How effective is ortho tri cyclen lo against pregnancy?

Ortho Tri-Cyclen

Ortho Tri-Cyclen is the brand name for a prescription birth-control pill.

Its generic name is based on the hormones it’s made of, ethinyl estradiol and norgestimate.

The combination of female hormones in this contraceptive drug prevents ovulation, which is the release of an egg from the ovary.

Ortho Tri-Cyclen Lo is another form of the drug that has a lower dose of the ethinyl estradiol part of the drug.

When taken on schedule and without missing any pills, oral contraceptives that combine two hormones are highly effective, with only 1 in 1,000 women getting pregnant (“failing”) in a year, according to the Food and Drug Administration (FDA).

But pregnancy rates are typically higher with birth-control pills, because many people take don’t them correctly. When studying large numbers of women taking pills that combine two hormones, the typical failure rate is closer to 3 percent a year, according to the FDA.

On the company website for Ortho Tri-Cyclen Lo, it says failure rates are about 5 percent per year.

Ortho Tri-Cyclen was approved by the FDA for birth-control in 1992 (and for acne in 1997). Ortho Tri-Cyclen Lo was approved by the FDA in 2002.

Ortho Tri-Cyclen is manufactured by Janssen Pharmaceuticals. The drug also comes in several generic forms.

In 2013, the FDA required companies to include additional warnings for birth-control products that use a combination of hormones, including Ortho Tri-Cyclen. (See Warnings section.)

Acne and Ortho Tri-Cyclen

In 1997, the FDA approved the use of Ortho Tri-Cyclen for acne in women ages 15 and older. It is thought to work by balancing hormones, so the body doesn’t produce as much oil and sweat.

In a study of more than 400 women, those who took Ortho Tri-Cyclen had a 42 percent decrease in number of pimples, compared with a 27 percent decrease in people who took a placebo.

However, some people actually report worse acne with oral contraceptives. You should talk to your doctor about this possibility and weigh the risks against the benefits.

Weight Gain and Ortho Tri-Cyclen

Ortho Tri-Cyclen may cause weight gain. Much of the weight gain women experience is due to fluid retention (not fat).

To combat this unwanted effect, you should avoid caffeine, alcohol, and salt (sodium).

Also, a healthy diet and exercise program can minimize weight gain.

Warnings for Ortho Tri-Cyclen

In 2013, the FDA added a black-box warning for Ortho Tri-Cyclen and other birth-control pills that use a combination of hormones.

A black-box warning against smoking was added. You shouldn’t use Ortho Tri-Cyclen if you smoke and are over age 35 because it can increase the risk of blood clots, stroke, or heart attack.

The FDA also added a warning that if you have high blood pressure, or you develop high blood pressure when taking Ortho Tri-Cyclen, you should work with your doctor to get your blood pressure under control and monitor it closely, or you should use a non-hormonal type of contraception.

If your blood pressure is already often above 160 (systolic) or above 100 (diastolic), you should stop taking Ortho Tri-Cyclen and other birth-control pills.

Ortho Tri-Cyclen may increase your blood pressure. If you have diseases related to high blood pressure or kidney disease, you also should not use a contraceptive pill.

Before using Ortho Tri-Cyclen, you should tell your doctor if you have or have ever had:

  • A blood-clotting disorder
  • High blood pressure
  • A heart valve disorder
  • Chest pain
  • A heart attack, stroke, or blood clot
  • High cholesterol or triglyceride levels
  • Any other type of heart or blood-circulation conditions (cardiovascular illnesses)
  • Kidney disease
  • Pre-diabetic glucose levels
  • Diabetes or diabetes complications of the eyes or kidneys
  • Liver disease or liver cancer
  • Jaundice caused by birth control pills or pregnancy
  • Severe migraines
  • Breast or uterine cancer
  • Unusual vaginal bleeding
  • A history of depression
  • Gallbladder disease
  • Seizures or epilepsy
  • A history of irregular menstrual cycles
  • Breast lumps, nodules, or an abnormal mammogram

You might need to use a backup birth-control method when you first start on Ortho Tri-Cyclen or if you miss a dose. You should follow your doctor’s instructions carefully.

