Brooke Thai, PharmD Student
Did you know that every type of birth control is unique and that switching from one to another can potentially resolve side effects? Because there are so many options out there, sometimes, it’s hard to know exactly which birth control will work best for you. People often tend to choose whichever type they know their friends are on, or ones that best fit their lifestyle. But, when they begin experiencing side effects, they may not know what to do. They may either continue on the medication while experiencing side effects, switch to something that doesn’t fix that problem or stop taking it altogether. I personally believe that if people knew more about the differences between birth controls and their unique properties, they would be more able to make informed choices on which birth control will truly work the best for them.
Therefore, in today’s article, we’ll be going over what types of side effects are possible, why this problem could be happening, and which birth control you could consider switching to.
Hot Flashes and Unpredictable Spotting: Increase Estrogen Dose
If you find that you occasionally get hot flashes that make your chest and face feel hot, sweaty and flushed while everyone else around you seems fine, this could be a sign that your estrogen dose that is too low. Another sign of low estrogen is spotting that occurs before you expect any bleeding to occur. This just means you could consider talking to your healthcare provider and switching to a product with a higher dose of estrogen, which comes in the form of ethinyl estradiol in birth control tablets.
Usually, estrogen doses range from 10 to 35 micrograms per tablet. But, if you’re using a patch or vaginal ring, there’s no way to increase the dose because there is only one patch (Evra®) and one ring (NuvaRing®) on the market. If this is the case for you, you may have to consider switching to the tablet form. And, no matter which form of contraceptive you’re taking, switching to an IUD (intrauterine device) is an option as well. Since IUDs work locally on the uterus and do not deliver any medicinal ingredient to the rest of the body, it decreases the risk of side effects altogether.
Other less common signs of low estrogen are hypomenorrhea (not bleeding at all when you expect to) and irritable and depressed mood.
Heavy and/or Delayed Bleeding: Change Progestin Type
Bleeding later and heavier than what’s normal for you during your “placebo week” (where you take “sugar pills” instead of active-ingredient containing pills) is a sign of low progestin dose. It’s not as straightforward to increase the dose of progestin because there are so many types of progestins whereas there is only one type of estrogen in birth control (ethinyl estradiol). Instead, all you need to do is try a different progestin altogether. I would recommend trying a birth control that has the same amount of estrogen, but a different type of progestin to solve this problem without the risk of creating new ones.
Again, if you’re using a patch or vaginal ring, there aren’t any products that are also patches/rings that contain a different progestin type. So, you may have to switch to taking tablets or choose to go with an IUD.
Side Effects: Change Progestin Type
Other reasons to switch the progestin type include weight gain, acne, bloating, or having a change in mood for the worse. These side effects are commonly tied to progestins that have androgenic effects, or in other words, testosterone-like effects. Progestins with testosterone-like effects include levonorgestrel, norethindrone, ethynodiol, and norgestrel. Typically, they go away with time as your body adjusts to the hormones, but if they persist for over six months and are affecting your quality of life, you might benefit from switching to a birth control containing progestin with anti-androgenic (anti-testosterone) effects. These progestins are called desogestrel, norgestimate, norelgestromin, etonogestrel, drospirenone, and cyproterone. Or, if your body seems to disagree with progestins no matter what you try, you could consider switching to an IUD since it has little to no risk of introducing progestins to your system.
Headaches and Migraines
If you’re getting headaches during the week that you take your “sugar pills,” this means your headaches are induced when your body is free of the hormones in the birth control. Therefore, you should change your birth control regimen to a continuous one where you don’t take that break and just take the medication continuously.
On the other hand, if you’re getting headaches while you’re taking the medicated tablets, then the estrogen dose may be too high. Here, you may have to decrease your estrogen dose or ask for a different progestin.
If you’ve ever had migraines with an aura at any point in your life (before or after you start taking birth control), estrogen-containing contraceptives are contraindicated, meaning you should not take them. Therefore, your only option would be to start taking progestin-only contraceptives which come in a daily pill form (Micronor®), or an intramuscular injection (Depo-Provera®) given every three months. Again, IUDs are also an option. If you have migraines without aura, this does not apply to you.
“I Don’t Have Side Effects, I Just Always Forget to Take the Pill”
If this is the case, switching from oral pills to anything that doesn’t have to be taken every day could help. For example, the patch is changed once a week for three weeks, removed for the fourth week, and the process is repeated. The vaginal ring is worn for three weeks; then a one-week break is taken before using another ring. Or, better yet, an IUD requires a one-time insertion and is in place for 3-5 years and can essentially be forgotten about.
Other Reasons to Switch to an IUD
As you may have noticed, switching to an IUD is an option for pretty much any problem you might have with your current birth control. Before the end of this article, here are even more reasons why someone might want to switch to an IUD:
- DVT (deep vein thrombosis) / PE (pulmonary embolism) history: If someone has ever had a clot in their legs or lungs, they’re automatically at increased risk of getting another one induced by the estrogen present in most forms of birth control. This makes IUDs an optimal choice because it can either be a copper IUD with no hormone or the levonorgestrel (progestin) IUD that doesn’t have any estrogen in it, minimizing the risk of an estrogen-induced clot.
- Cost: At first glance, people might think that IUDs are expensive. One of the most popular ones is priced at ~$350-400. Yes, this is a lot to pay at one time especially if it’s not covered, but if you consider the fact that it’s in place for 5 years, this averages to ~$70-80/year, which amounts to ~$6-7/month, which is much less than the monthly cost of the other forms of birth control (if uncovered, ranges from $16-$32/month).1
The bottom line of this article is there is a huge variety of hormonal contraceptives available! Each one has its pros and cons, but having a wide variety means that birth control medication can (hopefully) appeal to all the different types of women and lifestyles that exist. There is always another option to consider when the type of birth control you’re currently using isn’t working for you. Don’t give up on it, do your best to find out more by seeking help from your healthcare providers, and you’ll more than likely find the one that best suits your needs.
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