Posts tagged ‘the pill’

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. 

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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June 21, 2010 at 11:16 pm 4 comments

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.

June 9, 2010 at 10:12 pm 1 comment

Oral Contraceptives: The little pill that could (and did!)

Continuing our journey through the world of contraception, I think The Pill deserves special mention.  It has been used in the US since 1960 as a way of preventing pregnancy.  It continues to be one of the most popular methods of birth control.

Running the risk of waxing overly poetic, I’ll tell you that The Pill has a long and storied history which has helped shape the roles of women in society.  It has freed a generation of women from fear of unwanted pregnancy and has helped countless others battle the miseries associated with their monthly gift.  But what is this miracle tablet?  What’s in it?  And  how is it used?  

‘The Pill’ is a common term for what the medical community calls a ‘combined oral contraceptive’ or ‘oral contraceptive pill’ (OCP).  This consists of a combination of estrogen and progesterone which is taken in order to prevent pregnancy. 

It does this in several ways.  The most important of these is that OCP’s prevent ovulation, the release of an egg from a woman’s ovary.  No egg, no baby.  Easy. 

It also causes a thickening of cervical mucus.  While this may sound kinda icky, it actually serves the important purpose of reducing the likelihood sperm will be able to pass through the cervix and up through the uterus and tubes on its way to fertilize an awaiting egg (which isn’t going to be there anyway… see above).  No egg-sperm rendezvous, no baby.

It also causes a thinning of the lining of the uterus, reducing the likelihood that, even if a runaway egg and super-ambitious sperm were to elope successfuly, a resulting embryo would not be able to implant.  No implantation, no pregnancy.  (This, by the way, is NOT an abortion.  An embryo needs to implant in order to establish a pregnancy.  Otherwise, you get a normal period.) 

In order for an OCP to effectively prevent pregnancy, it needs to be taken every day for 21-24 days a month.  In a best-case scenario, it should be taken at the same time every day.  This is what’s called “perfect use.”  Humans are not perfect.  Given an opportunity to screw up, we will most likely take it at some point in our lives.  This is called “typical” use.  Therefore, when we talk about the likelihood somebody will get pregant while taking OCP’s we talk about “perfect” and “typical” use patterns. 

The pregnancy rate among “typical” users of OCP’s varies depending on the population being studied and ranges from 2-8% per year. On the other hand, the rate of pregnancy among “perfect” users of OCP’s is about 0.3% per year.  I don’t know about you, but I think that’s pretty good motivation to stive for “perfection.” 

Some combined oral contraceptives aren’t pills at all, but are administered as a vaginal ring (Nuvaring) or a patch (Ortho-Evra).  These can be good options for some patients who can’t reliably take a pill every day.  (However, the Ortho-Evra patch has been scrutinized for the possibility that it delivers more estrogen than most other combined contraceptives, including the ring, and that it may lead to an increased risk of blood clots in some patients.  See below.)

A caveat:  You want to talk to your gynecologist before starting an OCP.  The pill doesn’t protect you against sexually transmitted diseases (STD’s).  If you are at risk for STD’s, you should be using a condom and getting tested at regular intervals.

The Pill also has some risks.  That’s because combined oral contraceptives (those containing estrogen) can increase a woman’s risk of blood clots, heart attack and stroke.  This risk is minimal if you are young (under 35– ouch!), otherwise healthy, and do not smoke.  You should ask your gynecologist (or other healthcare provider) about your risk factors to help determine whether The Pill is a safe option for you.

If you have certain medical problems (like heart disease, a prior blood clot, or a history of certain types of cancer), are a smoker over 35, or are taking certain other types of mediation, you should not take estrogen-containing combined oral contraceptives. Ever. There are other, potentially safer options out there for women who can’t take OCP’s.  More on that in a future post.

I’m also planning a post to explain WHY OH WHY there need to be SO MANY different pills out there!  Really, I promise there’s a good reason.  See you soon!

June 4, 2010 at 3:55 pm 7 comments

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.

May 19, 2010 at 1:40 pm 3 comments


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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