OBG(WHY)N: Choosing the Right Birth Control Pill

The number one form of birth control that young women come in asking for is the birth control pill. There are quite a few things to consider when choosing the right pill and asking for “the pill your friend is on” may not be the way to go.

There are many benefits to the pill:

1. It prevents pregnancy and is 98% effective when used correctly.
2. It regulates the menstrual cycle.
3. It makes the cycle lighter and less painful.
4. It treats acne and excess hair growth.
5. 5 years of continuous pill use decreases your risk of ovarian cancer.
6. It may also be helpful in treating pms, menstrual migraines and cyclical bloating.

The main risk of pill use is an increase in blood clots, but this is usually in women who are over the age of 35 and smoke, or women who have an underlying blood disorder that they didn’t know they had. While this is a serious side effect, it is also very rare. Women who are at increased risk for blood clots should not take the pill.

The main side effects of the pill are breast tenderness and spotting, which usually resolve after the first three months of use.

There are a few things that the pill does NOT do:

1. It does not cause cancer.
2. It does not cause infertility.
3. It does not protect you from anything sexually transmitted.

After you have reviewed all of the pertinent information with your ob/gyn and you decide to go on the pill, the next question is Which pill should I go on?

It is important to think about what YOU are using the pill for:

• Am I using it only to prevent pregnancy?
• Am I using it to control the menstrual cycle?
• Am I using it to treat acne and excess hair?
• Am I using it to treat a combination of these things?

There are two broad categories of pills to consider:

1. Monophasic Pills: Every active pill has the same amount of drug in it. We generally
   use these pills to control the cycle and any other “cyclical issues”.
2. Triphasic Pills: Every week of pills has a different dose of medicine, mimicking a more
   natural menstrual cycle.

There’s either a 21 day formula, where you finish a pack, wait 7 days and than start a new pack, or a 28 day formula, which includes 7 placebo pills to help you keep track of the days you are not taking an active pill .

There are also newer formulas on the market which are becoming more popular. One is a 24/4 formula which contains 24 active pills and only 4 placebo pills which will give you a really short cycle or no cycle at all. The second is an extended cycle formula which contains 84 active pills and 7 placebo pills and allows you to have a cycle once every three months. The third is the vaginal ring which contains the same drugs as the pill but they are delivered intravaginally instead of by mouth.

Most pills on the market have 2 main ingredients:

1. Estrogen: Usually Ethinyl Estradiol which comes in a few different strengths (this is what differentiates a low dose pill from a regular dose pill).
2. Progesterone: There are a few different types of progesterone, which is what really makes one pill different from another.

Very often, women will come in asking for the pill “that makes my breasts bigger” or “won’t make me gain weight.” The main problem with these requests is that we don’t know who will react to which progesterone in which way. There are some general differences in progesterones, such as their level of androgenicity (male hormone), and your doctor will take this into account if you are looking to treat acne or excess hair. However, most side effects caused by different progesterones are purely trial and error. If we knew which progesterone didn’t cause unwanted side effects, there would only be one pill on the market.

There is also the question of brand name vs generic and a few things to consider here as well:

1. Generics are close, but not identical to their brand name counterparts.
2. Generic pills are just as effective as brand name pills.
3. Some women are very sensitive to any type of medication and may feel a difference between a brand name and its generic and some women do not feel any difference at all.
4. There can be a huge price difference between products depending on your insurance coverage.

It is important to take into account what you are looking to get out of your pill. Whether you are looking for a light cycle, a regular cycle or no cycle at all, there will be a product that’s just right for you. If you are going to choose to start a medication, than choose wisely and consult with your ob/gyn to ensure that you get the most out of it.