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Birth-control pills: What’s in a name? Oh, and what do they cost?

“I generally write prescriptions using the brand name but specifying that a generic substitute is OK. That’s better than writing for the generic brand because the different brands seem to come and go as pharmacies and insurance companies deal with different manufacturers. Some patients do report different side effects with different generics, and there are tons of posts on the web by women about their preference for one or another. I assume the differences are related to the inactive ingredients or variations in hormone content that is within the FDA requirements but enough different for occasional patients to notice.

“The numbers following the name of a birth control pill usually refer to the amount of the synthetic hormones, progesterone followed by estrogen, separated by a slash (/). Almost all U.S. birth control pills use ethinyl estradiol for the estrogen, but the amount varies from 15 to 35 micrograms (a few 50 mcg pills exist but are used for specific indications, not routine birth control). There are a handful of different progesterones used in different pills. They include norethindrone, norgestrel, levo-norgestrel, norgestimate desogestrel, drospirenone and ethynodiol. The different progesterones have different side effect profiles, so doctors may recommend a particular pill based on the patient’s particular situation – some help with excessive bleeding, others with acne or excess body hair, etc.

“Most pills are 21 day monophasic pills, meaning they are packaged with the same dose for 21 days. During a week of placebo pills (containing no active medication) or no pills at all, hormone levels drop so a menstrual period occurs. The same brand may be packaged in a 21- or 28-day pack. In that case, the number 21 or 28 will occur after a dash in the name. A few brands now include a much lower dose of estrogen during the last week in a pack or an insignificant amount of iron (Loestrin FE) or some folate (Vitamin B in Beyaz).

“I avoid using the 21-day packs because many patients forget to restart their pills after a week. With the pills packaged with placebo pills, they take a pill every single day, starting a new pack immediately after finishing the previous pack.

“A few pills are packaged with 24 days of the active pill and only 4 placebo pills. As a result, the menstrual period is shorter. There are also a few extended cycle preparations, with 84 active pills followed by 7 placebo pills, so menstruation occurs every 3 months.

“There are also triphasic pills which are packaged with slightly different concentrations of hormone throughout the month. They are generally in 28-days pack. One of the most popular pills is Ortho-Tri-Cyclen. The triphasics generally have ‘tri’ in their names or have 7/7/7 in the name.”

She adds: “I love smalltown, individually-owned pharmacies, but many of my patients use Target for Orthocylen/Sprintec/Mononessa/Prevafem or their Tri sisters for $9/pack. There aren’t many Walmarts around, so I haven’t had experience with them, but their website does list it on their inexpensive med list. Both companies’ websites have long lists of generic drugs available for $4-12/month supply and even bigger discounts for 90-day supply.”

The page pictured here is a great reference for brand names, issues and side effects. We also find a lot of good information on MedScape.

LoEstrin, Junel, Microgestin and other names

Here’s an example: LoEstrin is made by Teva Pharmaceuticals. It comes in several different generics, including Microgestin and Junel.

A common generic is Junel 1.5-30, meaning 1.5 mg norethindrone acetate) and 30mcg ethinylestradiol. There’s also Junel 1-20, which has 1 mg norethindrone acetate, and 20 mcg ethinyl estradiol.

Junel Fe/1.5-30 (Junel Fe/1-20) is the same prescription, but it has 7 iron pills, so the woman takes 21 active pills and then 7 iron pills.

For Junel, Microgestin, and Loestrin, we know of Junel 1.5/30, Junel 1/20, Junel Fe 1.5/30, Junel Fe 1/20.

Microgestin 1.5/30, Microgestin 1/20, Microgestin Fe 1.5/30, Microgestin Fe 1/20,

Loestrin Fe, Loestrin 21 1.5/30, Loestrin 21 1/20, Loestrin 24 Fe, Loestrin Fe 1.5/30, Loestrin Fe 1/20.

Loestrin 24 Fe, then, has 24 days of active pills and four days of iron in the placebo pills.

