WebMD Ask the Pharmacist

Birth Control Choices: Ask the Pharmacist

Nov. 9, 2010. Pharmacist Maria Marzella Sulli, PharmD, answers questions about birth control choices.

Question:

I just started a new type of birth control five days ago. I was prescribed Ortho Tri-Cyclen, but given the generic, Trinessa. Are the side effects for the generic any different from the side effects of the name brand?

Answer:

No. There is no difference in how you can expect to feel while taking the Trinessa. It contains the same active ingredients as the Ortho Tri-Cyclen. If you do notice anything different, you should talk to your pharmacist or health care professional.

Question:

Do multivitamins have negative interactions with birth control pills? Can multivitamins affect the absorption of the birth control pill?

Answer:

No. A regular multivitamin will not affect the absorption of birth control pills. There are no drug interactions. You should always check with your pharmacist before taking over-the-counter medications, vitamins, or supplements when you use a prescription medication. Your pharmacist would be the best person to help you avoid drug interactions.

Question:

Will taking cephalexin interfere with birth control?

Answer:

No. There is no evidence that cephalexin will affect birth control pills. It is a common belief that all antibiotics interfere with the efficacy of birth control pills, though that is not always the case. Missing a dose of your birth control pill, or vomiting, or diarrhea from your antibiotic may affect your hormone level. These reactions could affect the efficacy of your pills. Talk to your pharmacist about any of your concerns regarding drug interactions. They can help.

Question:

Does Ortho-Cyclen have a generic form? My insurance has changed and I now have to pay $50 a month for Ortho-Cyclen. I just cannot do that. I really like Ortho-Cyclen and have had no issues with it, so I wish I could stay on it.

Answer:

Yes. Ortho-Cyclen does have generic equivalents, which contain the exact same active ingredients. You should ask your health care professional about Mononessa, Previfem, or Sprintec. These are the generic versions of Ortho-Cyclen. They will work the same way and save you money. You should talk to your pharmacist about how he/she can help you save money and get the most out of your prescription therapy with cost-saving generic medications.

Question:

How do birth control pills work? Do they prevent fertilization of the egg, or prevent the fertilized egg from attaching to the uterus?

Answer:

Most birth control pills contain a combination of two types of hormones: an estrogen and a progestin. These work together to stop your body's production of a hormone that tells your ovaries to release an egg. So, in fact, they primarily work by stopping ovulation from occurring each cycle. If there is no egg released, there is no egg to fertilize, and you prevent pregnancy. The hormones in the birth control pills cause other changes that help to prevent pregnancy, as well. Nevertheless, this is their main mechanism of action.

Question:

I was going to start taking Adipex. But before I begin taking it, I want to know if it would interfere with my birth control pills – or even make them ineffective. I was also wondering if Adipex makes you infertile.

Answer:

There is no evidence that Adipex interacts with birth control pills or that it makes you infertile. However, women on birth control pills are at a higher risk of blood clots that can cause heart attacks and strokes. Adipex can raise your heart rate and blood pressure, which also increases your risk of blood clots that cause heart attacks and strokes. So be sure that the health care professional prescribing your Adipex is aware that you take birth control pills, and that he/she can monitor you appropriately.

Question:

I am taking birth control pills and the dentist put me on penicillin for an infection. Can I take any kind of pain reliever, like ibuprofen or acetaminophen?

Answer:

You can take a pain reliever such as acetaminophen or ibuprofen while taking birth control pills or penicillin. There are no drug interactions between the pain relievers and your prescription medications. You should always check with the pharmacist before taking OTC medications when you are using prescription medications.

Question:

How long does the birth control pill Errin take to become effective?

Answer:

Errin is a progestin-only form of birth control, commonly referred to as the "mini-pill" because it does not contain any estrogen. If you start the pack of pills on the first day of your menstrual cycle, you can expect them to be effective after 48 hours.

In the mean time, you should use a backup method of contraception such as a condom for the first two days you are taking the pill. Also, if you forget to take a pill, or are more than 3 hours late in taking it, you should use a backup method of contraception for 48 hours.

Question:

I use Mirena and was recently placed on an antibiotic. I know that with other forms of birth control, antibiotics can make them ineffective. Is this also true for Mirena?

Answer:

No. Mirena is not affected by antibiotics.

Question:

I am on birth control. My period is due to arrive later this week, at the same time as my long-distance boyfriend will be in town. I stopped taking my birth control a few days early to induce an early period. I then began taking the pills again on Sunday, which was yesterday. Is this going to reduce the effectiveness of my pills?

Answer:

It could. If you started the new pack of pills on the first day of your period, you should be OK. But if you did not, there is a slight chance that changing your schedule could change your cycle enough for ovulation to occur. I would suggest using a backup method of contraception for the first seven days that you take the pill, just to be more cautious.

