If you’re looking at hormonal birth control, hormone therapy, or even acne medication, you’ve probably seen the word “progestin.” It’s the synthetic version of progesterone, and not all progestins are the same. Some feel stronger, some cause less weight gain, and a few have extra benefits like reduced acne. Knowing the differences helps you pick the right pill, patch, injection, or IUD for your body.
Scientists group progestins by how they were built. The two biggest families are the 19‑nor (or “norpregnanes”) and the 19‑methyl (or “pregnanes”).
19‑nor progestins – like norethindrone, levonorgestrel, and desogestrel – are good at stopping ovulation. They tend to be more androgenic, which means they can act a bit like male hormones. That can lead to acne or a slight increase in facial hair for some users.
19‑methyl progestins – such as medroxyprogesterone acetate (Depo‑Provera) and dienogest – have a milder androgenic profile. They are often chosen when a user wants less acne risk or a more stable mood.
Beyond these groups, newer progestins like drospirenone (found in some combined pills) act like a natural hormone called spironolactone. That gives them anti‑androgen properties, which can improve acne and reduce water retention.
Strength of ovulation suppression: Levonorgestrel and desogestrel are among the strongest at preventing ovulation, making them popular in daily pills and IUDs.
Androgenic activity: If you’ve struggled with acne or oily skin, look for low‑androgen progestins like drospirenone or dienogest. If you’re okay with a little extra oil, norethindrone works well and is inexpensive.
Impact on mood: Some users report mood swings with androgenic progestins. Those who are mood‑sensitive often prefer the 19‑methyl family or drospirenone, which tends to be more neutral.
Weight and water retention: Progestins with higher mineralocorticoid activity (like medroxyprogesterone acetate) can cause water retention. If swelling is a concern, avoid them.
Bleeding patterns: Levonorgestone‑based IUDs often give lighter periods, while some combined pills with norethindrone can cause breakthrough spotting. Choose based on how you want your cycle to look.
Below is a quick snapshot of the most common progestins and where they shine:
When you talk to your doctor, ask which progestin is in your prescription and why they chose it. Knowing the profile helps you anticipate side effects and decide if you need a switch.
Bottom line: not all progestins are created equal. The main things to weigh are how strong the ovulation block is, how much androgenic activity it has, and how it affects mood, weight, and bleeding. Pick the one that matches your health goals, and you’ll feel more comfortable with your hormonal plan.
