Womens Health

Switching Pills (cont'd)

Keep in mind that what follows about pill potency is controversial. Some very prominent experts in the field feel that since there is so much individual variability in how any woman's specific tissue reacts to any specific hormone, you can't assign biologic potencies accurately enough to clinically prescribe different formulations according to different symptoms.

That being said, pills are assigned biologic potencies as a combination of both the estrogen and the progestin. Since almost all pills have the same estrogen (ethinyl estradiol), the estrogen potency only varies from a few pills at the 20 ug level (Loestrin 1/20® and Allesse®) to the majority at 30 and 35 ug.

In this respect, Loestrin 1/20® would be considered -low- but actually Loestrin 1.5/30® I wouldn't consider low.

The other component is the progestin. Progestin potency has in the past been measured by a "delay of menses" index, i.e., how well a hormone keeps the endometrium from sloughing. The higher the progestin potency (and it doesn't go mg per mg across different formulations) the more likely to stop heavy bleeding.

For example Levlen® (levonorgestrel) mg for mg is more potent than many other progestins such as the one in Desogen® which is actually a very mild progestin. Higher progestin potency also tends to decrease cramps more.

To complicate matters more, sometimes a higher estrogen potency (dose) is needed to "stabilize" the endometrium if the progestin makes the endometrium too atrophic. You went from Desogen®, a low potency progestin, to Loestrin®, an intermediate potency progestin and your doctor has now suggested a higher potency progestin in Levlen.

It seems like it would be worth a try. Another slightly higher progestin potency pill would be Demulen® 1/35. You may also need to get a thyroid check and a bleeding time check to rule out other causes of heavy bleeding.

Switching pills and switching back - Will they work the same?

I am switching from Loestrin 1.5/30® to Levlen® to try and lessen the amount of bleeding on the first day of my period, and also, to help some with the cramps. I will be starting these new pills this week.

I am still a little leery about switching pills thinking I may end up worse off than I am now, but I am willing to give it a shot. My main concern is that if I take these new pills and I am not happy with the results the first month for some reason, will I be able to go back to taking the LoEstrin® and have it work exactly like it was working before I made the switch, or will it be like starting a whole new pill in that there may be breakthrough bleeding, spotting, and I may not get it on the exact same day as I used to (it was always 3 days after my last hormone pill).

I am just asking this as I know that with other meds I've taken (like anti-depressants...I suffer from panic/anxiety disorder and depression) that you may take them once and have no side effects and they may work fairly well, but then if you stop that med for whatever reason and try and re- start it maybe a month or several months later, your body chemicals have now changed and the med either no longer works on you or you experience side effects this time around.

What do you think the chances are of me being able to re-start the LoEstrin® after being off of it for one month and having it work exactly like it used to?

80-90% - pure guess.

Table of Contents
1. Break through bleeding
2. When to start the pill
3. Shorter cycle?
4. Expired pills ok?
5. Light period on Pill. Am I pregnant?
6. Postpone a period
7. Switching pills
8. Switching brands
9. Pill and individual variability
10. Is it necessary to switch?
11. Severity of symptoms
12. Big decisions
13. And switching back
14. Which pill? Undecided?
15. Heavy flow
16. Pill problem finale
17. Why cramps?
18. Exercise help cramps?
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