A note of caution: When you’re buying, you might find that some independent or chain pharmacies carry one generic, while some carry another. This can be confusing (“I’ve been taking Microgestin, so why are you giving me Junel?”). It can also be true, as our doctor friend notes, that certain pills work better for some women than others, even though both are considered equivalent generics. And then you will encounter the term “formulary,” as in — when you try to fill a prescription at a different pharmacy or on a different insurance plan — you are told “that’s not on our formulary” or “we don’t carry that.” In other words, pay full price or go somewhere else — or choose our club-discount card, if you’d like.

Some pills use drospirenone as the first ingredient. Yasmin, Ocella, Zarah, Safyral, Syeda all have 3 mg drospirenone and 30 mcg of ethinyl estradiol for 21 days, then one inert tablet for 7 days.Their cousins, Yaz, Beyaz, Gianvi, Loryna and Vestura have 3 mg drospirenone and 20 mcg ethinyl estradiol for 24 days, then one inert tablet for 4 days. Source: Medscape.

Ortho-Tri-Cyclen has several generics: Trinessa and Tri-Sprintec. But Ortho-Tri-Cyclen Lo, as far as we can tell, has no generic yet; MedScape’s dictionary of drugs, again, is our source for that.

Confused yet? Don’t get us started on how a brand-name drug becomes a generic, or how a brand-name drug that is eligibile for generic manufacture might suddenly become a slightly different drug, and therefore not something that can be turned into a generic. We wrote about this in this blog post: for example, when Yaz, the popular pill, became eligible for generic manufacture, then acquired an added chemical, the vitamin folic acid, which is important for women planning to get pregnant to overcome spinal bifida and other birth defects. So Yaz became Beyaz.

Of course, you can find a lot of information on the web: Here’s a Microgestin-vs.-Junel conversation from Drugs.com, which includes consumer reviews.

We did an interactive map asking people how much they were paying for birth-control pills. It’s no longer active, but this is what it looked like. We used a collection of 600-some cash or self-pay prices at New York area pharmacies that we collected in April-May 2013, and the graphics team at WNYC made the interactive.

Further information? Here’s the . And here’s the .

* * * * * * *

Want still more information? There’s advice about buying prescriptions on our reference page on the topic. Also, see our preceding posts about birth-control pricing here (how much do they cost? $9 to $63? Really?) and here (chain stores vs. indies).

Certain types of birth control can help some women improve their acne by helping to regulate preexisting hormone imbalances. Others, however, can have the opposite effect and make acne worse! Below is your guide to choosing the right birth control to help with acne.

How common is hormonal acne?

If you’re dealing with hormonal acne, you are not alone! Hormonal acne is very common, particularly for women in their 20s and 30s. Data show that up to 50% of women in their 20s and 30s suffering with adult acne have some hormonal factor influencing their breakouts.

How to determine if acne is hormonal

There are two typical signs that help determine if your acne is hormonal in nature. The first is by the areas it appears on your face and second is timing of breakouts. Read below to learn more!

Where is hormonal acne typically located on the face?

While typical teenage acne appears most of the forehead and cheeks, the most common areas for hormonal acne to pop up are on the lower sections of the face, including around the mouth, on the jawline, and on the neck.

When are hormonal acne breakouts expected?

The most typical sign of hormonal acne is its connection to the monthly hormonal cycle. Some women experience breakouts during ovulation (mid-cycle), while others have pimples pop up before or during menstruation—2 times in the month when there are significant hormonal changes. During ovulation, higher levels of progesterone stimulate oil glands and rev up the production of sebum, which can cause pores to get clogged. During pre-menstruation, estrogen and progesterone levels drop, causing even higher levels of the production of sebum, often causing more inflamed breakouts.

For women with a hormonal imbalance, these normal hormonal fluctuations are often exaggerated, causing more significant changes in skin’s behavior and ultimately more numerous, severe, and inflamed breakouts.

How do birth control pills work?

Birth control pills work by temporarily changing the hormonal balance in your body. These pills contain a different combination of estrogen and progesterone. Some of birth control pills only contain progestin, the synthetic form of progesterone.

What are the best birth control options for women with hormonal acne?

Birth control pills, IUDs, implants can all potentially benefit some women with acne. Unfortunately, they do not have the same effect across the board and some birth controls that work well for certain women can be the worst nightmare for others.

