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Dr. Speroff


General birth control pill information:

Most pills are of 2 types: monophasic or triphasic. What this simply means is that the pill is either a continuous dose of medication that is the same all the way throughout the month(monophasic) or you take pills that are of varying strengths of medication throughout the month (triphasic). If you are going to take these 'continuously' or without taking a 4th week break for a period, you need to have monophasic pills. One thing I've heard from some endometriosis sufferers: if you take a pill continuously, it usually helps to have a 'low dose' (low estrogen dose) pill. There are varying levels of estrogen in pills, and pills are normally measured by the amount of estrogen compound they have, rather than the progesterone content. Mircette™ or Mircelon, Alesse (levonorgestrel), LoEstrin and Levlite are 20 mcg pills. Most other prescribed pills are 35 mcg (or 30) and Demulen, Desogen, Ortho-Cyclen, Ortho-Tricyclen, Ortho-Novum would be an example of these. Most pills with Tri in them are Triphasics. Remember to take the pill at about the same time each day: there is less chance of pregnancy and breakthrough bleeding occuring.

Birth control methods:

Don't think that the pill is the only form of birth control around. There are condoms, IUD's, the sponge may come out again, the rhythem method, abstinence, spermacides, a female condom is in the works also.

Can't pay for the pill?

Prescriptions By Mail or FemScript are programs that may be able to help. RXUSA is a discount store when you can get pills cheap. Planned Parenthood and other women's clinics have the pill available at low cost or free.

PCO and the pill

A study done over a period of 10 years found no increase in the risk of diabetes with pill use.
(Anonymous donor): Demulen 1-35 is good (1.21 androgens) due to the low type of androgens in the pill. Your worst three are Lo-estrin, Nordette, and Ortho-Tricyclen (or any Tricyclic BCP) by anecdotal evidence. Least androgenic progesterones to most androgenic are: desogestrel, norgestimate, norethindrone (when combined with higher levels of estrogen), ethynodiol diacetate, levonorgestrel, norgestrel, norethindrone (when combined with lower levels of estrogen). What you want to look for is the least androgenic BCP you can get. You might also want to try Mircette or Alesse, lower dose pills (lower estrogen compounds). Yasmin is made with a derivative of spironolactone, and this can help with the hirsuit problem and water gain. ARHP has come out with a androgen paper and a antiandrogenic and ovulatory benefits paper on the pill. The pill is NOT a 'cure' for PCO, your symptoms come back with a vengence once you get off of it. You might want to check out or ask your doctor to read the Journal of Clinical Endocrinology and Metabolism's Vol. 80 no. 11 article on pages 3327-34 about the 'Metabolic effects of oral contraceptives in women with polycystic ovary syndrome'. This article says that a reduction in insulin resistance happened. Another good article from S. Nader, M. Riad-Gabriel, and M. Saad on, 'The effect of a desogestrel-containing oral contraceptive on glucose tolerance and leptin concentrations in hyperandrogenic women' in the Journal of Clinical Endocrinology and Metabolism, Year 1997, issue 82, pages 3074-307. There are health benefits of contraception.
I just recently checked out Dr. Leon Speroff's book: A Clinical Guide for Contraception, 2nd edition. (If you are looking in a medical library, I believe the way to find it is to look for WP 630 5749c 1996 c.1.) He states that levonorgestrel monophasics have a 'negative impact' or don't work well on those with carbohydrate intolerances. Also that low doses have small but basically ignorable effects on carbohydrate metabolism and insulin resistance. (Pg 56 - 59.)

Taking the pill continuously for endometriosis:

An unofficial poll showed the most popular pill was Ortho Novum, after that, an Ortho-Cept/Mircette/Desogen combination. The reasons they changed pills or went to others was due to pain returning and headaches, nausea, etc. I would also advise that if you are taking thyroid medication, you watch to see if it interferes in that regard.

European pills and PCO:

Diane 35 or Dianette is a good PCOS pill.

Going off the pill: what to expect:

Depends, different people have had different reactions. For some, irregular bleeding, hirsutism, etc. occur.

Is the pill safe?