You may experience breakthrough bleeding, especially during the first three months you use Ortho Tri-Cyclen.

Every doctor or surgeon who treats you should know you are taking this medication. You may need to stop using Ortho Tri-Cyclen for a period of time if you need surgery or other medical procedures that require you to be on bed rest.

After stopping Tri-Cyclen, your increased risk of developing breast cancer and heart disease may continue for a number of years.

Pregnancy and Ortho Tri-Cyclen

You shouldn’t use Ortho Tri-Cyclen if you are pregnant. This medication can cause birth defects.

Tell your doctor immediately if you become pregnant or miss two menstrual periods in a row while taking Ortho Tri-Cyclen.

If you’ve recently had a baby, you should wait at least four weeks before taking this medicine.

The hormones in Ortho Tri-Cyclen can pass into breast milk and may harm a breastfeeding baby. You shouldn’t breastfeed while taking this medicine.

Medically reviewed by P. Thornton, DipPharm Last updated on Sep 2, 2019.

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The Ortho Tri-Cyclen brand name has been discontinued in the U.S. If generic versions of this product have been approved by the FDA, there may be generic equivalents available.

What is Ortho Tri-Cyclen?

Ortho Tri-Cyclen is a combination birth control pill containing the female hormones ethinyl estradiol and norgestimate. These hormones prevent ovulation (the release of an egg from an ovary).

Ortho Tri-Cyclen also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Ortho Tri-Cyclen is used as contraception to prevent pregnancy.

Ortho Tri-Cyclen is also used to treat moderate acne vulgaris in females who are at least 15 years old. This medicine should be used for the treatment of acne only if the patient desires an oral contraceptive for birth control.

Important Information

Do not use Ortho Tri-Cyclen if you are pregnant or if you have recently had a baby.

You should not use Ortho Tri-Cyclen if you have: uncontrolled high blood pressure, heart disease, coronary artery disease, circulation problems (especially with diabetes), undiagnosed vaginal bleeding, liver disease or liver cancer, severe migraine headaches, if you also take certain hepatitis C medication, if you will have major surgery, if you smoke and are over 35, or if you have ever had a heart attack, a stroke, a blood clot, jaundice caused by pregnancy or birth control pills, or cancer of the breast, uterus/cervix, or vagina.

Taking birth control pills can increase your risk of blood clots, stroke, or heart attack.

Smoking can greatly increase your risk of blood clots, stroke, or heart attack. You should not take Ortho Tri-Cyclen if you smoke and are over 35 years old.

Before taking this medicine

Taking Ortho Tri-Cyclen can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, or if you are overweight. Your risk of stroke or blood clot is highest during your first year of taking birth control pills. Your risk is also high when you restart birth control pills after not taking them for 4 weeks or longer.

Smoking can greatly increase your risk of blood clots, stroke, or heart attack. Your risk increases the older you are and the more you smoke. You should not take combination birth control pills if you smoke and are over 35 years old.

Do not use Ortho Tri-Cyclen if you are pregnant. Stop using this medicine and tell your doctor right away if you become pregnant, or if you miss two menstrual periods in a row. If you have recently had a baby, wait at least 4 weeks before taking birth control pills.

You should not take Ortho Tri-Cyclen if you have:

  • untreated or uncontrolled high blood pressure;

  • heart disease (chest pain, coronary artery disease, history of heart attack, stroke, or blood clot);

  • an increased risk of having blood clots due to a heart problem or a hereditary blood disorder;

  • circulation problems (especially if caused by diabetes);

  • a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina;

  • unusual vaginal bleeding that has not been checked by a doctor;

  • liver disease or liver cancer;

  • severe migraine headaches (aura, numbness, vision changes), especially if you are older than 35; or

  • if you take any hepatitis C medication containing ombitasvir/paritaprevir/ritonavir (Technivie).

To make sure Ortho Tri-Cyclen is safe for you, tell your doctor if you have ever had:

  • heart problems, high blood pressure, or if you are prone to having blood clots;

  • high cholesterol or triglycerides, or if you are overweight;

  • depression;

  • a seizure or migraine headache;

  • diabetes, gallbladder disease, underactive thyroid;

  • liver or kidney disease;

  • jaundice caused by pregnancy or birth control pills;

  • irregular menstrual cycles; or

  • fibrocystic breast disease, lumps, nodules, or an abnormal mammogram.