There are certain birth control pills that tend to affect the hormonal balance in a way that typically reduces breakouts, while other pills or IUDs tend to have the opposite and make acne worse. This effect typically depends on the dose of progesterone in the pills or IUD. As a rule of thumb, birth control that contains a higher level of progesterone will have a stronger androgenic effect and have a higher risk of promoting acne breakouts.
The best birth control pills for women with Acne are pills that contain drospirenone and ethinyl estradiol. Examples for these type of pills are Yasmin, Yaz, Beyaz, Ocella, Safyral, Syeda, Gianvi, Loryna, Nikki, Vestura, Zarah.

What are the risks of taking birth control pills?

While birth control pills may seem like an easy go-to option for treating hormonal acne, there are some risks associated with hormonal birth control pills including increased risk of blood clots, weight gain, nausea, mood changes, and breast tenderness. These are potentially serious side effects that need to be considered before starting or inserting birth control and monitored over time. If significant side effects occur, it may be a good idea to consult your physician about a different birth control option,

What are the best birth control pills for hormonal acne?

The best birth control pills for women with acne typically contain at least 35 mcg (.035 mg) of Ethinyl Estradiol and progestin with a low androgenic effect.
A study recently published in the Journal of Drugs in Dermatology categorized the different types of contraceptives by their efficiency in clearing acne. We found the study super interesting, so we just had to share the findings with you!

In addition to the contraceptive element, birth control pills can provide additional benefits such as reduction of acne breakouts, lighter and more regular periods, fewer menstrual cramps, and a reduced risk of certain cancers, including ovarian, uterine, and colon cancers

The U.S. Food and Drug Administration (FDA) has formally approved a handful of brands of birth control for the treatment of acne:

  1. Beyaz: combination of drospirenone, ethinyl estradiol, and levomefolate calcium
  2. Estrostep Fe: combination of which s norethindrone acetate, ethinyl estradiol, and ferrous fumarate
  3. Ortho Tri-Cyclen: norgestimate and ethinyl estradiol
  4. Yaz: drospirenone and ethinyl estradiol

Having said that many other birth control pills can help with adult acne including, Ocella, Yasmin, Trinessat, MonoNessa, Apri, and Reclipse. As mentioned above, some of these medications come with additional risks and side effects that should be considered before starting.

Birth control pils and IUDs that usually have little or no effect on acne

For some women, a preferred form of contraceptive birth control may be one that has little or no effect on hormones and acne. Some options in that category include the Nuvaring (a vaginal plastic ring that releases smaller amounts of estrogen and progesterone after being placed near the cervix), Microgestin (pill), and Orthoevra (patch). Paragard/Copper IUD does not contain any hormones and will usually not make acne better or worse.

Birth control pills and IUDs that can cause acne

There are several contraceptive options that are known to exacerbate or trigger acne in some women as they are higher in progestin (i.e. they increase testosterone-like activity) and low in estrogen. These include Depo-Provera (a shot), Skyla, Lylema, Implanon, and Nexplanon (a subdermal implant).

Is there a way to balance hormones without birth control?

There are several medications besides birth control that can help balance hormones and effectively treat acne. One of the most effective is called, Spironolactone (Aldactone), an oral medication that was originally used for the treatment of high blood pressure that was found to help with hormonal acne. Interestingly, Spironolactone does not contain hormones or synthetic hormones. It’s actually a diuretic that also works as an androgen blocker, which means it blocks the effects of male hormones in the body like testosterone, which contribute to oil production and ultimately, acne.

For more info on Spironolactone check the links below.
Spironolactone for Acne – read this first!
Here’s why spironolactone can cure your adult acne

So, what birth control should you use if you have acne?

Though there are certain guidelines you can follow above when considering birth control and acne. If you struggle with acne, it’s recommended that you choose an option known to help balance acne-producing hormones or at least, one that is known to have little or no effect on acne. This category includes a variety of options from hormonal pills to vaginal implants, to patches and others. Before consulting with your OB/GYN read through the above and create a list of questions and concerns to help you both identify the best birth control choice for you! As always, monitor any symptoms or side effects and discuss with your provider. Sometimes it takes trying a couple (or few…) different birth control options to find a good fit.
More info:
Effect of birth control pills on acne in women

Tips for Controlling Acne!!

