OP: Which pill? Your choice!

In the Birth Control Forum is the Sticky "Caution: Take Only as Directed' which should be read by any woman new to "the pill." This is a companion piece to that addressing the woman's role in choosing which pill and , so, is placed in the women's health forum.

Over the years, there have been many questions by women regarding using or abusing the pill. Many name the pill they are on specifically. Quite unscientifically it appears that women in Europe, Canada, Australia, places with national formularies, name well established, widely used, generic pills. Many of these are available all over the world with many names. Some that I have had to look up are simply common drugs that go under a different name where I have practiced. Whilst those in the U.S. almost always name one of the latest to market pills. That concerns me for a few reasons. There is no difference in the effectiveness of older generics and the new fads. There has been no change to "strength" of the drugs for about ten years. There are three differences:

1. Cost: pills commonly available can vary from as little a ten euros per month nearly four times that. A check on internet sources indicates that this is true in all countries that I checked. The newer pills are the most expensive.

2. The newest pills use newer synthetic hormones. Sounds great and we assume the newer are better. The fact is that after about three years on the market more women are having difficulty adjusting to the newer hormones than to the older ones. You are not signing up for a clinical trial; you are simply looking for acceptable contraception.

3. The newer drugs contain additional medication or supplements or are marketed as meeting other needs than simply contraception. For instance there are several pills now ending with "Fe" indicating that they have iron added. Others are effective as acne medication with the advert that "as long as you are on the pill, you may as well get this effect as well."

Many patients (most?) simply accept the prescription as written, have it filled and begin taking it. Given the forty or so formulations available under hundreds of different names and in three different categories you should ask the doctor why this particular pill. There may be good reason for a particular pill and you deserve to know what it is. Given the monophasic, biphasic and triphasic types, the doctor should choose one based on your personal and family medical history. Hard to argue with that: the doctor is trying to match the best possible for you to you. Beyond that, there are decision on specific strength, specific formulation and the administration regimen: 21 on, 7 off or a pill for every day of a 28 day cycle.

The doctor may simply be prescribing whatever is in vogue; you deserve to know that as well. Why prescribe a forty euro (or dollar or pound or whatever) a month medication when another at one-third the price may do just as well? Ask. Or would you rather waste that money? Those countries with national formularies do not include the more expensive drugs for the simple reason that they cost more but do not do more. The same is true for stomach medications, prostate medications, anti-depressants and all other drugs. Those nations without national formularies depend upon market forces to control the price of drugs. That is the primary reason drugs cost three times as much in the U.S. as in Canada or Europe. If Americans asked their doctors to justify the drug chosen, that might change while still giving Americans the choice they want. Europeans generally accept that the National Health Services are helping them to make decisions.

The doctor may prescribe the iron-added pills because you are anemic. You should know that. Or, if you are not anemic you do not need the iron. Even if you do need the iron, Ferrous sulfate is one of the cheapest supplements available; a cheaper pill with a bottle of ferrous sulfate will still cost about a third as much as birth control pills with iron added. There is also the issue of adjusting to the pill. Given what ferrous sulfate does to my intestines, I cannot imagine adjusting to a new medication with that going on. I simply will not prescribe iron added contraception.

My point: It is your body and you, not your doctor, are responsible for what you dump into it. Those women who ask these questions are more likely to also ask the questions to understand what the medication does to and for her body and is most likely to be compliant with the directions for use.

OP: Brandye 05/22/2011

Posted: 23 Sep 02:35