This medicine can slow breast milk production. Tell your doctor if you are breast-feeding.

How should I take Ortho Tri-Cyclen?

Take Ortho Tri-Cyclen exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You will take your first pill on the first day of your period or on the first Sunday after your period begins. You may need to use back-up birth control, such as condoms with spermicide, when you first start using Ortho Tri-Cyclen. Follow your doctor’s instructions.

Take one pill every day, no more than 24 hours apart. When the pills run out, start a new pack the following day. You may get pregnant if you do not take one pill daily.

Ortho Tri-Cyclen packs contain seven dark green “reminder” pills to keep you on your regular cycle. Your period will usually begin while you are using these reminder pills.

You may have breakthrough bleeding, especially during the first 3 months. Tell your doctor if this bleeding continues or is very heavy.

Use a back-up birth control if you are sick with severe vomiting or diarrhea.

If you need major surgery with long-term bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using Ortho Tri-Cyclen.

While taking Ortho Tri-Cyclen, you will need to visit your doctor regularly.

Store this medicine at room temperature away from moisture and heat.

Ortho Tri-Cyclen dosing information

Usual Adult Dose of Ortho Tri-Cyclen for Contraception:

1 tablet orally once a day

Usual Adult Dose for Acne:

1 tablet orally once a day
Comments: Not all preparations are indicated for the treatment of acne; the manufacturer product information should be consulted.

Usual Pediatric Dose for Acne:

15 years or older: 1 tablet orally once a day
-Use should be reserved for the treatment of acne only if the patient desires an oral contraceptive for birth control.
Use: For the treatment of moderate acne vulgaris in females at least 15 years of age with no know contraindications to oral contraceptive therapy and who have achieved menarche.

What happens if I miss a dose?

Follow the instructions provided with your medicine. Missing an Ortho Tri-Cyclen pill increases your risk of becoming pregnant.

If you miss 1 active pill, take 2 pills on the day you remember. Then take 1 pill per day for the rest of the pack.

If you miss 2 active pills in a row in Week 1 or 2, take 2 pills per day for 2 days in a row. Then take 1 pill per day for the rest of the pack. Use back-up birth control for at least 7 days following the missed pills.

If you miss 2 active pills in a row in Week 3, throw out the pack and start a new pack the same day if you are a Day 1 starter. If you are a Sunday starter, keep taking a pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new pack that day.

If you miss 3 active pills in a row in Week 1, 2, or 3, throw out the pack and start a new pack on the same day if you are a Day 1 starter. If you are a Sunday starter, keep taking a pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new pack that day.

If you miss 2 or more pills, you may not have a period during the month. If you miss a period for 2 months in a row, call your doctor because you might be pregnant.

If you miss a reminder pill, throw it away and keep taking one reminder pill per day until the pack is empty.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Ortho Tri-Cyclen?

Do not smoke while taking Ortho Tri-Cyclen, especially if you are older than 35 years of age.

Ortho Tri-Cyclen will not protect you from sexually transmitted diseases, including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

Ortho Tri-Cyclen side effects

Get emergency medical help if you have signs of an allergic reaction to Ortho Tri-Cyclen: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using Ortho Tri-Cyclen and call your doctor at once if you have:

  • signs of a stroke – sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance;

  • signs of a blood clot – sudden vision loss, stabbing chest pain, feeling short of breath, coughing up blood, pain or warmth in one or both legs;

  • heart attack symptoms – chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;

  • liver problems – loss of appetite, upper stomach pain, tiredness, fever, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • severe headache, pounding in your neck or ears;

  • swelling in your hands, ankles, or feet;

  • changes in the pattern or severity of migraine headaches;

  • a breast lump; or

  • symptoms of depression – sleep problems, weakness, tired feeling, mood changes.

Common Ortho Tri-Cyclen side effects may include:

  • stomach pain, gas, nausea, vomiting;

  • breast tenderness;

  • acne, darkening of facial skin;

  • headache, nervousness, mood changes;

  • qa

  • problems with contact lenses;

  • changes in weight;

  • breakthrough bleeding;

  • vaginal itching or discharge; or

  • rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Ortho Tri-Cyclen?

