Health Female Adda
1 year ago
How to Find the Best Birth Control for You

I take my health seriously, which is why I feel like such an idiot whenever I push the last pill out of the pack and suddenly realize that there are no refills left. It happened again a few months ago. I called my gyno's office to beg for an appointment and got the typical response: "Your regular OB-GYN isn't in, would you like to see another doctor?" Of course I did. What other choice was there?

Dr. K turned out to be even more rushed than your average M.D. "So you need a new OC prescription?" she asked hurriedly. It took a second to realize that "OC" meant oral contraceptive. I nodded. "Which pill are you on?" Without thinking, the name of a highly advertised pill popped out of my mouth. It didn't sound right, but since Dr. K was flipping through my chart, I assumed she'd correct me if I was wrong. Bad assumption. "Okay, I'll give you a script for 3 months, but then you have to come back for a full exam." I was eager to get on with my day, so I took the piece of paper and jetted.

It turned out that I had requested the wrong birth control pill, and it was considerably different from my usual one. Over the next month I felt noticeably more emotional, and toward the end of my cycle I had cramps for the first time in a decade. I called up my gyno's office in a panic and requested a script for my previous pill. Without arguing, they said I could pick it up the next day.

By that point, I'd made three mistakes that are common among women who take oral contraceptives: 1) I trusted an unfamiliar doctor to make sure I was on the right pill; 2) I switched to a new pill without understanding its unique attributes; and 3) As soon as I experienced negative side effects, I switched again without having an in-depth discussion with a doctor. This was no way to care for my reproductive system. Or my health in general.

If, like me, you're more than a little confused about the more than three dozen pills on the market and wonder which is best for you, rest assured that that's how most women feel. From gynos who are too busy to go into details to drug ads that promise everything from freedom to bliss, it's easy to feel misinformed and out of control. But understanding the real benefits and drawbacks of the various types of pills is both possible and necessary to your well-being.

Behind the Scenes of the OC

The most surprising thing about oral contraceptives is how many gynecologists prescribe them as carelessly as Dr. K. "Gynecologists will prescribe the pill they have the most experience with or the one they currently have free samples of in the closet," says James Simon, M.D., of the Women's Health Research Center in Laurel, Maryland. Why are docs so blas? "Because all brands of the pill are equally effective at preventing pregnancy, and all are FDA-approved as safe," Dr. Simon says. Since it's difficult to predict how a patient will react to any specific pill, the standard of care is to start with one — any one — and switch to another if there are problems.

Yes, making an informed selection is more difficult, but it's hardly impossible. "In choosing a pill for a patient, a clinician will review the patient's medical history in order to select one that is easy for her to take and that will maximize her health benefits," says Anita Nelson, M.D., professor of obstetrics and gynecology at UCLA's David Geffen School of Medicine. "That's why women who are thinking of changing their pill, or who are considering the pill for the first time, might want to pay attention to what happens to their bodies throughout their menstrual cycle." An easy thing you can do is to mark a calendar on the days when you feel certain symptoms, then take that calendar with you to your appointment. And the more you know about your options, the better. "It's up to you to do the research, because a lot of doctors won't," says Michael Thomas, M.D., a contraceptive researcher at the University of Cincinnati Medical School.

One effective but seldom-used tool for pinpointing the right pill is a hormone test. The test is easy — you just spit into a small plastic tube once during the second half of your cycle. The small sample of saliva is a snapshot of how your levels of estrogen, progesterone, testosterone, and cortisol fluctuate during the course of your menstrual cycle. "I give all of my patients a saliva test before prescribing them a pill," says Kenna Stephenson, M.D., of the University of Texas at Tyler. "If a woman feels good about her menstrual cycle, I put her on the pill that contains a combination of hormones closely matching her own natural levels — she's less likely to experience negative side effects. If a woman is already experiencing moodiness or other uncomfortable symptoms, I'll prescribe a pill that may balance her hormone levels and alleviate the symptoms."

Many doctors dismiss hormone tests as unnecessary. But for women who experience side effects, particularly moodiness, not having a test can mean more than just enduring unnecessary PMS. "After prescribing two or three types of pills for a patient who complains of moodiness, many doctors will throw up their hands and suggest that she go on antidepressants," Dr. Stephenson says. "So now you have a woman on psychoactive drugs who may have simply needed a different pill."

If you think you might benefit from a hormone test, find a doctor who is willing to take the time to give you one. Or do it yourself. Two certified labs that offer at-home hormone tests are ZRT Laboratory (Innovative Hormone Testing) in Beaverton, Oregon, and Great Smokies Diagnostic Laboratory (BodyBalance) in Asheville, North Carolina.

Your Body Off the Pill

As someone who's been on oral contraceptives for 14 years straight, my ovaries must be seriously out of shape. But if not lulled into a sleeplike state by the Pill, the ovaries would remain hard at work, producing the majority of the total estrogen in my body. In the middle of the reproductive cycle, just before ovulation, their estrogen production would skyrocket. That's a signal to the brain that it's time for one of the ovaries to release an egg. The extra estrogen also triggers preparation of the uterine lining for a possible pregnancy. When the egg is released, the ovaries lower their estrogen output and start producing large amounts of progesterone. High levels of progesterone in the blood are a message to the brain that ovulation has occurred, so it prevents the ovaries from releasing another egg.

