Which Oral Contraceptive Pill is Best for Me?
Frederick R. Jelovsek MD, MS
"I am 25 years old. I haven't had a period in about 6 months but I don't want to get pregnant now. I'm overweight and can't lose any, I am always tired, have acne that I can't clear up, and I have excess body hair. I have been put on birth control pills but they haven't helped. What would be the best brand of pills for me to be on for my problem? Also, my pills cost $30.00 a month. Are there any sources for free pills?" Anonymous
Be sure to give the pills you are currently taking a fair trial of at least 2-3 months. If your pills are switched, also give them 2-3 months trial because it often takes 2 months just for your body to adjust to the estrogen and progestin in an oral contraceptive. Also when we say a pill has certain characteristics because of its estrogen dose and its progestin dose and potency or androgenicity (male hormone effect), every woman responds differently to those components and sometimes the general principles just do not apply.
With your history of infrequent menstruation, you may have a condition of either polycystic ovarian syndrome (PCOS) or a stress-like hypothalamic anovulation. In either case, birth control pills are a good treatment for those conditions if you do not want to get pregnant at present.
In the case of hypothalamic anovulation there are often low or low normal estrogen levels and the pill will increase those levels to mid-normal range. In the case of PCOS, the extra estrogens from the pill will result in an increased binding (inactivation) of any excess testosterone from the polycystic ovaries as well as suppress some of the testosterone production from them.
With PCOS you would avoid a pill with increased androgenic (testosterone-like) activity and do better with one with higher estrogen levels as far as combatting the excess body hair you indicate is present now.
Many experts believe there are no consistent side effect differences between different formulations of birth control pills because all pills have been reduced in dose so much from when older data on higher dose pills was examined.
Others agree that those unique side effects have been reduced but they are still manifest in some women. In my experience some women still have side effects according to the different oral contraceptive components and their doses in a given pill formulation.