Written by Sophia Yen, MD, MPH

A guide for providers

The following are a few charts that are helpful for managing birth control pill side effects. These are intended for providers (e.g. doctors, NPs, PAs, Pharmacists) that write birth control prescriptions. But the information can also be useful to anyone who is having side effects with birth control and they can discuss with their provider.

Thanks to Frederick R. Jelovsek MD, MS who wrote an article from which this is based but no longer is available on the web. Other references below.

Side Effects and How to Treat Them

Side Effect Estrogen Progestin Androgen notes
Acne higher estrogen lower androgenicity  
Break Through Bleeding (BTB) higher estrogen higher progestin potency lower androgenicity  
Absent or too light menstrual flow higher estrogen  
Depression, moodiness, irritability lower progestin potency monophasic
New or worsening Headaches lower estrogen lower progestin potency if neurologic symptoms or migraine with aura – STOP estrogen containing OCP ASAP
Breast Tenderness/ Soreness lower estrogen lower progestin potency  
Weight gain lower estrogen lower progestin potency   If related to menses, consider skip placebo/bleeds.

Most likely due to natural weight gain with age.
Severe Menstrual Cramps higher progestin potency  
Endometriosis lower estrogen higher progestin potency higher androgenicity  
Nausea lower estrogen First try taking it with largest meal of day or right before going to bed
Libido lower estrogen higher androgenicity

Table of Androgen potency and Progestin potency of most birth control pills here

Progestin Progestational Activity (relative to 1 mg of norethindrone) Androgenic Activity (relative to 1 mg of norethindrone)
norethindrone 1 mg  1.0 1.0
norethindrone acetate 1 mg  1.2 1.6
ethynodiol diacetate 1 mg  1.4 0.6
levonorgestrel 1 mg 5.3 8.3
dl-norgestrel 1 mg  2.6 4.2
norgestimate 1 mg 1.3 1.9
norelgestromin 1 mg 1.3 1.9
desogestrel 1 mg  9.0 3.4
drospirenone 1 mg 1.5 0.0

Birth Control Pills and Hormone Dosages

From least androgenic to most

Medication Progestin mg of Progestin Androgenic Activity EE Progestational Activity
Gianvi, Loryna, Nikki, Vestura, Yaz drosperinone 3.00 0.00 20 4.5
Ocella, Syeda, Yasmin, Zarah drosperinone 3.00 0.00 30 4.5
Skyla LNG 0.014 0.07 0.12
Kyleena LNG 0.018 0.09 0.15
Liletta/Mirena IUD LNG 0.020 0.17 0.11
Xulane norelgestromin 0.15 0.29 20 0.20
Errin, Jolivette, Jencycla, Lyza, Norethindrone, POP, Sharobel norethindrone 0.35 0.35 0.35
Balziva, Briellyn, Femcon Fe, Gildagia, Philith, Ovcon 35, zenchent Fe, Zeosa, wymzya Fe norethindrone 0.40 0.40 35 0.4
NuvaRing etonogestrel 0.12 0.41 15 1.08
Estarylla, Norgestimate / Ethinyl Estradiol, Femynor, Mili, Mono-Linyah, Mononessa, Orthocyclen, Previfem, Sprintec, Vylibra, norgestimate 0.25 0.48 35 0.33
Brevicon; Modicon; Necon 0.5/35; Nelova 0.5/35; NEE 0.5/35 norethindrone 0.50 0.50 35 0.50
ortho novum 10/11, necon 10/11 [biphasic 0.5/35 and 1/35] norethindrone 0.50 0.50 35 0.50
Kariva, Kimidess, Mircette, Pimtrea, Viorele, Mylan generic desogestrel 0.15 0.51 20 1.35
Apri, Cyred, Desogen, Emoquette, Enskyce, Isibloom, Juleber, orthocept, Reclipsen, Solia  desogestrel 0.15 0.51 30 1.35
Demulen, Zovia, kelnor ethynodiol diacetate 1.00 0.60 35 1.4
ethinyl estradiol-ethynodiol 1/50 ethynodiol diacetate 1.00 0.60 50 1.4
Cyclafem 777, Pirmella 7/7/7, Dasetta 7/7/7, Alyacen 7/7/7, Nortrel 7/7/7, Necon 7/7/7 norethindrone 0.75 0.75 35 0.75
Amethyst, (lybrel, discontinued) LNG 0.09 0.75 20 0.477
Alesse, Aubra, Aviane, Delyla, Lessina, Levlite, Lutera, Orsythia, Sronyx, Vienva LNG 0.10 0.83 20 0.53
Amethia Lo, CamreseLo, Loseasonique LNG 0.10 0.83 20 0.53
Estrostep Fe, Tilia, Tril-egest norethindrone 1.00 1.00 20/30/35 1.00
Cyclafem, Dasetta, Necon 1/35; Nelova 1/35; NEE 1/35; Genora 1/35; Norcept-E 1/35; Nortrel, Genora 1/35; Norcept-E 1/35;Norethin 1/35E; Norinyl 1/35; Ortho-Novum 1/35 norethindrone 1.00 1.00 35 1.00
Necon 1/50, norinyl 1/50, orthonovum 1/50, ovcon 50 norethindrone 1.00 1.00 50 1.00
Chateal, Jolessa, Levlen, Levora, Nordette, Portia, Seasonale, Seasonique, Amethia, Ashlyna, Daysee, Camrese LNG 0.15 1.25 30 0.795
Lo Ovral, Low Ogestrel norgestrel 0.30 1.26 30 0.78
Blisovi, Blisovi 24, Gildess, Junel 1/20, Larin, Loestrin 1/20, Lomedia, Microgestin 1/20, Minasterin (chewable), Tarina, Taytulla norethindrone acetate 1.00 1.60 20 1.2
Blisovi, Gildess, Junel 1.5/30, Larin, Loestrin 1.5/30, microgestin 1.5/30 norethindrone acetate 1.50 2.40 30 1.8