If a woman were to become pregnant at this point, the ovaries would continue to make progesterone, which would help build up the uterine lining even more, as well as cause cervical mucus to get thick and sticky, preventing foreign substances — including sperm — from entering the uterus. If a woman doesn't get pregnant, production of estrogen and progesterone drops to its lowest point. That lets the brain know the body isn't knocked up, and for a few days the uterine lining weakens, sloughs off, and occasionally causes embarrassing moments and impossible-to-remove stains.

Your Body On the Pill

There are dozens of oral contraceptives available, but they all prevent pregnancy in a similar way — with synthetic hormones that confuse your reproductive system. Take synthetic estrogen. The kind used most frequently in birth control pills is ethinyl estradiol (EE). The Pill delivers a steady dose of EE that's higher than the amount of estrogen your body would normally produce. As a result, the estrogen level in your blood never peaks the same way it would if you weren't on the Pill, so there's no signal to the brain to release an egg. No egg, no baby.

All pills that contain EE also contain synthetic progesterone, called progestin. They're known as "combination pills" because they combine the pregnancy-preventing effects of both hormones. Like EE, the levels of progestin in the Pill are higher than normal, and that progestin is present during your whole cycle rather than just the 2 weeks after ovulation. The constantly high level makes pregnancy virtually impossible, keeping the ovaries from releasing an egg and making the cervical mucus so thick and sticky that sperm is blocked from entering the uterus.

Some pills contain only progestin (they're known as POPs, or mini-pills) and rely largely on the hormones' effect on cervical mucus to prevent pregnancy. Women who take progestin-only pills get pregnant slightly more often than women on combination pills. That's at least partly because the progestin in one pill only remains effective for 24 hours, so a new pill must be taken at the same time every day.

Now that you know the basics, let's move on to the finer points. Because that's what can affect everything from your mood to your skin to your cramps to how much hair grows on your upper lip. (Every woman could respond differently to any given pill. These are just general guidelines.)

Pill Type 1: Combined pill with more estrogen

Medical specs: 30 to 35 micrograms (mcg) of EE plus progestin.

Brand-name examples: Ortho-Cyclen, Nordette, Loestrin 1.5/30, Yasmin.

Delivery method: The same amount of EE is contained in every pill (monophasic).

Usually works best for: Women who experience breakthrough bleeding or spotting early in their cycle, vaginal dryness, or nervousness may benefit from increased estrogen. A pill that delivers a consistent amount of hormones throughout the cycle can also have a more stabilizing effect.

Fine points: Ortho-Cyclen contains a lower dose of progestin, so women who experience excess moodiness, fatigue, or acne — all of which are associated with too much progestin — may see some of their symptoms alleviated on this pill. Yasmin contains a particular progestin that has been shown to improve acne and reduce hirsutism (mustache begone).

Pill Type 2: Combined pill with less estrogen

Medical specs: 20 mcg of EE plus progestin.

Brand-name examples: Alesse, Mircette, Levlite, Loestrin 1/20.

Delivery method: The same amount of EE is contained in every pill (monophasic), except Mircette.

Usually works best for: Women who experience excessive nausea, breast tenderness, bloating, headaches, heavy menstrual flow, or a lowered sex drive on pills with more EE may find that some problems are alleviated by these pills.

Fine points: Mircette delivers just 10 mcg of EE on days 24 through 28 of the cycle to help prevent breakthrough bleeding that occurs after menstruation. Mircette also contains a lower dose of progestin — women who experience excess moodiness, fatigue, or acne may see some of their symptoms alleviated on this pill.

Pill Type 3: Combined multiphasic pill

Medical specs: Unique to each pill, but most remain within the range of 20 to 40 mcg of EE and .05 to 1 milligram (mg) of progestin.

Brand-name examples: Triphasil, Ortho Tri-Cyclen, Ortho Tri-Cyclen Lo, Estrostep FE.

Delivery method: Levels of EE or levels of progestin vary once or twice during the course of the cycle.

Usually works best for: Most multiphasic pills were introduced before oral contraceptives containing only 20 mcg of EE became available, with the intention of delivering the least amount of hormones necessary at each stage of a woman's cycle. Now that several brands of the Pill contain only 20 mcg of EE, the levels of synthetic estrogen in phasic pills are no longer significantly lower, nor are the levels of progestin.

Fine points: Estrostep FE can help prevent the breakthrough bleeding or spotting that occurs before menstruation.

Pill Type 4: Combined progestin-only pills

Medical specs: .075 to .35 mg norethindrone or norgestrel. Brand name examples: Micronor, Nor-QD, Ovrette.

Delivery method: Each pill contains the same amount of progestin.

Usually works best for: POPs have to be taken at the same time every day, so they're only a wise choice for very responsible women. Because synthetic estrogen has been shown to lessen the quantity of breast milk, POPs are recommended for women who are breast-feeding.

Pill Type 5: Reduced-period pills

Medical specs: A combination pill that is taken for 84 days in a row followed by a 7-day break, allowing for four periods a year.

Brand-name examples: Seasonale.

Delivery method: Each pill contains 30 mcg of EE and .15 mg of levonorgestrel.

Usually works best for: Women who prefer to have fewer periods and who are very responsible about not skipping pills — without a monthly period, an accidental pregnancy might be harder to detect. Women should be willing to tolerate possible breakthrough bleeding, which can happen several times as often as it does on conventional pills for the first few cycles. A woman who takes this pill must not have health risks that might be worsened by increased long-term exposure to synthetic hormones.
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