Posts tagged ‘contraception’
Progesterone In Your Pill: If the shoe fits, wear it!
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.
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.
Why are there so many different types of oral contraceptives? – The Estrogen Equation
Well, if you’ve read my previous post (which I’m sure you did!) you already know that the two main components of combined OCP’s are estrogen and progesterone. What makes each type of pill distinct is the way in which these two components are dosed and formulated. In this post, let’s discuss only the estrogen component. We can talk about the progesterone later.
Combination OCP’s can be described as low-dose, medium-dose or (rarely) high-dose. This refers to the dose of estrogen in the tablet. A low-dose pill usually contains 20 micrograms of estrogen. Medium dose pills contain between 30 and 35 micrograms. Higher doses can go up to 50 micrograms.
Why does it matter? Well, a low-dose pill is great for somebody who needs the pill for pregnancy prevention, but doesn’t require the higher doses needed to suppress other conditions (like endometriosis or excessive menstrual bleeding). A low dose of estrogen also minimizes the risk of complications from oral contraceptives (such as an increased risk of blood clots and other potentially life-threatening medical conditions).
So, why wouldn’t everyone choose to take a low-dose pill? Some women taking low-dose pills may not have bleeding during the week of placebos (inactive pills) because the low dose of estrogen keeps the lining of the uterus (womb) very thin. Therefore, little tissue is shed (as menstrual flow) when the body withdraws from the estrogen. Amenorrhea (absence of a period) can be normal and healthy in this situation and is not a cause for concern in the absence of other symptoms.
In some women, bleeding between periods (metrorrhagia) may occur when the dose of estrogen is too low to stabilize the lining of the uterus between cycles. If this occurs, it doesn’t mean the pill isn’t protecting you against pregnancy. It just means you may need to switch to a different pill in order to reduce inconvenient or unpredictable bleeding.
Spotting or mid-cycle bleeding can also be more likely to occur on a low-dose pill if doses are missed or are taken late. Therefore a low-dose pill may be a poor option for women who can’t manage to take their pill on time every day. Obviously, back-up contraception (a condom, perhaps?) should be used when necessary.
Oral contraceptives with 30 to 35 micrograms of estrogen may be a better choice for women who need to suppress their menstrual cycles because of endometriosis, pelvic pain, excessive menstrual bleeding (menorrhagia), or who have had irregular bleeding on lower dose oral contraceptives.
If they dose of estrogen is the same in every pill, the type of pill can be called “monophasic.” Some oral contraceptives have a dose of estrogen which varies from the first to the third week (triphasic). These pills are meant to mimic the natural variation in hormones that occurs during a normal menstrual cycle. Whether a monophasic or a triphasic pill is right for you will depend on a number of factors which you may wish to discuss with your gynecologist.
Condoms: A little something for everybody
Condoms are one of the cheapest and most widely available methods of pregnancy prevention. They are a type of barrier protection. This means that they work by forming a physical barrier between sperm and egg. Most condoms are made of either latex or lamb skin and may be lubricated (or not) with spermicide (a chemical intended to kill sperm).
A condom is placed over the penis prior to intercourse. If the condom is put sometime in the middle of intercourse (ie prior to ejaculation), unintended pregnancy is still possible. This is because the penis does emit some pre-ejaculatory fluid which can (and often does) contain sperm.
Female condoms are also availabe. These are placed in the vagina and are held in place by a flexible plastic ring. They are a little more expensive than male condoms and a little trickier to put in place, but they work essentially the same way.
So if you choose to use condoms, the rules are
1. put one on before intercourse
2. leave it on until after intercourse is complete
3. use a new condom with each act of intercourse
4. never “double-wrap” with more than one condom at a time (this causes friction and can lead to breakage)
Condoms come in a variety of shapes and sizes. Some have features like flavor (a plus if you are using one to protect your partner during fellatio [oral sex]), texture (ie “ribbed for her pleasure”), color (to match your partner’s dress and/or eyes?), or glow in the dark (for… I don’t know what– A sudden loss of electrical power?!). In short, there’s something for everybody.
