The pill messes with my hormones, am I doomed?
What’s the best kind of birth control pill for you?
The Trump administration recently rolled back part of the Obamacare contraception mandate, making it no longer mandatory for employers to cover the full cost of birth control on grounds of religious freedom. The 55 million women who were able to receive free birth control since 2012 are now at risk of losing it.
Now is a good time to understand your options as a woman, in order to find the best type of birth control for you that is not only affordable out-of-pocket, but won’t wreak havoc on your body either. Iodine’s resident pharmacist and women’s health expert, Christina Aungst, fills us in on the differences between the many brands and types.
Note: This article focuses on oral contraceptives AKA “the pill”, but if you already know they aren’t for you, check out our birth control tool and our previous report on IUDs for other options.
Top 5 prescribed brands (and their generics)
About 90% of the birth control pills used in the U.S. are generics. Here are the most commonly prescribed oral contraceptives, in both brand and generic form:
- Ortho Tri-Cyclen ($50.15); generics tri-sprintec ($9) and tri-previfem ($8.92)
- Alesse (discontinued); generics orsythia ($14.92) and aviane ($14.91)
- Loestrin FE 1/20 ($118.05); generic junel FE 1/20 ($15.17)
- Nor-Qd ($67.25); generics camila ($8.91) and norethindrone ($9)
- Desogen ($52.04); usually dispensed as generic apri ($15.64)
How do doctors decide what to prescribe?
The conversation for most women starts with their doctor asking what they would feel most comfortable using. If they aren’t sure or don’t have a preference, the doctor typically starts with Ortho Tri-Cyclen for adult non-smokers under 35, Loestrin Fe 1/20 for teenagers and young adults, and camila for women who smoke, are breastfeeding, or are over 35.
How do I know if I should switch?
Everybody reacts differently to hormones, so don’t worry if what and how you’re feeling doesn’t match the guidelines. While most hormonal contraception will effectively prevent pregnancy when used properly (the pill has a failure rate of 9% with typical use), they can also cause a lot of unpleasant side effects. The most common reasons women switch are menstrual cycle changes (flow becoming too heavy or irregular), weight gain, acne, headaches, and mood changes. It can take your body up to 3 months to get used to the new hormones, so don’t be afraid to talk to your doctor about other options if these side effects don’t get better after a while.
What kind of hormones are we talking about?
It only takes one hormone, progestin, to prevent pregnancy. On its own, progestin stops ovulation to prevent fertilization, thins the uterine lining to prevent implantation, and thickens the cervix to prevent sperm from entering the uterus. Estrogen helps boost the contraceptive effects of the progestin, and also helps to prevent ovulation. Its main purpose, though, is to help provide better cycle regulation. The more estrogen there is, the lower the chance of breakthrough bleeding or spotting.
Why are there so many different brands?
In a nutshell, each brand contains a different combination of progestin and estrogen meant to help women minimise side effects while effectively preventing pregnancy. Progestin, unlike estrogen, does not increase the risk of stroke and is safe to use while breastfeeding. But you have to take it at the same time every day or else you risk getting pregnant and experience breakthrough bleeding. For this reason, some women opt for brands that also have estrogen — so there is more flexibility to remembering to take the pill. Estrogen is also better for cycle regulation, but comes with a lot of side effects attributed to birth control, like lowered sex drive, acne, bloating, weight gain, and mood swings.
Your doctor will work with you to figure out what levels of progestin and estrogen are best for you, but it’s useful to know your options ahead of time. Below, we go into more detail about all the available types of oral contraceptives and how they may affect you.
Combination pill
A “combo” pill contains both progestin and estrogen. Most birth control pills fall into this category, but there are several sub-categories as listed below:
Monophasic pills are the most common type of birth control pill. They are “single phase”, meaning they provide a steady dose of hormones throughout the entire pack. Doctors will usually start women on a low dose of estrogen to limit the risk of stroke, and switch to a higher dose if they experience too much breakthrough bleeding or spotting.
Pros: Helps lighten or shorten the menstrual cycle and reduces cramps
Cons: Can cause changes to menstrual cycles, missed periods, and breakthrough bleeding or spotting
Examples: aviane ($14.91), junel FE 1/20 ($15.17), apri ($15.64)
Biphasic pills contain two sets of pills at different strengths. Usually, the amount of progestin changes and the amount of estrogen stays the same throughout the entire pack until you get to the inactive, or placebo, pills.