Other drugs interact with ethinyl estradiol and norgestimate, including prescription and over-the-counter medicines, vitamins, and herbal products. Some drugs can make birth control pills less effective, which may result in pregnancy. Tell your doctor about all your current medicines and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Ortho Tri-Cyclen for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 15.02.

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Other brands: Sprintec, Tri-Sprintec, Estarylla, Ortho Tri-Cyclen Lo, … +20 more

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This site will tell you if your birth control is making your acne better or worse

Image zoom

There’s an unfortunate myth that all birth control will help clear up acne. That is completely untrue because while some birth control methods will wreak havoc on your skin, others will clear it up completely and some might just help a little bit.

Why does this happen? Because not all birth controls are created equal. No, that doesn’t mean one birth control is better than others but rather, different birth control brands and methods prevent pregnancy in different ways using different hormones. Depending which you use, it will have a totally different effect on your skin.

Curology, a company that makes prescription-grade skin care, just polled 2,000 individuals with hormonal acne and found out how each of the major brands of birth control affected their skin.

Image zoom Image zoom Curology

The birth control that is BEST for acne is:

A Drospirenone, Ethinyl estradiol pill like Yaz or Ocella shows the greatest improvement in hormonal acne. **However, these pills are the ones that are often associated with lawsuits that have to do with blood clots, so please consult with your doctor.

The birth control that is WORST for acne is:

Subdermal implants like Nexplanon are the worst for acne because they contain so much progesterone.

How to find your birth control:

Use Curology’s search tool HERE to find the birth control you use and what the study found about its effects on acne.

I searched for Ortho Tri-Cyclen Lo and found that it’s pretty moderate on the acne-healing scale (which makes sense because it has MOSTLY rid me of my hormonal acne).

Image zoom Curology

The information presented here is only meant to inform. Consult with your doctor or dermatologist before beginning any course of treatment.

  • By Madison Vanderberg

Ethinyl Estradiol; Norgestimate tablets

In some women, tenderness, swelling, or minor bleeding of the gums may occur. Notify your dentist if this happens. Brushing and flossing your teeth regularly may help limit this. See your dentist regularly and inform your dentist of the medicines you are taking.

If you are going to have elective surgery, you may need to stop taking this medicine before the surgery. Consult your health care professional for advice.

This medicine does not protect you against HIV infection (AIDS) or any other sexually transmitted diseases.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

  • breast tissue changes or discharge

  • changes in vaginal bleeding during your period or between your periods

  • chest pain

  • coughing up blood

  • dizziness or fainting spells

  • headaches or migraines

  • leg, arm or groin pain

  • severe or sudden headaches

  • stomach pain (severe)

  • sudden shortness of breath

  • sudden loss of coordination, especially on one side of the body

  • speech problems

  • symptoms of vaginal infection like itching, irritation or unusual discharge

  • tenderness in the upper abdomen

  • vomiting

  • weakness or numbness in the arms or legs, especially on one side of the body

  • yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • breakthrough bleeding and spotting that continues beyond the 3 initial cycles of pills

  • breast tenderness

  • mood changes, anxiety, depression, frustration, anger, or emotional outbursts

  • increased sensitivity to sun or ultraviolet light

  • nausea

  • skin rash, acne, or brown spots on the skin

  • weight gain (slight)

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

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Ortho Tri-Cyclen (Ethinyl Estradiol & Norgestimate)

Table Of Contents

    • What is Ortho Tri-Cyclen?
    • Important Information
    • Before taking the Medication
    • Dosage Information
    • What happens if I missed a dose?
    • What happens if I overdose?
    • What to avoid while taking medication?
    • Side Effects
    • What other medications affect this Birth Control option?

    What Is Ortho Tri-Cyclen?

    Ortho Tri-Cyclen includes a blend of female hormones (ethinyl estradiol and norgestimate) that prevent ovulation (the release of an egg from an ovary). This drug also causes changes in uterine lining and your cervical mucus, making it more difficult for a fertilized egg and more difficult for sperm to reach the uterus.

    It is used as contraception to prevent pregnancy.