From least progestin activity to most

Medication Progestin mg of Progestin Androgenic Activity EE Progestational Activity
Xulane norelgestromin 0.15 0.29 20 0.20
Estarylla, Orthocyclen, Sprintec, Mono-Linyah, Previfem, Estarylla, Norgestimate / Ethinyl Estradiol, Femynor, Mononessa, Sprintec, Mili norgestimate 0.25 0.48 35 0.325
Errin, Jolivette, Jencycla, Lyza, Norethindrone, POP, Sharobel norethindrone 0.35 0.35 0.35
Balzivia, Briellyn, Gildagia, philith, Ovcon 35 norethindrone 0.40 0.40 35 0.4
Brevicon; Modicon; Necon 0.5/35; Nelova 0.5/35; NEE 0.5/35 norethindrone 0.50 0.50 35 0.50
ortho novum 10/11, necon 10/11 [biphasic 0.5/35 and 1/35] norethindrone 0.50 0.50 35 0.50
Aviane, Levlite, Lutera, Alesse(off market) Camrese Lo/ Loseasonique LNG 0.10 0.83 20 0.53
Cyclafem 777, Pirmella 7/7/7, Dasetta 7/7/7, Alyacen 7/7/7, Nortrel 7/7/7, Necon 7/7/7 norethindrone 0.75 0.75 35 0.75
Lo Ovral, Low Ogestrel norgestrel 0.30 1.26 30 0.78
Altavera, Chateal, Jolessa, Kurvelo, Levlen, Levora, Lillow, Marlissa, Nordette, Portia, Seasonale, Seasonique LNG 0.15 1.25 30 0.795
Cyclafem, Dasetta, Necon 1/35; Nelova 1/35; NEE 1/35; Genora 1/35; Norcept-E 1/35; Nortrel, Genora 1/35; Norcept-E 1/35;Norethin 1/35E; Norinyl 1/35; Ortho-Novum 1/35 norethindrone 1.00 1.00 35 1.00
Necon 1/50, norinyl 1/50, orthonovum 1/50, ovcon 50 norethindrone 1.00 1.00 50 1.00
NuvaRing etonogestrel* 0.12 0.41 15 1.08
Blisovi, Gildess, Junel 1/20, Junel Fe 24, Larin, Loestrin 1/20, Microgestin 1/20 norethindrone acetate 1.00 1.60 20 1.2
Kariva, Mircette, Viorele desogestrel 0.15 0.51 20 1.35
Apri, Desogen, Emoquette, Enskyce, orthocept, Reclipsen desogestrel 0.15 0.51 30 1.35
Demulen, Zovia, kelnor ethynodiol diacetate 1.00 0.60 35 1.4
Blisovi, Gildess, Junel 1.5/30, Larin, Loestrin 1.5/30, microgestin 1.5/30 norethindrone acetate 1.50 2.40 30 1.8
Gianvi, Loryna, Nikki, Vestura, Yaz drosperinone 3.00 0.00 20 4.5
Ocella, Syeda, Yasmin, Zarah drosperinone 3.00 0.00 30 4.5

At Pandia Health, looking at the side effect profile, we have found that a desogestrel or norgestimate based birth control pill such as Apri/Viorele or estarylla/sprintec will be the birth control pill most women do well on and have the least amount of side effects. Desogestrel seems to have less breakthrough bleeding (BTB) when trying to skip periods.

If you choose to lower the estrogen you should know, Dr. Sophia Yen (our CEO/Co-Founder) is an Adolescent Medicine specialist and she and her academic colleagues currently do NOT recommend a birth control pill with less than 30 mcgs of estrogen for women under the age of 30 years old, because if you go less than 30 mcgs of estrogen, you risk having a low bone density, which increases your risk of bone fractures later in life or is at least a proxy for bone density accrual (making your bones strong so you won’t get fractures when you are old). Young adolescents to Young Adults accrue bone density from age 8 years old to 30 years old.

References

Contraceptive Technology, 21st Edition, pages 299-305.

Disclaimer: The views expressed in this article intend to inform and induce conversation. They are the views of the author and do not necessarily represent the views of Pandia Health, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners.