"Customers who liked Ortho Evra also liked ___________?"

October 5, 2010 3:49 PM

If you've had good luck with Ortho Evra for birth control and also, at a different time, successfully used a birth control pill, what pill did you use? My current pill is not working for me and I need some help deciding between the multitude of pill options out there.

I was on Ortho Evra in the past, and it was great. I didn't have any negative side effects and I never had any problems with breakthrough bleeding, but I hated the patch itself. It moved around, it fell off, it stuck to my underwear, it was basically a huge hassle.

I went off birth control for two years, but decided to start again this summer. My gyn prescribed Loestrin24Fe because her patients have had good luck with it in the past.

I... haven't. I started basically having my period halfway through the first pack. I called the doctor and she said this was normal for the first pack, but I should call back if it didn't stop when I started the second pack. Starting the second pack did stop it, but now I'm at about the same point as before in the second pack and it's started again.

I'm going to call my doctor and see what she says, but I have a feeling she'll tell me my options are either stop birth control or start a new pill. I don't *have* to be on the pill, since I always use condoms, but peace of mind is the main reason I started them to begin with, as well as regulating a cycle that varies wildly between 24 and 40 days long, so I don't want to just give up.

As for starting a new pill, that's my question. I'd really like to replicate my Ortho Evra experience in pill form, but I can't figure out what might have made it work (going back on Ortho Evra is an option, but I'd rather experiment with different pills before I resign myself to the patch). If you've had good experiences with a BC pill *and* the patch, what worked? Can anyone who knows more about these things than I do guide me to what pill might be an option?

posted by anonymous to health & fitness (23 answers total)

might try nuvaring. it has once-a-month convenience. i used it for maybe half a year before i opted for ortho evra. i really liked it except it made me, um, excessively moist.
posted by miss patrish at 3:59 PM on October 5, 2010

I was on Ortho Evra for about two years, loved it, but the patch kept falling off. I'm now on Nuvaring (and have been for three years) and it's fantastic.
(As a note, when a previous BC pill gave me breakthrough bleeding for the first three months, my doctor gave me a low dose of estrogen for a few weeks and it took care of the problem, not only that month but for the rest of the time I was on the pill. YMMV.)
posted by OLechat at 4:00 PM on October 5, 2010

I'm here to suggest nuvaring, too. I had lots of problems with breakthrough bleeding on various pills, but the ring has been terrific. I figure it has something to do with the extremely steady dose it secretes. Also, it's less weird than you'd think.
posted by juliapangolin at 4:02 PM on October 5, 2010

Interesting. This unfortunately doesn't answer your question, but doctors and nurses I've worked with (at reproductive health clinics) usually say that menstrual irregularities are common in the first 3 months of a hormonal birth control method, not just the first month. IANYD, but you might want to double-check with her about what timeframe you should be waiting out.
posted by verbyournouns at 4:03 PM on October 5, 2010

I've tried several varieties of "the pill," including Ortho Tri-Cyclen Lo (apologies if I'm butchering that), Trinessa, and Yaz, among others. I honestly didn't have good experiences with any of them: horrible mood swings, very decreased libido, depression, breakthrough bleeding, etc. I know you've specifically asked for pill recommendations, but can I suggest the NuvaRing? As someone who's used the patch, perhaps the ring would be a good alternative since it's a comparable delivery method. Instead of taking a dose of hormones, so to speak, once a day for 3 weeks, the ring delivers a constant, low dose stream of hormones 24/7 for 3 weeks straight.

I've used the ring for about 3 years and have had breakthrough bleeding only a handful of times. I do have decreased libido, but not nearly as badly as I did when using the pill. The mood swings and other emotional side effects are minimal or non-existent.
posted by pecanpies at 4:05 PM on October 5, 2010

This isn't quite answering your question but I use Loestrin and, oddly, it synchs my menstrual cycle with the lunar cycle. All I have to do to make it work is ensure that my pill free week occurs at the same time as the new moon. I took a week's worth of extra pills one month to make this happen. Of course, ymmv but that was my experience!
posted by lumiere at 4:25 PM on October 5, 2010

Nthing the Nuvaring suggestion. I tried tons of different pill options over a period of five years, all of which led to breakthrough bleeding and extreme nausea. I tried Nuvaring about four years ago and haven't looked back; it was suggested by my doctor, who knew I had had it with pills but who also wouldn't give me the IUD I asked for (because I had not had children). For me, what works seems to be the difference between the estrogen-based pills, and the progesterone-based ring. It definitely isn't as weird as it might seem at first, and it is awesome to not have to think about it for three weeks at a time.

