Three hours to choose, two kinds of birth control, one confused person.
November 2, 2010 8:45 PM   Subscribe

I started a new birth control pill. Then, unexpectedly, a bunch of my old birth control showed up in the mail. Now what do I take?

Non-relevant how-did-this-happen part: I was on Pill A. My refills ran out. I called my old doctor and asked them to fax in a new prescription to my mail-order pharmacy. Old Doctor was no longer covered under my insurance so I didn't want to go in. They never called me back, so I assumed they weren't able to provide the prescription. (Mistake #1.) I went to New Doctor. I asked New Doctor for a new prescription that would be much cheaper under my new insurance. New Doctor obliged. I got and filled a one-month prescription for Pill B. The next day, a 3-pack of Pill A showed up in the mail, with a substantially lower bill than usual.

Relevant stuff: I have been taking Pill A for several years. Yesterday, I took the first pill of Pill B. Then a bunch of Pill A showed up. Now I don't know what to do. Do I finish up the pack of Pill B, then take the three packs of Pill A? Do I just start the pack of Pill A, and have a not-quite-full pack of Pill B?

Here's the rub: Now that I have a bunch of packs of Pill A, I expect my insurance won't give me a refill on Pill B for several months, so I will have to take all of the packs of Pill A. However, I don't know whether I will go back on Pill A or Pill B after these few months. (This will be determined by two factors: cost, and whether I have any bad side effects on Pill B. If I were for sure going to stay with Pill A, the answer would be clear.)

So, here are my real questions:

1. How bad would it be on Pill A, then take Pill B for a month, then take Pill A for three months, then start on Pill B indefinitely? I am mainly wondering if this will produce any unusual hormonal wonkiness that I should worry about. I am also wondering how protected from pregnancy I am each time I start a "new" pill.

2. If I start a pack of Pill A tonight, that would leave me with 20 active pills from Pill B. Seems kinda useless. If I were to go back on Pill B later, could I just tack those on to another pack of 21 and skip a period? My understanding is that it's okay to take any random number more than 21 active pills, just not less. Am I right on this?

Further info:
Both bills are monophasic. Both contain the same amount of estrogen and prostegerone; they just have different progesterones.

For the sake of this question, I'm not worried about the possibility of unpleasant side effects from a mostly-untried new pill. I'm worried about effectiveness in preventing pregnancy. I also wonder if switching my hormones around a few times could cause mystery wonkiness, but I realize that you are not physic, YANMD, and you probably can't answer that for me.

I've seen this question and attempted to Google, and it seems like I probably don't have to worry about pregnancy prevention effectiveness, but I'm not totally sure and would appreciate more feedback.

Obviously, I will be talking to a doctor or pharmacist about this, but it's late at night and I'm supposed to take a pill in three hours, so I have to make a decision without professional input.
posted by mandanza to Health & Fitness (14 answers total)
Best answer: I can only say from my experiences - is that it didn't affect me.
I've done similar things several times. I was on pill Z but lost my insurance, went to Planned Parenthood and got Pill F. Took that for about 4 months, then got health insurance again and decided to try the patch. Didn't like it, Went back to Pill Z.

I'm currently not on birth control, but when I was, I would toss the sugar pills out and just take active pills so I wouldn't get a period. I did that for about 5 years.

So, obviously I'm not a health professional but thought I'd share my experience.
posted by KogeLiz at 9:07 PM on November 2, 2010

Response by poster: (Sorry, lakersfan, my response was unnecessarily snippy. I realize that questions like this do attract snark and this is a consequence of asking questions on the interwebs; I will chill out.)

KogeLiz, thanks for your response! I appreciate hearing someone else's experience.
posted by mandanza at 9:16 PM on November 2, 2010

Best answer: Even though you let me off the hook, I still gotta disclaim: IANAMD, IANAPharmaD, IANYRN. I do know somewhat more than the average lay person about reproductive endocrinology but that doesn't mean I know squat about you or your situation or these pills.

Speaking for myself, in this particular situation, I would finish out the full cycle of Pill B, because then I would know if I liked Pill B well enough to stay on it, a good thing to know if I might need to switch off Pill A for monetary reasons anyway. Admittedly, you're supposed to give it three cycles to find out if you're suited to a particular pill, but at least that first cycle would give me a hint.

Based on the similarity between the pills (both monophasic combined oral contraceptives, same dosages, different progestin), and assuming that you're not sensitive to any of the inactive substances in the pills:
- It's pretty unlikely that, even if you go through the pack of Pill B, switch over and take all three cycles of Pill A, and then go on Pill B permanently, you'll experience any new side effects as long as you take your pills the way you're supposed to and you switch only at cycle end (after the last pill in the pack).
- It's pretty unlikely to make a difference in terms of side effects if you switch back to Pill A after a single dose of Pill B. (Side-effects-wise, I would tend to write off anything I experienced after a single dose short of anaphylaxis as coincidental anyway, so it wouldn't be a serious consideration for me.) If you're at all uneasy about effectiveness, use a backup method for the first week of the cycle, if only for peace of mind.

