Womens Health

Birth Control Pill FAQS

From the Woman's Diagnostic Cyber - Frederick R. Jelovsek MD


Heavy flow when stopping a pill cycle early

I took 3 pills out of a new pack of pills. Three days after I stopped taking the pill I started a menses! My problem is I have had some rather large clots and I am worried!

In your case, there was more endometrium present either because your own estrogens were higher or the 3 days of the pill built up some endometrium. If the large clots don't slow down to spotting only by seven days, you should call your doctor to see if you shouldn't go ahead and restart the pills over one more cycle. Next time it would be better to stop the pills at the end of a cycle.


Leg and arm pains on DeproProvera®

I had a baby about 3 months ago (my 3rd) and since have had 2 injections of Depoprovera®. I'm not sure if it's related or not but I have noticed increased pain in my legs, mostly inner knee area (both legs) and sometimes calves. It is not a joint or muscle pain. I also have unaccounted for bruises on my legs and an amazing increase in varicose veins. Regarding my arms, I occasionally have similar pains but have also noticed numbness and some weakness. It is almost like how your hand feels if you've had a rubber band on your wrist. Fortunately, my baby sleeps great and through the night but I am almost constantly tired to the point of having difficulty keeping my eyes open. Hopefully I'm just paranoid, but I just don't feel "right."

You can sometimes get symptoms from hormones like you describe but it can just as easily be low estrogen rather than increased progesterone. I would consider coming off the DepoProvera® as birth control and using some form of mechanical birth control (IUCD, diaphragm) for awhile to see how you do off of hormones.

If you get any acute redness in the legs, you need to see the doctor about possible blood clots in the legs. It can happen with DepoProvera® although more commonly it is from estrogen. The Depo Provera® may be making the varicose veins worse and that can be the cause of some of the symptoms. Also, be sure to increase your dietary potassium.


How long does it take Provera® to start a menses?

My doctor prescribed Provera® for 7 days to bring on my period. How long does it usually take before the period begins?

About 3-14 days after finishing the last pill. Most often in 3-5 days after finishing, but sometimes it hits just as you ovulated.


Continuous pill therapy for endometriosis

I am 39yrs old. with endometriosis. The pain, bleeding, and mood swings were so intense. Currently, I am on Loestrin® 1.5/30. This is my second month taking it continuously with no menstruation. After 21 days I begin the next pack as to keep the hormone levels the same. I am also anemic. Two questions: 1) What, if any, are your concerns about taking the pill continuously?

No long term concerns, as long as you are not a smoker. As far as short term, breakthrough bleeding and spotting are the main problems.

2) While the pill seems to help somewhat, the lethargy, bloating, and depression almost negates the benefits. What other pills might you suggest? More estrogen? More Progesterone? Any information would be appreciated.

Not more estrogen, just a different progestin. The bloating and depression are progestin side effects. You might try the OrthoCyclen®, Orthocept® or Desogen®. I think they have somewhat less progestin side effects but some women will react the same to almost any progestin.


Emotional on monophasic pill after menses

I have been on the Levlen® ED Birth control pill for just over 2 months now. I find the week after my period I become negative and very emotional, feel useless and lack confidence, am grumpy and have a very short tolerance span and feel almost suicidal. I have been on the pill before but it was Triphasil® and didn't seem to have problems like this. I don't have any reason in my life to feel these above feelings and most of the other time I am fine and happy. I am wondering if it would be the pill effecting me this way and should I change brands?

It is possible you could be sensitive to the different rate of changes in hormones between Triphasil® and Levlen®. Whether you go back to a triphasic pill (e.g., Triphasil®, TriLevlen®, Ortho-Tricyclen®, Tri Norinyl®, Ortho Novum® 777, etc.) depends on why you switched in the first place. If you didn't switch because of any symptoms, then going back to the Triphasil or some triphasic pill would be very reasonable just to see if your current symptoms go away.


Cramps and BCP's with iron

My gynecologist recently switched my birth control pills from Ortho-Cyclen® to Loestrin® FE 1/20. Since the switch I have been experiencing strong to severe abdominal cramps. It is like I am on my period even though I am in the middle of my pill pack. I am a little concerned but I am not sure if I should call my doctor. I have also been having an increase in appetite and weight but I thought this is normal. I am not sure what to do, any suggestions?

In your pill switch you've gone from a less potent progestin to a more potent one and a lower estrogen dose. The net result is a moderate increase in the progestin/estrogen ratio. This may be giving you some of the symptoms you describe. Appetite increase is a known progestin effect, however cramps are usually lessened by progestin. Skip the iron pills this next cycle (the 7 different colored pills) to see if the cramps are just a gastrointestinal upset due to iron. If the cramps still continue during another cycle, you may need to switch back to OrthoCyclen®.

But how long have you been on these pills and why did the doctor switch you. If it is because you were having some problems, could the current symptoms be a continuation or worsening of those problems rather than new problems possibly associated with the pill change?


Do I need emergency contraception?

I'm 18 and I was just wondering, is it possible for semen to go through underwear, and up into the uterus? Do I need emergency contraception? I am a virgin but I think my boyfriend leaked semen on my underwear. My friend told me there is a possibility. Is it true?

Anything is possible but the circumstances you describe would be very very unlikely. The underwear would block almost all sperm like a diaphragm does. I wouldn't suggest a morning-after-pill in this situation.

