Progesterone In Your Pill: If the shoe fits, wear it!

June 21, 2010 at 11:16 pm 4 comments

So, what makes one combination oral contraceptive pill (OCP) different from another?  What’s the difference between brand-name and generic versions, if any? 

The answer generally boils down to one word: progesterone.  How do we know this?  Because the chemical composition of the estrogen component of almost every OCP marketed in the U.S. is exactly the same.  It’s ethinyl estradiol.  The only thing that changes from pill-to-pill is the dose (thus the idea of “low dose” pills, “triphasic” pills etc), as described in my previous post

So, although all “low dose” OCP’s may contain 20 micrograms of estrogen, there are dozens of different kinds because each manufacturer uses one of eight different kinds of progesterone in each type of pill. 

Progesterone

The type of progesterone is indicated by the second word in the pill’s generic name.  For example, Loestrin is ethinyl estradiol and NORETHINDRONE.  Other pills have other progesterone components (i.e. Ortho-Tri-Cyclen and Ortho-Tri-Cyclen-Lo contain NORGESTIMATE, Yasmin andYaz contain DROSPERINONE).  You get the idea.

So, why do we need so much variety?  Can’t everyone just use the same pill in different doses?  Like Advil or Tylenol, just use a higher dose if you need more of it?

Well, it’ s not that simple.  The dose isn’t the important thing (it’s usually low, about 1-2 mg).  It’s the differences in the chemical characteristics of the progesterone that make each pill unique and separate it from its similar contraceptive cousins.   

Some progesterones have a higher level of progestational activity.”  This means the degree to which it binds with progesterone receptors in the body.  In addition to preventing pregnancy, stronger progestational agents can lessen menstrual bleeding, reduce acne, lessen excessive hair growth, etc. 

Some progesterones have an effect on blood levels of potassium or cholesterol.   Some can increase a person’s risk of blood clots.   These risks and benefits are an important topic to discuss with your gynecologist (or other prescriber). 

As if things weren’t confusing enough, generic OCP’s have active ingredients (estrogen and progesterones) which are chemically identical to the brand-name version.  They are, however, made by different manufacturers. They may contain different additives or be formulated in a slightly different way.

That’s why some people find that, while the brand name version worked well for them, different symptoms occur when they switch to the generic version(or vice-versa).   This means you may need to pay more (or less) for the version you prefer.  The cost difference can be significant ($50 or more!), so consider the choice carefully. 

It’s often difficult to predict which oral contraceptive (and which progesterone) will work best with a particular person’s chemistry.  While your gynecologist (or other provider) can often guide you toward picking an oral contraceptive which is the most likely to satisfy your partiuclar needs, sometimes, it’s necessary to try out a few different types before you hit on a pill that you like.  

But when you do…  Wow.  It’s like Cinderella fitting perfectly into that glass slipper and living happily ever after.   And not getting pregnant on that pumpkin-carriage ride home.

Happily Ever After

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Entry filed under: Gynecology. Tags: , , , , , , , , , , , , .

Why are there so many different types of oral contraceptives? – The Estrogen Equation The IUD 4 U! (An intro to the Intrauterine Device)

4 Comments Add your own

  • 1. Josette Elias  |  August 28, 2011 at 6:17 am

    my sister has catamenial pneumothorax is scheduled for robotic surgery for hysterectomy with a fenestrated diaphragm that has only been dealt with by gluing/staples & pleurodysis, but no repair of diagphram has taken place. I noticed that you have been involved with research on this topic and I was wondering if it is wise to do a hyst prior to repair of diaphragm? Also is a vaginal hyst better to perform rather than robotic in this circumstance? She has been on depo lupron for 9 months since the 3rd collapse of the lung. Your answer to this question is greatly appreciated.
    Concerned big sister.

    Reply
    • 2. drnicoll  |  September 13, 2011 at 6:53 pm

      Hi Josette,
      Care needs to be tailored to each individual. I don’t give out individual medical advice on my blog because it would be inappropriate to do so without having met the patient in question and performed a detailed history and physical exam.

      My advice is for your sister (and you) to discuss treatment options with her doctor. If you want or need a second opinion, I would strongly encourage you to make a timely appointment with an appropriate specialist.

      I can see, since you found the study I published, that you’re an excellent researcher and a devoted sister. Your sister is lucky to have you in her corner and I wish you both the best of luck.
      Dr. N

      Reply
  • 3. Andrea  |  December 29, 2015 at 2:11 am

    Hi – I am really surprised, that a gnyae wouldn’t know that what you refer as progesterone to the synthetic hormone in Mirena – it is NOT, it is PROGESTIN, which has absolutely nothing to do with progesterone … to say it is a progesterone is terribly misleading.

    Reply
    • 4. drnicoll  |  February 3, 2016 at 6:15 pm

      Hi Andrea,
      Progestins are synthetic progestogens whose pharmacologic effects are similar to those of progesterone. It is not unusual to use the term ‘progestin’ and ‘progesterone’ interchangeably although the latter often refers to endogenous hormones and the former to synthetic or lab-created versions. Levonorgestrel, the active hormone in hormonal IUDs such as Mirena, Skyla and Liletta, is indeed a progestin (synthetic progesterone) but to say that it is not progesterone is, as you put it, ‘terribly misleading.’
      But thank you for your feedback.
      Best regards,
      Dr N

      Reply

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Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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