Condoms are cheap and, when used correctly, over 90% effective in preventing pregnancy. They are also one of the only methods of birth control that can also help prevent the transmission of a number of sexually transmitted diseases, including gonorrhea, chlamydia, HIV/AIDS, hepatitis, syphillis, HPV (human papilloma virus), herpes and other unpleasant nasties.
So what do you do if the condom breaks, falls off, or never made it out of your partner’s wallet? Plan B is a medication intended to prevent unintended pregnancy if used within 72 hours of unprotected intercourse. It’s more effective the sooner it is taken (ie 24 hourse is better than 48 hours is better than 72 hours). It contains progesterone, a hormone that is one of the 2 main components of conventional birth control pills.
Plan B is not the abortion pill and won’t bring an end to an already-established pregnancy. It is available over the counter at a number of major pharmacy chains nationwide. If you have questions about how to use it properly or how to make sure it was effective, or you need testing for sexually transmitted diseases, you should call your doctor.
Abstinence: The world’s oldest form of contraception
There’s a lot more buzz about abstinence than there was when I was a teenager. My high school generated a lot of buzz back in the 1995 when it was the first on Long Island to distribute condoms. (Then again, a lot of the fashion in those days had an unintended contraceptive effect.) But I think the pendulum has begun to swing the other way in a lot of communities. So I think it may be time to take another look at abstinence.
Abstinence is the oldest and cheapest form of contraception. Not having sex with a male partner is a sure way for a woman to avoid pregnancy. 100%. Pretty simple math.
Historically, abstinence has the method of choice for a lot of people because of expectations set by religious faith and family roles. You remember: First comes love, then comes marriage, then comes baby in a baby carriage. Premarital sex and unintended pregnancy don’t rhyme well. (Neither does Baby Bjorn, so I guess baby carriages are also a more moral option for infant transport).
The downside of abstinence is that it can be an unrealistic expectation, especially for younger people. Teens in particular may struggle with their natural inclination and interest toward sex. This is compounded by things like peer pressure and widening social acceptance of premarital sex and sex outside of monogamous relationships. We won’t even go into what constitutes maintaining one’s “virginity.” But oral sex doesn’t get you pregnant.
If you choose to abstain from sex, it’s not a bad idea to have a back-up plan (ie condoms, the pill, etc…). This doesn’t mean you’re not committed to abstinence, it means you’re realistic. You wouldn’t drive a car without a spare tire, would you? Does that mean you’re planning on getting a flat? No. It means you’re responsible. What? You don’t know how to change a flat? Well, that’s what boyfriends are for.
When to schedule your first exam with a gynecologist.
Your first gynecololgic visit can be a daunting prospect at any age. But with a better idea of what to expect, there’s no reason for your visit to be intimidating, uncomfortable, or painful.
It is appropriate to make an appointment to see a gynecologist for the first time, whatever your age, for any of the following reasons:
- If you are considering becoming sexually active and need to discuss contraceptives and STD prevention
- If you are already sexually active
- If you have not been sexually active, but are experiencing symptoms which may be related to your menstrual cycle (such as pain, irregular cycles or excessive bleeding)
- If you think you may be pregnant
- If you think for any other reason you might need gynecologic care. (Even if you might be wrong.)
Some organizations recommend seeing a gynecologist by age 21 even if none of the above applies to you.
It is not unusual to bring a parent, a good friend, or your partner to your first visit. It can help to have someone there to share your concerns, be an additional listening ear, or to calm your nerves. They don’t have to go into the examining room with you. Most of the time, they don’t want to anyway.
There should always be a time during your visit when your doctor gives you the opportunity to discuss things with him or her alone, so that you can discuss private issues in PRIVATE, without alienating the person who accompanied you. This is especially important to remember if you are under 18 and you are considering bringing a parent.
A note on timing: The best time to schedule your visit is about a week after your period. However, it may not be necessary to cancel your visit if you are still bleeding the day of your exam. If you are unsure, call ahead and ask if your provider recommends that you still keep your appointment. Most providers don’t charge a cancellation fee if you need to reschedule.