It seems as if this was a "close call" and maybe you should consider seeing about birth control. There is often a dilemma for young women in that they think if they get on contraception, that is the same as be willing to engage in sexual relations which you may not desire to do at this stage of your life. As a result many young women may not seek out contraception but some of those have accidents that they were not intending and they end up with a pregnancy long before one is intended.

I look at it differently. I don't expect anyone to be perfect, myself or others. We all make mistakes even though we have the best intentions. I buy car liability insurance even though I'm a good driver and don't intend to cause any accidents. I have medical malpractice insurance in case anyone even thinks I've made a mistake because I can't control the actions of others who may sue me, but it could end up hurting me or my family.

A pregnancy could end up hurting you or your family. You may not have control over your partner. That happens much more often than you think even though you may do everything possible to avoid sex or getting pregnant or even getting into a situation where that could happen. Contraception would be a form of insurance.

Thanks for answering my question. This is a big relief. I plan on being way more careful next time. And I'll think twice before even starting to go too far with someone who isn't my husband!


Do antacids interfere with birth control pills?

I had heard somewhere from a source (which I'm not sure to believe or not) that antacids interact with the pill in some way, as in decreasing effectiveness. I have never heard this before, had only heard about antibiotics, epilepsy medications. There's also no mention of it in my pill pack info. Has anyone heard this..and if it is true, what happens and why aren't women told about it?

I have not heard that antacids affect the efficacy of oral contraceptives. I found one abstract (included below that maintains that antacids do not affect pill effectiveness. I think that's why women are not told about this. Note that there are some inflammatory diseases of the bowel that could affect absorption. Also, antibiotics are not now considered to decrease contraceptive efficacy.

Am J Obstet Gynecol 1990 Dec;163(6 Pt 2):2204-2207

Gastrointestinal disease and oral contraception.
Hanker JP
Zentrum fur Frauenheilkunde of the Westfalische Wilhelms-Universitat, Munster, West Germany.

Oral contraceptive steroids play a major role in modern family planning. With the present tendency to decrease the doses of both estrogens and progestogens, any factor that reduces the bioavailability of the lower-dose preparations may have an impact on contraceptive protection. Although ethinyl estradiol, the most commonly used oral estrogen, is liable to an enterohepatic circulation as unchanged drug, the commonly used progestogens are not. At present, no convincing evidence exists in the human subject that disruption of the enterohepatic circulation by antibiotics or antacids does reduce contraceptive efficacy of the pill. Oral contraceptive steroids are mainly absorbed from the small bowel, and contraceptive efficacy depends on its absorptive capacity. Enhanced passage of gastrointestinal contents or impaired absorption may thus contribute to contraceptive failures in patients who have chronic inflammatory disease, diarrhea, ileostomy, or jejunoileal bypass.


Faintly positive pregnancy test 1 month after DepoProvera®

I use Depo-Provera® injections for birth control. My last injection was last month. My doctor told me that I had no more chance of getting pregnant using this method than women who have had their tubes tied. Recently, I have felt sick, all of the time (vomiting, and ache in lower belly and upper groin area). I took a pregnancy test just to see what it said. It came back faintly positive. Is this possible or due to other factors???

Usually Depoprovera® is quite effective with an extremely low pregnancy rate if taken every 14 weeks or less. While the nausea goes along with pregnancy, you don't mention breast soreness. Pain does not go with pregnancy.

Some things can give a false pregnancy test. Urinary tract infection comes to mind with your symptoms, although viral illnesses can also cause interference. I would wait about 3 or 4 days to check the pregnancy test, but in the meantime if you are having any urinary symptoms or diarrhea, you should have that checked out by your doctor.


Can a lower estrogen pill cause weight gain?

In the 80's my doctor changed my pills from 1/50's to 1/35's, I gained over 25 pounds. A few years later a doctor told me it was a thyroid reaction to the pill and my body eventually (1 year) evened out and got back to normal. Now I'm having night sweats and irritability, so my doctor changed me from Orthocept® to Estrostep®. In three months I have gained 5 pounds and feel sluggish. She is now going to change me to Ortho Novum® 1/35's. Is it possible that some women feel better and keep weight gain down with a higher estrogen pill? She told me most women lost weight when they went from 1/50's to 1/35's. Could I possibly have some estrogen deficiency? I'm only 31. I've had my thyroid checked and it is normal.

Weight change on pills has different components. Estrogens cause salt retention which in turn causes fluid retention and up to about 3-5 pounds in weight as a one time event. This is visible on the scale but shouldn't change clothes size. Estrogen also picks up metabolism somewhat and can keep weight gain from eating down.

Progestins in pills usually stimulate appetite and thus are most often responsible for continuing weight gain. For example DepoProvera®, which is pure progestin is notorious for stimulating appetite and causes weight gain in many women using it.

Finally, progestin blocks the effect estrogen so a pill with a weaker progestin (e.g. Orthocept®) in effect might be a stronger estrogen effect than Demulen® 1/35 which has a stronger progestin even though both pills have 1 mg of progestin and 35 mcgm of estrogen.

Your doctor is correct that many women will decrease weight going from 1/50 to 1/35 because they have less of the fluid retention due to salt retention. On the other hand, some women are more sensitive to the progestin component. Estrostep® has less estrogen but that makes a higher progestin/estrogen ratio and thus a stronger progestin effect.


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