochemical profile and assumptions about how that will impact patients?

A top-down view of a pregnant person seated on a couch with a cozy blanket.

Feb. 8, 2024

2 minute read

What Are the Benefits of Taking Progesterone With a Cerclage?

I recently had a cerclage [cervical stitch] put in place at 20 weeks. They also prescribed progesterone for the remainder Read more

Feet on scale

Apr. 12, 2024

3 minute read

Does Progesterone-Only Birth Control Cause Weight Gain?

I was recently prescribed progesterone-only birth control to help with bleeding. I have had my fallopian tubes removed, so this Read more

Packet of partially used birth control pills

May 3, 2024

2 minute read

Does Taking Birth Control Long Term Affect Menopause?

Does taking birth control for over a decade in my teens and 20s affect the timing or symptoms of menopause? Read more

Progesterone patch on blue background

May 31, 2024

3 minute read

Is There a Difference Between Oral and Topical Progesterone?

My doctor has prescribed me hormone replacement therapy. I take an estrogen patch, and 10 days per month I take Read more