Pros: Reduces the likelihood of menstrual changes and breakthrough bleeding
Cons: Higher chance of side effects like acne, headaches, and bloating than monophasic pills
Examples: azurette ($23), necon 10/11 ($18.17), LO Loestrin FE ($125.23)
Triphasic pills provide a steady dose of estrogen but three different doses of progestin throughout the pack. The level of progestin gradually increases as you go through the pack similar to what the body does naturally. The most common pattern is 7 days of one strength, 7 days of another strength, 7 days of a third strength, and then 7 days of inactive pills.
Pros: Very low chance of menstrual changes and breakthrough bleeding
Cons: Most likely to cause side effects. Mood changes and headaches are seen most often with triphasic pills
Examples: tri-previfem ($8.92), camrese ($50.11), necon 7/7/7 ($16.06)
Quadriphasic pills contains four different strengths of hormones and is supposed to be the best at imitating a woman’s natural hormone changes throughout her menstrual cycle.
Pros: Side effects and breakthrough bleeding are least likely to happen on this type of combo pill
Cons: Missed pills are very hard to correct, meaning that a woman is more likely to get pregnant by accident if she misses a dose
Examples: Only one brand available, and it’s expensive — Natazia ($192.92)
Extended cycle pills are designed to deliver hormones for 91 days so women only have 4 periods a year. They usually come as monophasic pills but there are a few triphasic options as well.
Pros: Good option if you want fewer periods (for personal or health reasons) or want to adjust your periods for life events
Cons: Because it changes your natural cycle so dramatically, you are very likely to experience breakthrough bleeding or spotting
Examples: jolessa ($48.18), camrese ($50.11), camreselo ($74.15)
Continuous cycle pills are similar to extended cycle pills except there are no periods at all. You can do the same thing with your regular monophasic packs, though — doctors often instruct women to take only the active pills in the pack and continue on to the next pack without any breaks.
Pros: Virtually eliminates menstrual periods and reduces cramps
Cons: Extremely likely to cause breakthrough bleeding or spotting. The lack of a period can also make it difficult to know if an unintended pregnancy has happened
Examples: Only one generic available – amethyst ($29.29)
Progestin-only pill
This is the other major type of birth control pill, commonly referred to as the “minipill”. It provides a steady dose of progestin throughout the month. It doesn’t contain estrogen, there are no inactive pills, and you don’t take a break between packs.
Pros: Best choice for smokers, women over 35, women with a history of strokes or heart problems, and breastfeeding women
Cons: The minipill is very unforgiving — you must take it at the same exact time every day. If you miss a dose by 3 hours or more, you can get pregnant and you are very likely to have heavy breakthrough bleeding
Examples: camila ($8.91), jolivette ($8.91), norethindrone ($9)
The name game
Brand name pills are usually pretty simple to pronounce and remember. Some are even pretty clever. Loestrin, for example, prides itself on providing the lowest amount of estrogen compared to other brands. Ortho Tri-Cyclen is a triphasic pill. With Seasonale and Seasonique, women only get 4 periods a year — so once every season.
Unlike other drugs, the names of generic oral contraceptives aren’t just their chemical names. Manufacturers usually give them special names to make them easier for people to pronounce and remember. While some still try to cleverly play on the type of pill it is (tri-previfem and tri-sprintec are generics of Ortho Tri-Cyclen), most seem random — albeit very feminine (Portia, Zarah, Camila). In general though, birth control pill names can be a bit confusing but we have managed to pick up on a few patterns.
When a number is included in the name, it can mean one of two things. Usually, the number refers to the strength of the hormones in the pack. For example, junel FE 1/20 contains 1 mg progestin and 20 mcg estrogen and Ovcon 35 contains 0.4 mg progestin and 35 mcg estrogen. But sometimes, the number refers to the layout of the pack, so Loestrin 24 FE has 24 active tablets in it. Necon 7/7/7 increases the strength of hormones every 7 days in a pack.
Some manufacturers include a small amount of iron in the inactive pills of the pack, marked by the “FE” at the end of the name (iron is FE on the periodic table). Sometimes women will lose iron during their menstrual period so the extra iron can actually help prevent temporary anemia.
The last thing included in some of the names is “low” or “lo”. Some drugmakers produce a second version of their birth control pill with a lower strength of estrogen than the original. This is a better choice for women who experience issues tied to hormonal imbalances during their cycle (like acne, PMS, and moodiness). On the flip side, LO versions of the pill may not be able to help women who take birth control for acne treatment.