These observations would not hold if you were switching to or from pills with different formulations (dosage or hormone.)
posted by gingerest at 9:23 PM on November 2, 2010

Are they completely different hormones? Or just generic vs brand name?

Keep taking pill B tonight. Think about back up protection.
posted by fontophilic at 9:25 PM on November 2, 2010

I've been on the pill for years and have switched brands a couple times based on price/insurance coverage. It was never a problem. Your doctor will probably advise you to continue taking the new pack (pill B) for this cycle, and then it will probably be okay to switch over to pill A for the next few months (but IANAD, of course). As long as you haven't missed any pills, you should be protected (but you could always use a backup method for peace of mind).
posted by lucysparrow at 9:30 PM on November 2, 2010

Best answer: it's cool, i'm thinking about it. in the meantime i found some garden-variety google fare, below:

some possibly interesting information

possibly more possibly interesting information

yep, sorry too to be snarky. not really my style.

do you mean that the progesterones are different types or diff levels? because it does not appear to be a huge deal as opposed to estrogen levels:

posted by lakersfan1222 at 9:32 PM on November 2, 2010

You may not be able to call your doctor at 9pm, but you can call a 24-hour pharmacy. They'll know the similarities and differences of the pills, and may be able to advise you until tomorrow.
posted by galadriel at 9:43 PM on November 2, 2010

IANYD, but these pills tend to be very similar and they are all highly effective at preventing pregnancy, over 99% if used correctly (just meaning that you take it around the same time every day, and take it every day). I don't consider this an "OMG" level question. Agreed that with most questions about a medication in general it's much easier to ask a pharmacist than a doctor.

As a personal note not from my medical perspective, when I was younger I used to take whatever pill my mom's office had as free samples. I took different pills nearly every month. Always worked fine for me. I also did what KogeLiz did, and most of the time skipped the sugar pills. To feel nearly 100% secure, you have to use two methods, but if you don't need "code red" level security, you should be OK with just pills.
posted by treehorn+bunny at 11:54 PM on November 2, 2010

Response by poster: They are different hormones, yes, not just brand name vs. generic. They both have the same progesterone levels, just different types. It's good to know that different progesterones aren't too big of a deal, since that's the only difference here. (Pill A is Ocella, generic of Yasmin, which likes to make a big deal about how "unique" their progesterone is. Although the literature that comes with the pill follows that up with how it can cause issues with potassium retention, so I'm not really sure what's so special about it!)

Thanks for the answers, all! I appreciate all the great information. I feel much better about this now. I took Pill B and I plan to finish out the pack. I'll get the official scoop from my doctor tomorrow, but it sounds like my switching pills around is not going to cause any crises, which is reassuring!
posted by mandanza at 12:01 AM on November 3, 2010

Maybe I am all out of whack here but as a chemist I think that progesterone is progesterone. It isn't a class of compounds it is a compound with a steroid core a methyl ketone at the top and whatever else around it. Pharmaceutical companies like to tell all kinds of things to differentiate their drugs, but this to me seems like asking which vodka gets you drunk faster if one was advertised with turbo ethanol or something like that. Ethanol is ethanol, progesterone is progesterone, sulfur is sulfur.
posted by koolkat at 2:47 AM on November 3, 2010

Mod note: A couple comments removed. "OMG!" flavored one-liners are rarely helpful as answers.
posted by cortex (staff) at 6:30 AM on November 3, 2010 [1 favorite]

koolkat: Speaking as another chemist, there actually are different progestins used in different forms of hormonal birth control; progesterone itself is not actually frequently chosen as a progestin for birth control (it's got crappy bioavailability as an oral medication, among other problems), although a lot of people inaccurately refer to all progestins as progesterone. Anyway, take a look at levonorgestrel (one of the more common ones for birth control pills) vs. drospirenone (the Yasmin one.) They're not actually structurally identical - take a look at those funky 3-membered rings on drospirenone - and I am completely unsurprised that they might not have identical pharmacological profiles.

That said: I doubt mandanza will have any serious problems either.
posted by ubersturm at 6:59 AM on November 3, 2010 [1 favorite]

I don't have any knowledge on the which pill question but thought I would make a quick PSA-please don't flush your extra pills (if you end up with any). throw them away or ask your pharmacy too. The hormones in flushed pills do not get treated at the sewage treatment plant and those hormones may have some nasty effects in what ever body of water your local treatment plant goes to. And to answer the next question-yes you do discharge some of the hormones yourself after you *ahem* use them, however it is much lower dose and spread out over the course of a month, not all at once. And yes, a very low dose appears to really screw up animals that live in the water-especially amphibians.
posted by bartonlong at 10:08 AM on November 3, 2010

Response by poster: Good point, bartonlong!

And, ah ha, now I know the difference between progestin and progesterone! Bonus knowledge.

Anyway, just wanted to follow up with what my doctor said, in case anyone else ends up finding this thread helpful later on: She said that since I was on birth control before with no break between them, the new type of pill is effective immediately, and that as long as I tolerate the new pill without any wacky side effects I don't have anything to worry about.
posted by mandanza at 12:05 PM on November 6, 2010

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