Understanding Estrogen in Birth Control
Combination oral contraceptives are a highly effective method of preventing pregnancy that use two types of hormones: an estrogen and a progestin [1.9.2]. The estrogen component, most commonly ethinyl estradiol, works with the progestin to prevent ovulation (the release of an egg), thicken cervical mucus to hinder sperm, and alter the uterine lining to prevent implantation [1.3.1, 1.4.1].
Historically, birth control pills contained much higher doses of hormones. Over the decades, formulations have evolved to use lower doses to reduce side effects while maintaining efficacy. Today, most pills are considered "low-dose," containing between 20 and 35 mcg of ethinyl estradiol [1.6.4]. However, high-dose pills containing 50 mcg of estrogen still have a role in modern medicine [1.2.3].
What Birth Control Has 50 mcg of Estrogen?
Pills with 50 mcg of estrogen are less common but are still prescribed. They are typically reserved for specific clinical situations where lower-dose pills may not be as effective or suitable.
Here are some of the brand names of high-dose combination pills:
- Ogestrel® 0.5/50: Contains 0.5 mg of norgestrel and 0.05 mg (50 mcg) of ethinyl estradiol [1.3.1].
- Demulen® 1/50: Contains 1 mg of ethynodiol diacetate and 50 mcg of ethinyl estradiol [1.4.2, 1.4.5].
- Ortho-Novum® 1/50: A well-known high-dose option [1.2.3].
- Ovral®: Some formulations of Ovral contain 50 mcg of ethinyl estradiol, though the brand has been largely discontinued in the U.S. [1.5.4]. Generic equivalents like norgestrel and ethinyl estradiol may be available [1.3.3].
- Zovia 1/50E: Contains ethynodiol diacetate and ethinyl estradiol [1.4.3].
These medications act by suppressing gonadotropins to inhibit ovulation [1.3.1]. A healthcare provider must prescribe these pills, as they are not suitable for everyone [1.9.1].
Who Needs a High-Dose Pill?
A doctor might prescribe a 50 mcg estrogen pill for several reasons. While 14% of women use oral contraceptives for non-contraceptive reasons like managing menstrual disorders, higher-dose pills can be particularly useful [1.7.3].
Indications can include:
- Managing Breakthrough Bleeding: Women who experience persistent spotting or bleeding on lower-dose pills may find that a 50 mcg pill provides better cycle control [1.7.4].
- Drug Interactions: Certain medications, such as some anticonvulsants or St. John's wort, can decrease the effectiveness of birth control pills. A higher estrogen dose may be needed to overcome this interaction and prevent pregnancy [1.4.1, 1.10.5].
- Heavy Menstrual Bleeding or Endometriosis: Oral contraceptives are sometimes used to treat heavy or irregular menstruation and symptoms of endometriosis [1.10.5]. The higher estrogen dose can offer more robust management of these conditions.
- High Body Weight: Some providers may consider a higher dose for individuals with a higher body mass index, although this practice is debated and requires individual assessment.
Risks and Side Effects of 50 mcg Estrogen Pills
The primary reason for the shift to lower-dose pills was to reduce the risk of side effects, particularly serious cardiovascular events. The risks associated with oral contraceptives increase with the dose of estrogen [1.6.3].
Serious Risks:
- Blood Clots: There is a higher risk of developing blood clots, such as deep vein thrombosis (DVT) or pulmonary embolism (PE) [1.6.3].
- Heart Attack and Stroke: The risk of heart attack and stroke is elevated, particularly for women who smoke and are over 35 years of age [1.9.3, 1.5.4].
- High Blood Pressure: Pills can increase blood pressure [1.4.1].
Common Side Effects:
- Nausea and vomiting [1.5.3]
- Breast tenderness [1.4.1]
- Headaches [1.4.1]
- Bloating and fluid retention [1.4.1]
- Mood changes [1.4.1]
- Breakthrough bleeding, especially in the first few months [1.4.1]
It is crucial to discuss your full medical history with your doctor, including any history of migraines, high blood pressure, blood clotting disorders, or cancer, before starting any hormonal contraceptive [1.5.1, 1.10.3].
Comparison of Birth Control Pill Dosages
| Feature | High-Dose (50 mcg) | Regular-Dose (30-35 mcg) | Low-Dose (20 mcg) |
|---|---|---|---|
| Estrogen (EE) | 50 mcg [1.2.3] | 30-35 mcg [1.2.3] | 20 mcg [1.2.2] |
| Example Brands | Ogestrel 0.5/50, Demulen 1/50 [1.2.3] | Levora, Ortho-Cyclen, Yasmin [1.2.3] | Levonorgestrel-Ethinyl Estradiol 0.1-20 [1.2.2] |
| Primary Use | Specific indications like managing side effects from lower doses or due to drug interactions [1.7.4]. | Standard contraception for most users [1.6.4]. | For users sensitive to estrogen's side effects. |
| Risk Profile | Higher risk of blood clots, stroke, and other estrogen-related side effects [1.6.3]. | Standard risk profile, generally well-tolerated [1.6.4]. | Lower risk of estrogen-related side effects, but may have higher rates of irregular bleeding [1.6.1]. |
Conclusion
Birth control pills containing 50 mcg of estrogen, such as Ogestrel and Demulen 1/50, represent an older class of oral contraceptives that are now used for specific clinical situations rather than as a first-line choice. While effective, they carry a higher risk of serious side effects compared to the more common low-dose pills. The decision to use a high-dose pill must be made in careful consultation with a healthcare provider who can weigh the benefits against the risks based on an individual's health profile and needs.
For more information on contraceptive options, you can visit the CDC's webpage on Combined Hormonal Contraceptives [1.7.4].