In the future, you should consult your health care professional ahead of time about the best way to handle this situation. There are ways to adjust your birth control pills that wouldn't be as risky to your fertility. But only your gynecologist should provide you with that advice.

Question:

Is it safe to take Oxyelite Pro while taking oral contraceptives?

Answer:

While there are no known interactions between this supplement and oral contraceptives, I cannot say for sure if it is safe. As a pharmacist, I never recommend weight loss supplements. Many have dangerous side effects, such as increased heart rate and blood pressure (which could be dangerous for someone on birth control pills), and have been found to contain dangerous ingredients.

These supplements are not regulated the same way as drugs that are approved by the FDA. We can never really know for sure what is in these supplements. So I cannot tell you with any certainty about the possible interactions.

Question:

I am currently taking Ortho Tri-Cyclen Lo (I have been taking it for about 2 consecutive years.) I'm considering taking a dietary supplement for sexual health that contains Korean ginseng. The supplement is called Arginmax. I was just trying to find out if this supplement would have any effect on my birth control?

Answer:

While there are no known significant drug interactions between the ingredients in Arginmax and birth control pills, as a pharmacist, I would not recommend this product. There is no evidence that it would provide you any benefit. Since you are asking about a supplement that is taken to effect sexual health, I would ask if you are noticing a difference in your sexual desire, which could be a side effect of birth control pills.

If you have noticed a difference, talk to your health care provider. It might be as simple as making an adjustment to your birth control pills to fix the issue. And you won't have to spend extra money and take six capsules of a supplement every day to feel better.

Question:

I am taking Ortho Tri-Cyclen Lo and was just prescribed Caziant oral. How do these two prescriptions compare? I was put on the low-hormone birth control because I had a bad reaction to the higher-hormone pills.

Answer:

Caziant and Ortho Tri-Cyclen Lo are both birth control pills that contain a combination of estrogen and progestins, known as "tri-phasic" oral contraceptives. This means that each pill pack has three different strengths of hormones.

The difference between these two brands is that Ortho Tri-Cyclen Lo contains norgestimate and Caziant contains desogestrel – two similar but different version of progestin. As far as efficacy goes, they are equally effective. Although you shouldn't notice much difference, if you experience any changes in how you feel, you should talk to your health care provider.

Question:

Can you tell me if Zenchent and Balziva are generic versions of the same type of birth control pill?

Answer:

Yes. Zenchent and Balziva both contain the same ingredients in the same amounts – 35 micrograms of ethinyl estradiol and 0.4 milligrams of norethindrone, per tablet.

Question:

Can you take LoEstrin 24 and Chantix together?

Answer:

Yes. You can take LoEstrin and Chantix together. There are no significant drug interactions between the two medications. It is a great idea to quit smoking, especially for women who take birth control pills. Smoking while on birth control pills significantly raises the risk of blood clots.

Question:

Do any supplements, like cold-milled golden flax seed, affect the effectiveness of birth control pills?

Answer:

Flax seed will not affect how birth control pills work. But there are some supplements that should be avoided by women who take birth control pills. St. John's wort, commonly taken for mood and energy, can actually lower the amount of hormones you get from your pills, making them less effective… which could lead to an unexpected pregnancy. It should be avoided.

Before taking any supplements, you should always check with your pharmacist to make sure they do not interact with your prescription medications.

Question:

What oral contraceptives are likely to cause less weight gain?

Answer:

All of the combination oral contraceptives can cause weight gain. The estrogen in them promotes water retention. But, the weight gain from birth control pills is usually transient, and goes away with continued use. The amount of weight gain may be decreased with lower-dose versions, and with the progestins that are less like testosterone. Those that contain desogestrel, norgestimate, or drospirenone tend not to stimulate the appetite so much.

Talk to your doctor about which birth control pill is the best one for you.

Question:

I'm going on my honeymoon over Thanksgiving. I heard about Microgestin, and wanted to know how long you have to take Microgestin FE before it's safe to...you know...

Answer:

It would depend on where in your cycle you are when you start the pills. If you start on day 1 of your cycle, which is the first day of menstruation, you are protected from pregnancy immediately. If you start on the first Sunday after your period starts, you should use a backup method of contraception for seven days. After the first seven days, you are protected from pregnancy.

Question:

How long does it take for hormonal birth control (pills or injections) to leave your system completely once you stop using them?

Answer:

Birth control pills are out of your system in a day or two after you stop taking them – which is why you need to take them every single day in order for them to be effective. The injectable forms of birth control, such as Depo-Provera, are designed to provide contraception for three months. But it can take up to 9 or 10 months to be completely dispelled. After 3 months since your last injection, this form of birth control can no longer be guaranteed as an effective contraceptive.

Question:

I know my antibiotic reduces the effectiveness of my birth control pills. So I have been using a backup method of birth control in addition to my pills. How long should I continue the use of a backup method after I stop taking my antibiotic?