    It might also be used for functions not listed in this medication guide.

    Don’t use Ortho Tri-Cyclen if you’ve had a baby or if you’re pregnant.

    Taking birth control pills can raise your risk of heart attack, stroke, or blood clots, in case you are heavy, or particularly if you are at risk of having high blood pressure or diabetes.

    Smoking can significantly increase your risk of heart attack, stroke, or blood clots. You must not take birth control pills if you are over 35 years old and smoke.

    You may have to use back up birth control, like a spermicide or condoms, when you begin using this birth control option or if you miss a dose. Follow the directions of your physician.

    Some drugs can make Ortho Tri- Cyclen less successful in preventing pregnancy, including hepatitis C medications, antibiotics, HIV/AIDS medicines, seizure medicines, or barbiturate sedatives. Inform your doctor about all other medicines you use.

    Before Taking The Medication

    Taking this birth control option can raise your risk of heart attack, stroke, or blood clots. You’re more at risk in case you are heavy, or if you have high blood pressure, diabetes, high cholesterol.

    Smoking can significantly increase your risk of heart attack, stroke, or blood clots. Your risk increases the more you smoke and the older you are. Blend birth control pills should not be taken by you if you are over 35 years old and smoke.

    Don’t use Ortho Tri-Cyclen if you’re pregnant. Stop taking this medication and tell your physician if you miss two menstrual periods in a row, or if you become pregnant. Wait before taking birth control pills, if you’ve recently had a baby.

    Some reasons why you shouldn’t take this medication:

    • chest pain
    • unusual vaginal bleeding that has not been assessed by a physician
    • Difficulties with circulation, kidneys or your eyes due to diabetes
    • a history of hormone-related cancer like breast or uterine cancer
    • liver cancer
    • a history of jaundice due to pregnancy or birth control pills

    To make certain Ortho Tri-Cyclen are not dangerous for you, make sure your doctor knows if you’ve:

      • High blood pressure, heart disease
      • gallbladder disease
      • Kidney or liver disorder
      • diabetes
      • seizures or epilepsy
    • A history of irregular menstrual or
    • A history of nodules, lumps, fibrocystic breast disease, or an abnormal mammogram

    The hormones in Ortho Tri-Cyclen can pass into breast milk and may harm a nursing infant. It may also impede breast milk production. Don’t use if you’re breast feeding a baby.

    Dosage Information

    Take Ortho Tri-Cyclen precisely as prescribed by your physician. Don’t take in smaller or bigger quantities or for more than recommended. Follow the directions in your prescription label.

    You may have to use backup birth control, like a spermicide or condoms, when you begin using Ortho Tri-Cyclen. Follow the directions of your physician.

    Take one pill daily, no more than 24 hours apart. Begin a fresh pack the following day, when the pills run out. Should you not take one pill you may get pregnant.

    Your period will normally start when you are using these reminder pills.

    Tell your physician if this bleeding is quite significant or continues.

    Use a backup birth control should you be ill with diarrhea or acute vomiting.

    If you will need if you’ll be on bed rest or medical tests or surgery, you may have to discontinue using the birth control medication for a brief time. Surgeon or any physician who treats you should be aware that you’re using Ortho Tri-Cyclen.

    While taking this medication, you’ll need to see your physician regularly.

    What happens if I missed a dose?

    Follow the patient instructions supplied with your Ortho Tri-Cyclen. Should you not understand these directions ask your physician or pharmacist.

    Take two pills on the day that you just recall if you miss one active pill. Take one pill daily for the remaining part of the pack.

    Take two pills daily for two days in a row if you miss two active pills in a row in Week 1 or 2. Take one pill daily for the remaining part of the pack.

    If you miss two active pills in a row in Week 3, throw out the remaining part of the pack and begin a fresh pack the same day in case you are a Day 1 starter. In case you are a Sunday starter, keep taking a pill daily until Sunday. On Sunday, throw out the remaining part of the pack and begin a brand new pack that day.

    In case you are a Sunday starter, keep taking a pill daily until Sunday. On Sunday, throw out the remaining part of the pack and begin a brand new pack that day.

    You may not have a period during the month if you miss a couple of pills.