Did you ever look forward to that big date or the important job interview only to have a pimple show up the day of the big event? This uninvited guest has the power to sap your self-confidence and make you so self-conscience that it’s ruining your big day.

Acne is the most common skin condition in the United States and it is not limited to teenagers. In fact, the number of adults with acne is actually growing, especially among women between the ages of 30-55 years old. Although the reasons for the increase in adult acne are unknown, dermatologists understand that adult acne can be especially frustrating. Treating acne not only reduces the condition itself, it can boost your confidence and self-esteem.

Acne signs

Acne is not limited to pimples. Acne blemishes include blackheads, whiteheads, papules, pustules (pimples), cysts, and nodules. Signs of acne can appear on the face, neck, chest, back, shoulders, upper arms, and buttocks.

It may cause low levels of self-esteem: Many people with acne, especially during sever outbreaks; say it makes them feel bad about themselves. Some claim they do not want to be with friends, acquaintances, and even miss school or work. Such low self-esteem may develop into depression and suicidal thoughts – especially in teenagers. Even small outbreaks can be perceived as ‘bad’ depending on the individual.

Acne needs constant attention

As areas of of your skin heal, dark spots can appear that can take months or years to disappear. Cysts and nodules often leave permanent scars once the acne clears. These scars can be prevented and treatments are available to have them removed after healing. Speak to your dermatologist for treatments available to prevent and treat scaring.

Who gets Acne?

Acne does not have to be a rite of passage into adulthood, however, 40 to 50 million Americans have acne at one time or another during their teenage years. Although the most common sufferers of acne are teenagers or young adults, acne can occur at any age – even newborn babies can get acne. Most of us can get reoccurring acne outbreaks well into adulthood. Some women get severe acne when they reach their 30s and 40s and which may last into their senior years.

Most people who have mild acne have a few blemishes, which may include whiteheads, blackheads, papules, and/or pustules (pimples). There are many over-the-counter scrubs for the prevention and treatment of acne. A product containing benzoyl peroxide or salicylic acid often clears the skin however, despite TV claims; this does not mean that the acne will clear overnight.

What causes Acne?

Acne appears when a pore in our skin clogs with dead skin cells. Typically, dead skin cells rise to the surface of the pore and are shed through normal washing. When the body starts to make lots of sebum (oil that keeps our skin from drying out), dead skin cells can stick together inside the pore. Instead of rising to the surface, the dead skin cells become trapped inside the pore and mix with bacteria that live on our skin, clogging the pore with infection. Once inside the pore, the bacteria have a perfect environment for multiplying very quickly causing the pore to become inflamed, red and swollen. If the inflammation goes deeper into the skin, an acne cyst or nodule may appear.

Treatments

There are a number of effective treatments for acne. Although not every acne treatment works for everyone, it does mean that virtually every case of acne can be controlled. Once acne clears, continued treatment is required to prevent breakouts.

Letting acne runs its course is not advised. Acne can be hard to control and without proper treatment, dark spots and permanent scars can appear on the skin as acne outbreaks begin to clear.

Unfortunately, if you have a lot of acne, cysts, or nodules, over-the-counter medicines may not be effective and you should see a dermatologist if you want to see clearer skin.

Your dermatologist may prescribe topical treatments to help kill the bacteria or reduce the oil produced through your pore. Topical medicine may contain a retinoid, prescription-strength benzoyl peroxide, antibiotic, or even salicylic acid. Your dermatologist will determine your specific needs.

Tips

1. Keep your skin clean. Washing your face or skin area with acne in the morning and evening can help combat further breakouts. There are many over-the-counter options with benzoyl peroxide or other bacterial cleansers that can be used on your face. When you exercise or if you are perspiring frequently, take the time to clean your skin during the day. It pays off!

2. Hydration helps! Keeping your body properly hydrated with water can help your system. The hydration keeps all your bodily functions working optimally and helps your body eliminate toxins and impurities. Give it a chance!

