Changing generic birth control side effects and endometriosis
August 25, 2018 10:59 AM   Subscribe

Can different generic versions of birth control affect a person differently? And, specifically, can they be more or less effective in treating endometriosis?

YANMD. We will be scheduling a(nother) doctor appointment on Monday, but I wanted some AskMe opinions--last time I talked to a gynecologist about endometriosis, she told me that you don't get endo cramps when you're not on your period, which is... blatantly false, so I'm hoping for some baseline information we can bring into the appointment.

My partner has been having cramps, constipation, diarrhea, stomach pain, and nausea for the past three weeks. The largest and most prevalent problem is the cramps. About a week and a half ago they were also having a lot of breakthrough bleeding, even though they've been on continuous birth control for years and have never had this problem before. They went to the doctor who said they're probably just constipated and prescribed a Miralax purge. That was 5 days ago and doesn't seem to have helped. Because most of the pain is lower in the pelvis, we're considering that it might be endometriosis--their mother had this severely enough to have her uterus removed, so there's family history.

It has been suggested before that they may have endometriosis due to their painful periods, but the doctor did not think it was severe enough to do a laparoscopy. She prescribed continuous birth control which worked well. However, about four months ago they started taking a different generic birth control--they had previously been taking Camrese, but for the last two refills the pharmacy has been giving them the Mylan generic of levonorgestrel and ethinyl estradiol instead. All of these symptoms have happened on the new birth control; however, they didn't happen until about 2 and 1/2 months into the pack. I'm not sure how long it would for the body to start noticing the differences, though, especially if the problem is largely endometriosis.

I've read a few anecdotal accounts of people having difficulties when switching from Camrese to the Mylan generic. Given they have been on this birth control for years, the sudden breakthrough bleeding seems odd. I know the pharmacy says generics are the same, but I also know that their endocrinologist insists on brand name for Synthroid, so I don't know what to think. Does anyone have any experiences with this? And know if different birth control brands/generics differ in their effect on endometriosis?
posted by brook horse to Health & Fitness (12 answers total)
Fuck yes. Switch back.
posted by bq at 11:08 AM on August 25, 2018 [5 favorites]

Definitely, seconding switching back. There is a lot of individual variation in how people respond to hormone-based birth control. Personally, I have endometriosis and could not get my heavy breakthrough bleeding under control when trying to suppress periods using different types of the pill (which I was doing because of the endo). I switched to a Mirena IUD and this has been excellent! After about 9 months I stopped getting my period entirely other than very occasional spotting. There is also some research that has suggested the Mirena diminishes existing lesions from endometriosis. This might be something to look into; personally it has been a lifesaver for me after dealing with years and years of pain and heavy bleeding. But if this is not a preferred option, definitely go back to whatever pill is working!
posted by DTMFA at 11:58 AM on August 25, 2018

I've had better luck with generics when they're made by the brand-name drug's parent company; Seasonique and Camrese are manufactured by Teva.
posted by Iris Gambol at 12:06 PM on August 25, 2018 [1 favorite]

Super-anecdotally, my pharmacy switches generics of my (progestin-only BC) once a year or so. Earlier this year they started giving me the Mylan generic, and my cycle has been all over the place: first a few months with lots of spotting, then several sixty-day cycles. I told my gynecologist about the weirdness and mentioned that I’d switched generics, and she was like “yeah, they can do that.”

It sounds like your partner’s health matters are much more severe than mine are, and it sounds like their doctor’s being suuuuuper shruggy about it, so it might be time for a second opinion. Find a doc who’s willing to dig into the possibility of endometriosis.
posted by Metroid Baby at 12:27 PM on August 25, 2018 [1 favorite]

I experienced something similar when switching to a generic bc pill. My gyno said that even if the hormones in the two pills are exactly the same, the binders (nonactive ingredients) are different and that can affect how quickly and completely the hormones are absorbed by the body.
posted by entropyiswinning at 12:41 PM on August 25, 2018

Can different generic versions of birth control affect a person differently?

Yes. I tried pretty much all of the options when I first started treating what turned out to be endometriosis. Different meds gave me different (horrible) side effects. Not all generics are the same.

And, specifically, can they be more or less effective in treating endometriosis?

Yes. My anecdata isn't useful here because for me they were all terrible and I finally got a hysterectomy, but different things work for different people. One of the later meds I tried gave me continual bleeding. If there was one that worked for your partner, they should ask to go back on it.

Also consider changing doctors if this doctor is not listening. Endometriosis is horrible and a lot of gynecologists don't want to listen about how bad it is because issues that impact AFAB folks are often not taken very seriously, even within that specialty.
posted by bile and syntax at 12:54 PM on August 25, 2018 [3 favorites]

Yes. I was on several different pills when I was being treated for endo. (Side note: When they say to use a condom for the first 30 days after switching pills, they mean it. It was during this time that Kid Ruki was conceived. Precisely, the day after my laparoscopic surgery was scheduled and my GYN had joked about getting pregnant to fix it. Ha. Best joke of my life, as it turned out, but just saying.)
posted by Ruki at 1:26 PM on August 25, 2018

I was pretty baffled that getting pregnant actually did fix it.
posted by bq at 2:54 PM on August 25, 2018 [1 favorite]

Yes. Midwife here. Don't have data at the ready, but off the top of my head, I seem to recall that to meet FDA equivalence standards, different formulations can be off by as much as 10% or so...? Definitely switch back to the one that works or have the provider write for brand only prescription. It should be authorized by insurance if its for a reason of patient intolerance.
posted by stillmoving at 1:41 AM on August 26, 2018

Oh here's some info from ACOG.

The average blood level deviation from the brand must be in the range of 80–125%--this is huge given the teeny doses of hormones in contraceptives and how sensitive some women are to dosing shifts (even enough to consider it another drug altogether!)

They also add:

Products are considered bioequivalent if they fall within the required parameters; the mean bioequivalence cannot be more than 20% lower or 25% higher, with 95% certainty. In practice, the reported ranges of generics are much narrower. Given the range of acceptable generic bioequivalence, switching between generic OCs or from branded to generic OCs might be associated with increased side effects or other problems, but similar problems theoretically might occur when switching between two batches made by the same manufacturer.
posted by stillmoving at 1:48 AM on August 26, 2018 [1 favorite]

Pharmacists AND my doctor years ago insisted that my generic med switch in BCP couldn't have been causing my health changes. When I switched back to my old one, I got better immediately. Switch.
posted by agregoli at 6:23 AM on August 26, 2018

Especially since they have been stable and not experiencing breakthrough bleeding for so long on the non-generic, I'd say it's at least an easy try to go back to the brand and see if it fixes it. If not, it could just be the fucking endo bullshit and that that dose/combination isn't working for them anymore.

Even if your partner isn't going to pursue surgery, it's worth finding a doctor on the Nancy's Nook list, because then at least you know they aren't going to push outdated "treatments" (Lupron, pregnancy-as-cure) on them. I saw many different doctors and it wasn't until my Nook doctor that I finally didn't have to educate them on endometriosis. That alone was worth it. The subreddits /r/endometriosis and /r/endo are both active and have great support, too.

<3 Endo blows.
posted by fiercecupcake at 11:58 AM on August 27, 2018

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