Answer:

It depends on where in your cycle you are and what antibiotic you are taking. Not all antibiotics affect birth control pills. A general rule of thumb is to use an alternative method of birth control for the course of the antibiotic usage, and for seven days after you stop. But it really would depend on your individual situation. You should talk to your gynecologist or pharmacist about what you should do.

Question:

What is the difference in norethindrone 0.35mg, Azurette, and LoEstrin birth control pills?

Answer:

Azurette and LoEstrin are combination oral contraceptives, which means they contain an estrogen and progestin that work together to prevent pregnancy. Norethindrone 0.35mg is a progestin-only form of birth control. These forms are generally reserved for women who cannot take estrogens, such as women who are breastfeeding.

Progestin-only forms of birth control are not as effective as combination versions, and need to be taken every day with no pill-free days.

Question:

Is it dangerous to skip the sugar pills in a birth control pack to adjust a menstrual cycle? I've done this once before, several years ago, when I wasn't sexually active and didn't think much about it. I'm more hesitant this time.

Answer:

No. It is not dangerous. But you would want to do it with the advice of a health care professional to make sure you do it right. There are actually versions of birth control that are approved for less or even no placebo days at all – making them continuous use pills.

If you want to change the timing of your period by adjusting when you take the placebos, you should talk to your gynecologist to be sure you do it right… or you could end up pregnant.

Question:

Can you buy hormonal birth control (pills or shots) over the counter?

Answer:

No. All hormonal forms of birth control require a prescription. Only emergency contraception is available over the counter to people age 17 and older – and this is not a reliable method of birth control. It is intended to be used only in the event of regular contraceptive failure.

Question:

Is there any link between stopping birth control and experiencing a slump in your energy level or mood? I stopped taking birth control pills about 2 months ago and am feeling very clumsy and lethargic.

Answer:

Mood changes are possible when hormone levels change. But 2 months seems like a long time for these experiences to be occurring in conjunction with your birth control. If you are feeling different, you should consult with your health care provider.

Question:

What vitamins can you take with birth control pills that will not cancel out the birth control?

Answer:

There are no significant interactions between any vitamins and birth control pills. You can take a regular multivitamin while taking birth control pills without any problem.

Question:

I have been taking Tri Lo Sprintec, a generic form of Ortho Tri-Cyclen Lo, for about 3 months now. I was recently prescribed Bactrim DS for a UTI. My menstrual cycle was supposed to start this week. I'm on pill number 3 and I have yet to start menstruating. Is this normal or should I be concerned about being pregnant?

Answer:

Anytime you skip a period, you should be concerned about being pregnant. It is always a possibility. You can take an over-the-counter pregnancy test, or contact your gynecologist.

Question:

I dropped a birth control pill, and decided to immediately take the next pill instead of skipping one. Once I get to my placebo pills, should I skip one?

Answer:

You are going to finish your active pills a day early. So you can decide to start your new pack of pills a day early to stay on the 7-day placebo schedule. If you choose to skip a day and wait to start the new pack on your regularly scheduled day, there is a very slight chance that the one day can make a difference in the risk of an unexpected pregnancy. The more pills you miss, the more likely you are to get pregnant.

Question:

I use Vivelle estrogen patch, and they're very expensive. I found some patches in my home that expired in February of 2010. Can I still use them?

Answer:

Medications can only be guaranteed to be at their most effective when they are used before their expiration date. Once expired, they may not be as effective.

Question:

I received my first prescription for birth control pills last Thursday. I misunderstood my doctor, and didn't realize that I was supposed to wait until the Sunday AFTER my period starts to take the pill. I started the Sunday after my doctor's appointment, which was a few days before my period was supposed to come. I have been on the pill for about four days now. My period hasn't come and I'm not sure what to do. Was it OK that I started taking the pills before my period came?

Answer:

It is OK to start mid-cycle. But you are not protected from pregnancy until you have taken the pill for at least seven consecutive days. It is also likely that the pills may change your cycle. You should expect to get your period about three days after you finish the active pills in the pack. In the meantime, you may notice some breakthrough bleeding or spotting since you started right before your period was supposed to come. Talk to your gynecologist if you notice anything new or unusual.

Question:

I just had my Mirena IUD removed 2 weeks ago. The next day I came on my period. Now -- a week and a half later – I'm bleeding again. What should I do? Is this normal?

Answer:

It is possible to have irregular bleeding in the first few cycles after Mirena is removed. But if you are experiencing unusual bleeding, it's best that you check with your gynecologist to make sure nothing else could be wrong.

Question:

If I stop taking the birth control pill, will I lose weight? If so, how quickly will I lose the weight?

Answer:

It depends. Some people gain a little weight while on birth control pills. But not everyone does. You may notice a bit less water retention, which would go away rather quickly -- most likely in the first week or two after you stop taking the pill. But you are not likely to notice a significant drop in your weight simply by stopping the birth control pill.

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