When Eva Rios started taking the birth control pill Ortho Tri-Cyclen, she suffered enough breakthrough bleeding between periods that she returned to her doctor.
She wanted to stop taking the pill, but after being diagnosed with polycystic ovarian syndrome, a hormonal imbalance, she learned that certain formulations of the pill actually help control it.
Rios and her doctor experimented with two more pill formulations, eventually settling on Triphasil, a birth control pill with a phased, rather than constant, distribution of estrogen.
“So far, so good,” said Rios, 28, of Chicago, who has been taking Triphasil for about two years. “I’ve had a few problems here and there, but nothing major.”
Originally a one-dosage-fits-all recipe when it was approved by the Federal Drug Administration in 1960, the birth control pill now is available by prescription in more than 30 varieties, with different hormone formulations. And for the approximately 40 percent of women like Rios who experience side effects, chances are better than ever that the potency can be adjusted to fit their needs.
But which pill is best to take, if any? Medical experts say there is no perfect formula, because every woman responds differently to the assortment of pills available.
Some pills cause mood swings, breast tenderness, nausea, bloating or headaches. Others, especially progestin-only pills, cause spotting and erratic bleeding patterns. The best pill, doctors say, depends on your reasons for using it, your body and what your doctor recommends based on your medical history.
“Different pills suit different women,” said Susan Tew, a spokeswoman for the Alan Guttmacher Institute, a non-profit organization that focuses on reproductive health research, policy analysis and public education. “Some women are very sensitive to hormones, weight gain and breast tenderness, while others don’t notice anything at all.”
Although women trust the pill’s safety and effectiveness more than ever, according to a recent survey by the American College of Obstetricians and Gynecologists, oral contraceptives are not without risks. Serious ones, while rare, include blood clots, strokes and heart attacks. Cigarette smoking increases the risk of dangerous cardiovascular side effects, especially if you’re over 35. And the pill does not protect against HIV or sexually transmitted diseases.
Still, for many women, the benefits of this tiny puck-shaped pill outweigh the headaches. About 16 million women in the U.S. are taking it, making it the most popular method of reversible birth control in the country.
The birth control pill can reduce menstrual cramps, make cycles regular and provide non-contraceptive health benefits, such as decreasing the chance of breast cysts and pelvic inflammatory disease. It also lowers the risk of ovarian and endometrial cancers, according to the American College of Obstetricians and Gynecologists. Most studies indicate it does not increase the risk of cervical or breast cancer, ACOG says.
At least one pill, Ortho Tri-Cyclen, now is advertised for its non-contraceptive uses with FDA approval, but all pills help with skin problems.
“Most physicians have a favorite three pills and know fairly well what the side effects will be,” said Dr. Andrea Pennington, director of medical content for Helios Health, an on-line information resource.
Pills are divided into two basic types: combination pills, which contain estrogen and progestin and are used by the majority of women; and mini-pills, which consist solely of progestin (a synthetic version of progesterone, a hormone found in women).
Combination pills, which come in 21- or 28-day packaging, contain varying levels of estrogen and progestin. Those on a 21-day regimen skip the pill for seven days after finishing the packet. On a 28-day cycle, a pill is taken every day, but at least seven are a different-colored placebo and are ingested simply to stick with the routine.
The combination pills have a 99 percent success rate when taken properly, but, according to Planned Parenthood, only 28 percent of women always take the pill correctly and only 42 percent take it every day.
The major difference between the types of combination oral contraceptives is the amount and type of progestin, according to Theresa Tamboer, of Ortho-McNeil Pharmaceutical. Its pill Ortho Tri-Cyclen, for example, differs from other pills in that it contains a progestin called norgestimate, which in clinical trials proved less likely to cause weight gain than some other pills, the manufacturer said.
Some combination pills contain a constant dose of both estrogen and progestin. Others, called phasic pills, vary the levels throughout the menstrual cycle for more natural hormonal balances. The overall doses are lower so the cycle is more regular and side effects, such as missed periods, mood swings, nausea, spotting, breast enlargement and tenderness, are less severe.
“The trend is certainly moving towards lower and lower doses [of estrogen],” Pennington says, “but some bodies are more sensitive to estrogen levels than others.”
Mini-pills are recommended for women who are sensitive to estrogen and for those who are breast-feeding–estrogen can interfere with lactation. They are slightly less effective (97 percent) than combination pills. Also, menstrual irregularities, such as spotting or bleeding between periods, are more common while taking mini-pills than combination pills. But other side effects are less likely to occur with mini-pills because they contain no estrogen.
Many side effects disappear with time anyway, but if they linger after three months, a pill with a different progestin might be in order. If nausea persists, doctors suggest taking the pill at night, rather than the morning, or taking it with a meal or a snack.
Although the pill looks the same as it did when it was introduced 40 years ago, the original pill, called Envoid, contained about five times more estrogen and 10 times more progestin than today’s versions, according to the Mayo Clinic. The first types of pills were packed with about 150 micrograms of estrogen and a whopping 10,000 micrograms of progestin, according to Planned Parenthood. Today’s pill contains only about 20 to 35 micrograms of estrogen and 50 to 150 micrograms of progestin.
WHAT ARE YOU ON?
Most birth control pills are quite similar within categories and most women could take any low-dose pill. Here are the categories into which some brands fall.
COMBINATION PILLS (estrogen type, in micrograms, is ethinyl estradiol)
20-mcg pill
Loestrin 1/20 (Parke-Davis)
Alesse (Wyeth-Ayerst)
Levlite (Berlex)
Tri-phasic pills (between 20 and 35 mcg)
Estrostep Fe (Parke-Davis)
Ortho Tri-Cyclen (Ortho McNeil)
Triphasil (Wyeth-Ayerst)
30-mcg pills
Nordette (Wyeth-Ayerst
Desogen (Organon)
Levlen (Berlex)
35-mcg pills
Ortho-Novum 7/7/7 (Ortho McNeil)
Genora 1/35 (Rugby)
Ovcon (Mead Johnson)
MINIPILLS
Micronor (.35 micrograms norethindrone) (Ortho-McNeil)
Nor-QD (.35 mcg norethindrone (Ortho-McNeil)
Ovrette (.075 mcg norgestrel) (Wyeth-Ayerst)