Yes it appears it is safer than it once was.

Drug interactions and the pill:

drug interactions and the pill aren't a huge worry. Only one antiobiotic, rarely prescribed, will really interfere with the pill. The information can be found from docs on the women's health list at

Emergency contraception:

Previn and the progesterone only pills and other types are listed on Princeton University's site work.

The pill and problems:

The Pill may increase the risk of breast cancer is all I can find where there is medical documentation that this may be a problem.

I had a discussion previously with Christine DeZarn, head of PCOSA on the pill and PCOS. PCOSA does list the pill as a possible treatment of PCOS. When I talked with her concerning this, the following is an excerpt of what she had to say.
While I am not aware of an oral contraceptive directly causing diabetes, I don't want people to ever think that PCOSA only lists treatments that carry no risk with them. All treatments carry both benefit and risk. Some oral contraceptives have been shown to slightly increase insulin resistance in some studies. Others have not. But a pill is not a pill is not a pill. There are actually several different types of oral contraceptives, some of them with entirely different ingredients than others, so this accounts for the varying results. But no drug is without risk, and all of those listed as "treatments" for PCOS carry risk as well. Women with PCOS need to educate themselves about all of the different types of oral contraceptives on the market, and the research that goes with them, then select the best choice for them.
That being said, endometrial cancer is a much greater risk than a slight increase in insulin resistance. Even if insulin resistance is slightly raised by an OC, oral contraceptives irrefutably protect against endometrial cancer - the more immediate life-threatening risk. What women really need to understand is that they must treat the insulin resistance *in addition* to protecting themselves against endometrial cancer. Too many doctors just tell a woman to take the pill and that's it. But that's not enough. The IR absolutely must be treated. We know that insulin resistance is treatable with diet, exercise and/or insulin sensitizers. If we are treating the insulin resistance, then a slight increase in IR from the pill will be addressed anyway. It's always a balance of benefit and risk, and an educated decision is what is needed.

In addition, I made this post on the women's health discussion list at The original post was made on the pcos medication forum there, so I sent it to another doctor for an opinion. Search for it on Wed, 15 May 2002 08:56:09 -0500 (CDT), From: William McIntosh, MD, Subject: Re: Question for doctor
regarding my 14 May post.

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This article talks about the myths about oral contaceptives if you are interested. Of course, smoking and the pill isn't a good thing, so try and cut down or stop smoking (this is a public service announcement from your webmaster). Another article: Oral Contraceptive May Reduce Symptoms of Premenstrual Dysphoric Disorder suggests that the pill is positive. Here are a few URL's that go both ways on the pill: The pill and breast cancer Study finds no link - June 26, 2002
Study suggests 'the pill' doesn't affect weight
New study adds to evidence that taking oral contraception does not increase risk of breast cancer
Low goitre prevalence among users of oral contraceptives in a population sample of 3712 women
Oral Contraceptive Use and Diabetes
The Risk of Cardiovascular Disease With OCs
Oral Contraceptives and Bone Mineral Density in White and Black Women in CARDIA
Oral Contraceptives
Prolonged use of oral contraception before a planned pregnancy is associated with a decreased risk of delayed conception
Concomitant Use of Fluoxetine, Oral Contraceptives Is Safe
Contraception Study shows OC use by young women does not contribute to weight gain
New low-dose Ortho Tri-Cyclen approved by FDA
Altering the OC regimen
Changing the 21/7 and 28 day pill standard
OCs may not increase cancer threat
Highest Rates of Oral Contraceptive Use Reported in Germany
Third Generation Oral Contraceptives Do Not Raise Risk of Myocardial Infarction
Low-Dose Oral Contraceptive Safe And Effective Treatment For Acne
Effects of two oral contraceptives on plasma levels of nitric oxide, homocysteine, and lipid metabolism
Hormonal contraception: what is new?
Efficacy of a low-dose oral contraceptive containing 20 µg of ethinyl estradiol and 100 µg of levonorgestrel for the treatment of moderate acne
Also for reference: Emergency Contraception. There are health benefits of contraception.
Last Update:

May 27, 2003