    Throw it away if you miss a reminder pill and keep taking one reminder pill each day until the pack is empty. You don’t want backup birth control if you miss a reminder pill.

    Seek emergency medical attention right away or call the Poison Help line at 1-800-222-1222.

    What to avoid while taking this medication?

    Don’t smoke while taking this medication, particularly when you’re older than 35 years old.

    Ortho Tri-Cyclen is not going to shield you from sexually transmitted diseases – including AIDS and HIV. Using a condom is the lone way to shield yourself from these disorders.

    Side Effects

    It is important that if you experience any of these serious side effects that you get emergency medical help right away.

    If you have issues with swelling of the tongue, throat, face or lips. If you have trouble breathing or break out into hives you should seek medical attention as soon as possible.

    If you experience any of these side effects below you should stop using this birth control option and all your doctor:

    • Hints of a blood clot in the lung – rapid breathing, chest pain, sudden cough, wheezing, coughing up blood
    • Hints of a blood clot in your leg – pain, swelling, heat, or redness in one or both legs
    • Heart attack symptoms – pressure or chest pain, pain spread to shoulder or your jaw, nausea, perspiration
    • liver problems – nausea, upper stomach pain, itching, exhausted feeling, loss of appetite, dark urine, clay-coloured stools, jaundice (yellowing of the skin or eyes)
    • a change in the pattern or severity of migraine head aches
    • a breast lump
    • Symptoms of melancholy – disposition changes, sleep difficulties, weakness, exhausted feeling

    Some of the more common side effects of this birth control include:

    • changes in appetite or weight
    • vomiting and/or nausea
    • breast tenderness
    • nervousness, head ache, dizziness
    • rash
    • difficulties with contact lenses
    • unusual menstrual spotting or bleeding

    Please note that this may not be a complete list of side effects and it is possible for other side effects to occur. If you would like more information about the side effects that may occur you should contact your doctor for medical advice.

    You can also report side effects to FDA at 1-800-FDA-1088.

    What other medications affect this Birth Control option?

    Some drugs can make Ortho Tri-Cyclen powerful, which might lead to pregnancy. Other drugs may interact with ethinyl estradiol and desogestrel, including prescription and over-the-counter medicines, vitamins, and herbal products.

    Tell each of your health care providers about any medication you begin and all medications you use currently or quit using.

Loestrin, Mircette, Yasmin, Yaz, Ortho-Tricyclin, Ortho-Novum, and Alesse—the list goes on and on. Many of us have sampled more pills than flavors at our local ice cream shop (even when the sign says one per customer). And no, it is not all in your head; different pills make you feel differently! Who is the culprit, or the Oz, making your body and maybe even mind feel different on Ortho-Tricyclen vs. Yasmin? Drum roll, please: it’s the progesterone!

While almost all oral contraceptive pills share the same type of synthetic estrogen component (ethinyl estradiol, a.k.a. EE) the progesterone content can vary significantly. Some may make you feel good, even great, while others can make you feel down right crummy. In order to understand the difference in progestins, we want you to picture your family tree. Hone in on four consecutive branches, or generations: from great grandma right down to you. And as with most families, generational changes are huge—think landline to the iPhone, black and white TVs to flat-screen monstrosities, a quarter to ride the subway to a whopping $2.50 per ride.

Similar changes can be seen in the generational changes of synthetic progesterone. The first-generation crew was not so specific in whom they “mated and connected with.” Therefore, they would bind to both progesterone and androgen receptors alike. Their affinity for the androgen receptors resulted in some unwanted side effects: think hair, acne, and bloating. Oh, what a joy! Such side effects made them somewhat unattractive and unpopular.

However, over the next several years, scientists found ways to alter the synthetic progesterone component and reduce the androgenic properties; this translated into way less negative side effects and even some positive ones! Such alterations made pills way more appealing and widespread in their use. Bottom line, if one type of pill (a.k.a. progesterone) doesn’t agree with you, try another. There are many “branches” to climb!

Now, while the progestin component varies, the synthetic estrogen component is pretty much always the same—think of the menu at Applebee’s. It’s just not going to change! However, while the estrogen content is always the same, the dose will differ. And what makes the modern-day pills low dose or, even better, low, low dose is the very low dose of estrogen that each pill contains.

