Which contraceptive pill is best

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Which contraceptive pill is best

Postby Hols969 » Wed Oct 20, 2010 9:16 am

Doing a sticky for Meringoo to put her wealth of knowledge down on which pill is best.
Unless stated, my views do not represent the official views, position or standing of Verity
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Postby Hols969 » Thu Oct 21, 2010 1:41 pm

Here are some suggestions from Meringoo as she has done loads of research on which pill is best:

Yasmin - the best alternative to Dianette, with a much newer progestogen which is very anti-androgenic (no androgenic activity therefore won't encourage sebum production --> acne and excess hair). Also helps cut down bloating as it has a diuretic effect.

Marvelon - has been around slightly longer and contains desogestrel which works well for PCOS problems.

Cilest - as above, and is the only combined pill licensed as an acne treatment in the USA (called Ortho-Cyclen there). Is often prescribed for women who suffer from cyclical depression. Slightly more androgenic progestogen but the oestrogen dose balances it out! A good pill if the top two don't agree with you.

Femodene - very similar to Marvelon.

Brevinor and Ovysmen - Like Cilest but slightly less effect on androgenic symptoms, however not too bad. The usual issue with this pill is breakthrough bleeding.

Although lots of women get on with progestogen methods such as mini-pills, the implant and the Mirena coil, they aren't the best options due to the reasons mentioned above.
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Postby Meringoo » Wed Oct 27, 2010 3:02 pm

Hello!

Apologies for my actual post being a little late - have had a hectic week!

Holly and I noticed that there are so many similar posts relating to pills and contraception for PCOS ladies, that we have started a sticky as a reference guide.

I'm not a GP, but I do have extensive experience with pills and have done absolutely loads of research for myself, for this forum and because when I was younger I wanted to go into medicine. On a less positive note, I have spent so much time researching this because I received so little help from doctors and gynaecologists over the years, I literally had to rely on my own knowledge to find the most suitable treatment. So, there's a little background info to help you understand why I'm a Pill-geek! :lol:



You may be familiar with the need for PCOS to be "controlled" somehow. For most women, the combined pill is the best option because it
a) suppresses ovulation therefore reduces the occurence of ovarian cysts;
b) controls the other hormone-related side effects of PCOS;
c) regulates periods (which may have ceased altogether if PCOS has been unmanaged or only recently diagnosed). The periods you have on the pill are not true periods, but they keep the womb healthy by shedding any build-up of tissue, which is at a reduced rate in comparison to women who don't take the pill.

The combined pill comes in varous guises. I'm going to concentrate on the best form for PCOS, which is the standard-strength monophasic combined pill. This means pills which contain between 30-35mg of Ethinylestradiol (the synthetic oestrogen), plus a progestogen (synthetic progesterone). Monophasic means that every pill contains the same amount of synthetic hormones, and doesn't vary at all. There are other types such as "bi-phasic" and "tri-phasic" pills, and this simply means that the hormone proportions change according to the day/week of the pill. These can be helpful if monophasic pills don't help symptoms however.

Having PCOS can limit your choice of Pill significantly. You need one which combines Ethinylestradiol with an anti-androgenic progestogen. This means a progestogen which reduces or prevents the testosterone effects of the male hormone, i.e. excess hair, acne and hair loss. Combined with synthetic oestrogen, anti-androgenic progestogens will alleviate PCOS symptoms after a few months' usage and continued usage. Normally effects on hair and skin can be seen 6 months after starting treatment, though this can take 9 months depending on severity.

I really hate it when doctors tell women that every pill is the same, and changing brand won't make a difference. This is complete rubbish in most cases. I also hate it when doctors prescribe cheaper, older pills to PCOS sufferers who in fact need more thoughtful treatment.

You should avoid and refuse the following pills because they are too androgenic and will likely make any existing PCOS symptoms such as acne and hair issues worse, as well as possibly making depression and low moods more significant:

Microgynon 30/30 ED (contains levenorgestrel)
Ovranette (same as above)
Loestrin 20 (low oestrogen plus high amount of norethisterone acetate)
Loestrin 30 (as above)

...any other pills which contain norethisterone acetate, levenorgestrel, norethisterone or gestodene.

The best progestogens cause little or no androgenic activity and don't have a very strong progestogenic effect (may be called "oestrogen-dominant pills". These are:

cyproterone acetate
drospirenone
desogestrel
norgestimate

The pills containing these progestogens are:

Dianette (for short-term use, e.g. 3-6 months before continuing with another pill from this list due to DVT risk)

Yasmin (drospirenone)
Marvelon (desogestrel)
Cilest (norgestimate)

If you smoke, are obese or don't "get on" with oestrogen, then you might prefer to take the lower oestrogen-version of Marvelon, called Mercilon. If you CANNOT TAKE OESTROGEN, then the progestogen-only pill (mini-pill) called Cerazette is the best option. Cerazette inhibits ovulation, is taken continuously without any breaks, reduces bleeding and may even cause bleeds to stop altogether after 6-12months and contains desogestrel, mentioned above.
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Postby Hols969 » Wed Oct 27, 2010 3:11 pm

Excellent, thanks meringoo
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Postby Meringoo » Wed Oct 27, 2010 3:23 pm

For women who cannot take the combined pill, here are some other options you may wish to consider:

Cerazette progestogen-only pill

Mirena IUS (insertion is more painful for those who haven't had children, but is still possible and is becoming more popular)

Info about the Mirena IUS can be found here:

http://www.cks.nhs.uk/patient_informati ... system_ius

http://www.netdoctor.co.uk/sex_relation ... 000244.htm

Although it isn't the best option, it's less likely to cause nasty side effects than others non-combined pill options.