3. Wear sunscreen! If you are outside frequently, make sure you wear a proper sunscreen on your skin. If your skin overheats and burns, acne can begin to form because of the clogged pores.

4. Consult your doctor! Your medical professional can give you medical advice about your particular acne and what medications can help control your breakouts. It may be an over-the-counter solution or a prescription drug. Always follow your medical professional’s recommendations so that your get adequate treatment and don’t overuse the medication.

Acne Before

Acne After

There are certain acne treatments that work throughout the body, which is usually necessary to treat acne cysts and nodules. Your dermatologist may prescribe one or more of these medications:

1. Antibiotics to help kill bacteria and reduce inflammation

2. Birth control pills and other medicine that work on hormones

3. Other procedures to treat acne include:

4. Lasers and other light therapies to reduce the p. acnes bacteria. Your dermatologist may recommend limited exposure to sun light for instance

5. Chemical peels to treat blackheads and papules and remove excess dead skin

6. Acne removal: a procedure called “drainage and extraction” removes large acne cyst when the cyst does not respond to medicine. It also helps ease the pain and the chance that the cyst will leave a scar. To remove a cyst quickly, your dermatologist may inject the cyst with medication.

The Best Outcome

See your dermatologists for recommendations to properly treat acne. Treatments are available for the prevention and healing of acne.

Common Medications to treat Acne

DRUG NAME

Amethia oral

Apri oral

Aviane oral

Azurette (28) oral

Beyaz oral

Claravis oral

clindamycin HCl oral

Cryselle (28) oral

Doryx oral

doxycycline hyclate oral

doxycycline oral

Epiduo topical

Femcon Fe oral

Generess Fe oral

Gildess FE oral

Jolessa oral

Junel FE 1.5/30 (28) oral

Junel FE 1/20 (28) oral

Kariva (28) oral

Lo Loestrin Fe oral

Loryna (28) oral

Lutera (28) oral

Microgestin FE 1/20 (28) oral

Minastrin 24 Fe oral

minocycline oral

Mononessa (28) oral

Natazia oral

Necon 1/35 (28) oral

Ocella oral

Ortho Tri-Cyclen (28) oral

Ortho Tri-Cyclen Lo (28) oral

Ortho-Cyclen (28) oral

Quasense oral

Reclipsen (28) oral

Seasonique oral

Solodyn oral

Sprintec (28) oral

Sronyx oral

Tri-Previfem (28) oral

Tri-Sprintec (28) oral

TriNessa (28) oral

Viorele (28) oral

Yasmin (28) oral

YAZ (28) oral

Acne medications can be expensive and many are not covered through insurance due to the cosmetic nature of some of them. If you do not have insurance coverage or your insurance company does not cover your medication, you can get prescription drug discounts by using our free Easy Drug Card prescription drug card.

Our free prescription savings card provides discounts at over 60,000 pharmacies. Download a card to your printer or use our free app to begin saving today. There are no limitations or restrictions to use our discount drug program.

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Birth Control Made My Hair Fall Out, and I’m Not the Only One

I have to stop taking my birth control. I have to stop taking it, like, yesterday. I know it immediately and I hate that it’s true.

I’ve been on Loestrin (and more recently, Watson’s generic Microgestin) since around the time I turned 21—over four years now. It’s the only birth-control pill I’ve ever taken and it’s never given me much trouble. In fact, I quite like it. My period is light and infrequent, no cramps, no weight gain, no pregnancy, no problem.

Except maybe I’ve been shedding a bit more hair than I used to. A loose strand across my forearm in the morning, later one at my desk. The drain clogs in the shower every few days, and the clump of tangled brown hair is springy between my fingers. Alone, this is not much cause for concern. On average, humans lose between 50-150 scalp hairs each day. For me, it’s nothing so noticeable. I’m certainly not going bald, and I can’t seem to remember my ponytail ever being much thicker than it is now. The forums and message boards all cite “waking up to loose strands on your pillow” as a real indicator of significant hair loss. And so far, I’ve found none there. It has been gradual, anyway. Hard to pinpoint when the shed started. I’d never dyed my hair before this year, and I’d like to think it was the shock of bleach and toner on a virgin scalp.

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