Today, most pills have between 20–35 mcg of EE. This is in contrast to traditional pills (circa 1960), which contained about 50 micrograms of estrogen in each pill. The past 50 years have shown us how low we can go on the estrogen—minimizing clots, strokes, and a slew of negative side effects—while maintaining the efficacy. So although lower dose EE = lower negative side effects, lower dose ≠an increased chance of pregnancy. Currently, we are, taking it back to the limbo reference, as low as you can go without giving up on efficacy.

While intuitively, it seems that the lowest would be the best, this is not the case for everyone. Sometimes the low-low versions cause lots-lots of breakthrough bleeding; this can often be fixed by raising the estrogen dose. So just because low-low seems to be the “in thing” to do, it may not be right for your uterus. A slight bump up in the estrogen dose won’t take you back to the doses seen in the 1960s, but it will give your body just enough estrogen to maintain the lining and maintain your sanity.

You might be wondering what is up with the Tri and even Bi part in the name of some pills (e.g., OrthoTri-Cyclen vs. Ortho-Cyclen). For all of you number fans who can’t wait to travel back in time to middle school math class, tri means three, bi means two, and mono means one. The number part of the name describes the number of phases or changes in hormones that will occur throughout the cycle (a.k.a. the pill pack). Monophasic pills (Loestrin, Ortho-Cyclen, Yaz, Yasmin, Seasonale) contain the same amount of estrogen and progestin in all of the active pills. Biphasic pills (two-phase pills; e.g., Mircette, Ortho-Novum) alter the level of estrogen and progestin twice during the active pack. Last, triphasic pills (three-phase pills; e.g., Ortho Tri-Cyclen, Enpresse) have three different doses of estrogen and progestin in the active pills; the dose changes every seven days during the first three weeks of the pack. These triphasics were the original pills. Scientists were doing their best to mimic the natural cycle. However, research soon showed us that we didn’t need to vary the dose each week. Slow and steady could also win the race! In fact, monophasic pills are equally as effective and in many ways more tolerable. The consistency of the dose translates into less side effects and less breakthrough bleeding.

We have covered doses, phases, and progestins. Last but certainly not least is the number of active pills contained within the pill pack. Traditionally, pill packs contained 21 active pills and seven inactive (a.k.a. placebo or sugar pills). This, like the triphasic pills, was designed to mimic the natural cycle. However, newer formulations have increased the number of active pills to 24 and reduced the number of inactive pills to four. By altering the balance and pushing the pendulum a bit further to the right, there are fewer days off the active pills. Fewer days off the active pills means fewer days of bleeding. In fact, some women skip the placebo pills all together every month and only take the active pills. This does no harm to them or their fertility. It merely removes the need to buy tampons or pads.

Believe it or not, the pill has benefits beyond contraception. It can reduce the risk of ovarian and endometrial cancer, improve acne and unwanted hair growth, regulate the menstrual cycle, decrease heavy menses, reduce the size of fibroids and painful periods, treat PMS symptoms and menstrual migraines, and offer symptomatic relief to women with endometriosis. The list is long, and the benefits variable. Simply stated, the pill can do a lot more than prevent pregnancy!

However, with every peak there is always a valley, and with every pro, there is also a con. Even with the best medications, you must read the fine print. Although the pill has a lot of benefits, there are some of us for whom the glass slipper just doesn’t fit. Certain medical problems preclude women from even trying to shove their foot in! Such conditions include women with a history of blood clots (or a family member who harbors an inherited clotting disorder), impaired liver function, smokers older than 35 years, elevated blood pressure, migraines with visual aura (think flashing lights), and markedly elevated cholesterol/triglycerides. Before starting you on the pill your doctor will likely take a thorough medical and family history to make sure you are a good candidate.

You will likely not marry the first person you date or say yes to the first dress you try on. Don’t quit after one bad month on OCPs; just because one didn’t agree with you it doesn’t mean the dozen others will too. OCPs are a great form of birth control and come with a lot of other benefits. As long as you can remember to take it daily (put it by your toothbrush or face wash!), it’s worth giving it a go. You’ll find something that fits!

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