Methods that I would seriously avoid are the Depo-Provera injection and the etonogestrel implant (Implanon/Nexplanon). This is due to their androgenic effects, post-usage effect on fertility (ovulation can take a year to return after stopping the depo injection!!) and the fact that they don't really have any benefits on PCOS apart from suppressing ovulation in some cases.

********************************************************

Another thing I need to mention about the usage of combined pills is that you can start them at any time as long as you are sure you're not pregnant. This is helpful to know, especially if like me, your periods had stopped altogether.

You can also take the combined pill continuously for 3-6 packs without any breaks. This is safe to do and can be helpful if you suffer from acne, PMT or find the pill-free breaks horrendous!


Feel free to ask me anything about contraception and hormonal treatment for PCOS.

Meringoo xx
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Micronor

Postby Alice S » Wed Oct 27, 2010 9:29 pm

Hi there,

I wonder does anyone know anything about the suitability of Micronor for PCOS? I am on it for contraceptive purposes but I'm worried it will foil my attempts to halt my biggest symptom - hair loss.

Any advice would be so appreciated .

THANK YOU!

A x
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Postby Meringoo » Thu Oct 28, 2010 7:07 am

The short answer is no, it's not a good option.

The reason is that the older progestogen-only pills are far less effective at stopping ovulation, because their primary function is to create a mucas plug in the cervix to prevent fertilisation rather than actually stopping an egg being released. For that, pills such as Micronor/Noriday, Femulen and Norgeston are really not going to help reduce or prevent ovarian cysts. Also, the actual progestogens are too androgenic therefore will probably make any acne and hair issues worse.

If you are not allowed to take the combined pill for whatever reason, I would definitely change to the newest POP available, Cerazette, as it is more effective as a contraceptive and suppresses the ovaries more effectively, making it a better treatment. It is also far less androgenic than the old pills, and irregular bleeding will more like stop after 6 months. If you can take the combined pill, then Dianette and Yasmin are the most effective for that.

As an aside, a friend of mine got pregnant on Micronor because she was still ovulating.

Another thing I should mention, is that with the older POPs, if you weigh more than 11 stone (70kg), they won't work, and you must take 2 a day (but this rule doesn't apply to Cerazette).

Hope this helps xx
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Postby Meringoo » Fri Dec 03, 2010 12:56 pm

Hi all,

Just wanted to update the pills as there are some more on the market, which are the same as others I've mentioned but manufactured by a different company.

Marvelon (Ethinylestradiol 30 micrograms, desogestrel 150 micrograms) can also be called Gedarel 30/150.

Mercilon (Ethinylestradiol 20 micrograms, desogestrel 150 micrograms) can also be called Gedarel 20/150.

The new brands are a couple of pounds cheaper on the NHS, so you may be prescribed them/switched to them. They will work exactly the same.

Femodene and Femodette can also be called Millinette (30/75) / (20/75). There is another version called Katya.

Microgynon 30 can also be called Ovranette, Levest, Rigevidon (just so you know, as it's still not great for PCOS.
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Postby celicachic » Sun Jan 09, 2011 9:59 pm

hi

my dr gave me yasmin on wed,i was ok with it but then come friday i had a bad migraine, so i went back to the drs of which she told me to stop medication and told me to go for a blood test ( which I have done and im gonna see her next week)

anyone else had this???
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Postby Meringoo » Tue Jan 11, 2011 7:52 am

As long as your migraine didn't have an aura or your vision wasn't blurred along with numbness in your arms etc, it would have just been the rise in oestrogen from starting an oestrogen-containing pill. You could try a lower-oestrogen pill such as Mercilon, or a progestogen-only pill like Cerazette.

It's normal to get headaches and occasional migraines.
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Postby celicachic » Tue Jan 11, 2011 7:23 pm

thanks for replying, but no didnt have any other symptom apart from pain (left side).

im going back to see dr for blood results and discuss what to do next in terms of taking a 'pill', and altho she said to me i need a 'combanation pill' ( as my periods are really messed up..thry were tooooo frequent and i was getting 2 a month, i had this prob for 5/6 months , doc kept putting it off and saying it was my thyroid or pcos playing up and they couldnt do anything bout it apart from thyroxine and mef acid for heavy periods...wot a mess!!!
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Postby Meringoo » Tue Jan 11, 2011 7:34 pm

You're welcome.

A combination pill (oestrogen + progestogen) like those mentioned on this thread will be fine as long as you don't get migraines with aura. I started getting migraines a few years ago (and they don't necessarily have to be connected with the pill) and my doctor took me off it. I then went back on as it was another medication causing them, and I had no aura etc. They said I could use the combined pill "with caution" which basically means they will ask you at your prescription appointments if you're ok/had an increase in migraines, and monitor your blood pressure closely.

I am on Yasmin and find it to be the best for most things, but I get oestrogen withdrawal headaches during my pill-free days. This is normal and not dangerous, just due to the change in hormone levels.

See what your doctor says, but you'll most likely me fine on Yasmin unless your blood tests show otherwise.

Taking your pill at night before bed can help, as you'll sleep through the headaches. xx
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Postby celicachic » Tue Jan 11, 2011 8:45 pm

:D thanks
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Postby celicachic » Fri Jan 14, 2011 4:57 pm

yup, went to drs she gave me cerazette
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Postby Meringoo » Sat Jan 15, 2011 9:06 am

OK well that's better than no pill at all! Remember you don't take any breaks with Cerazette. One pill a day, everyday. Good luck with it!
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