The only downside, depending on your income/insurance coverage, is that there isn't a generic and it can therefore be rather expensive, at least compared to other b.c. options.
posted by stellaluna at 4:25 PM on October 5, 2010

A friend was on Ortho Lo for a while. She had the first three symptoms pecanpies mentioned -- she was effectively psychotic for months because of it until she finally got the lucidity to stop taking it and get on something else. I really don't recommend taking that. Her local friends knew her well enough to realize this wasn't entirely her fault and were very patient with her, but gawd.

If you had trouble with the patch staying put, did you try another place? I think my friend ended up on it for a while, and used it on her upper arm (since she never wears tank tops).
posted by Heretical at 4:29 PM on October 5, 2010

The only downside, depending on your income/insurance coverage, is that there isn't a generic and it can therefore be rather expensive, at least compared to other b.c. options.

True - forgot to mention this. My insurance doesn't cover it, so I pay out of pocket every month. It's about $67 a month at Walgreen's for self-pay. Not cheap, but certainly less expensive than pregnancy!
posted by pecanpies at 4:30 PM on October 5, 2010

Another vote for NuvaRing. It's much easier to keep track of, so I have FAR less "OMG I forgot a pill" panic attacks. It also (for me) has less side effects than the pill - less weight gain, less moodiness, and my PMS is now almost non-existent. And other than the occasional 'hole-in-one' moments with my husband, it's not awkward or weird at all.

For me, it costs about $35 with insurance if I buy it monthly, or $70 for 3 months if I mail order.
posted by tryniti at 4:45 PM on October 5, 2010

You may want to explore your options with the NuvaRing, but here's my experience with various pills. Note that I've never used the patch.

I have used Ortho Tri-Cyclen (both Lo and Regular, and I would not recommend Lo with your breakthrough bleeding issues), Trinessa (it's a generic for Ortho Tri Cyclen), Yaz (low dose version of Yasmin), Loestrin (similar to Yaz), and some random other ones. I liked very few of them (Yasmin was probably my favorite). I found this chart helpful for sorting out the doses and brands.

The really random one that I'm taking now is called Desogen. I've found my moods better than on the Ortho pills and I never have bleeding issues (but then, I never have) but I did gain a little weight and my sex drive isn't as high as it should be.

I agree with others above that every one of my doctors (over the past decade or so) have insisted on giving it three months before giving up on a pill method. You're welcome to switch, but I'm thinking your doc will believe it's too early yet.

When sorting through the answers given here, you may find also this WebMD comparative list helpful. Not every brand is included, but you can get an idea of what the differences are among some major ones.
posted by librarylis at 4:57 PM on October 5, 2010

NuvaRing is even cheaper if you use it continuously. There is no medical need to have the fake periods you get on the regular pill. Each NuvaRing works for 28 days, by the way, not just 21.
posted by prefpara at 5:25 PM on October 5, 2010

When I said cheaper I meant in the universe of wrong. Everything else I said was right, though. Sorry.
posted by prefpara at 5:25 PM on October 5, 2010

For me, what works seems to be the difference between the estrogen-based pills, and the progesterone-based ring.

FYI, NuvaRing has estrogen in it. It secretes 15mcg, which is 5mcg less than combined pills with the least amount of estrogen (this includes LoEstrin), but that still doesn't make it a progestin-only method.

IANAD, and I know everyone here is a NuvaRing cheerleader, but you're already on a 20mcg pill with a potent progestin (see here). If you're bleeding when you shouldn't be, it's attributable to any one of:

-not enough estrogen
-not enough/not the right type of progestin (usually this means that the progestin isn't potent enough)
-not enough progestin in the second/third weeks of your cycle
-taking your pills incorrectly

Some of this is a crapshoot, but you might respond best to a pill with more estrogen and/or a stronger progestin. If you're experiencing breakthrough bleeding because it has less estrogen than the patch, then NuvaRing might be a step in the wrong direction. If that's the issue, then you might have better luck with a 30mcg pill like Desogen or the stronger LoEstrin 1.5/30. NuvaRing might be an improvement insofar as it delivers a steady hormone dose, but really, some people's uteruses (uterii?) need a bit more hormonal convincing to stop them from being hair-trigger bleedy.
posted by thisjax at 5:28 PM on October 5, 2010 [1 favorite]

IANAD(Y) and IANAW, but I think the best strategy is probably to try to find a pill that has the same ingredients in roughly an equivalent dose to Evra. According to the monograph, Evra dispenses 200 mcg norelgestromin (progesterone) and 35 mcg ethinyl estradiol (estrogen) every day. I don't think norelgestromin is used in any oral pills, but what's pretty close to it is levonorgestrel. Now, what pill gives you the same ingredients at roughly the same dose? I have a chart that compares all the different pills but unfortunately it's not here at home with me, so the chart that librarylis linked to will have to substitute:

Alesse or Levlite: 20 mcg ethinyl estradiol, 100 mcg levonorgestrel
Levlen or Levora or Nordette: 30 mccg ethinyl estradiol, 150 mcg levonorgestrel (Seasonale, the pill that gives you three months without a period, has the same combination)

Note, no guarantees with this, and this isn't medical advice, but it might be a good place to start from when choosing your next pill!
posted by greatgefilte at 5:29 PM on October 5, 2010 [1 favorite]

I think you should probably give yourself more time with the new pill you've been taking. It can take a couple months to adjust... Nthing what folks have said about needing to try a new pill for at least 3 months before making a final yay or nay decision on it. Especially if all you're experiencing now is irregular bleeding, which seems pretty normal when trying a pill.
I have in the past been on Ortho Tri-cyclen... terrible mood swings, depression, epic crazytimes. I've had a wonderful experience with Yasmin... I'm a little weepy during that 3rd week, but it's great for my skin, and I agree, it's nice to have things regulated down to the day. The generic is effing cheap as hell, and you can take extra pills to delay your period a bit if you need to. It took some adjusting to, however. I had the same problems you are having now, with a continuous period for almost a month. But it got better, so, I would hang in there and wait for your body to adjust. And if it doesn't, hell, the Nuvaring sounds awesome!
posted by mostlybecky at 5:38 PM on October 5, 2010

Alas, I've forgotten to mention another nerdy strategy to pick another pill -- deciding based on what kind of activity the progesterone in question has... Although I think it would probably come down to roughly the same choices.
posted by greatgefilte at 5:52 PM on October 5, 2010

I used the patch for several months back when it was new - I liked it and had no issues with it. I stopped using BC altogether for a long time, though b'c I was single and didn't see the need to fuss with my hormones.

Now, I'm taking Seasonique/Seasonale - the BC that lets women have just four periods a year. It rocks! Trust me, not bleeding every flipping month? OMG, so, so nice. And my moods and general sanity while on it have been stellar.

The only issue I've had with the Seasonique is when I combined it with Wellbutrin - apparently Welli screws up hormonal BC. I stopped taking the Welli b'c of that horrible little side effect and everything is back to normal.
posted by LOLAttorney2009 at 6:15 PM on October 5, 2010

Im on microgestin. Its the very low dose birth control, I don't want some big hormonal change. It works well for me. Not much more to say...lol
posted by femmme at 6:20 PM on October 5, 2010

My first birth control experience was with Ortho Evra. It made me depressed and weepy and not me. But hang on a sec. I had attack of the seven day extremely heavy 'WTF IS this?' period at the end of the first month (pre-birth control, I always had 3-day light-med periods). The second month was better. However, most side effects can take up to three months to subside or be reduced, so you may want to stick with this pill a little longer. Knowing that, I was on the patch for six months but switched to a pill after that. And then due to a nagging side effect of that pill, switched again. And again, finally, to Ortho TC-Lo, which has been great. No discernible side effects at all.

But ultimately, even if a lot of her patients like a certain pill, it doesn't mean it'll work with your particular chemistry. Unfortunately, a bit of trial and error can be required until you find something that clicks. But the good thing is after you wait three months, you don't have to go through the adjustment period each time.
posted by cmgonzalez at 6:36 PM on October 5, 2010

Man, I hate birth control. I tried Ortho Evra and hated how it always got weird and sticky-fuzzy around the edges - gross. I tried the NuvaRing and was really discharge-y all the time - double gross. I've tried maybe 4 different types of pills and have finally settled on Yasmin, which I like, but I'll be the first to admit that I forget them waaaaay more than is acceptable. There are no good answers, as far as I'm concerned. However, if you felt good on Ortho Evra, I second the comment somewhere above that suggested seeking out a pill with similar-ish hormone levels - ask your doctor how to best approximate that.
posted by naoko at 8:12 PM on October 5, 2010

I love my nuvaring, but running them for 28 days consecutively without a break does seem to increase the breakthrough bleeding (which i otherwise don't get on it at all).
posted by nat at 9:54 PM on October 5, 2010

I started on Microgestin 1/20 Fe initially, but it caused huge anxiety spikes for me, so I did a lot of reading and switched to Ortho-Cyclen (which I'm liking so far). There's a very helpful chart here that helped me pick something out. It details how much of which hormones are in each method, and includes a symptoms/solutions chart as well. (By the way, my doctor recommended sticking to monophasic pills if you're concerned about mood swings) Hope it helps!
posted by uniq at 1:37 PM on October 7, 2010