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 Effect How to Treat It

Side Effectestrogenprogestinandrogennotes
Acnehigher estrogenlower androgenicity
Break Through Bleeding (BTB)higher estrogenhigher progestin potencylower androgenicity
Absent or too light menstrual flowhigher estrogen
Depression, moodiness, irritabilitylower progestin potencymonophasic
New or worsening Headacheslower estrogenlower progestin potencyif neurologic symptoms or migraine with aura – STOP estrogen containing OCP ASAP
Breast Tenderness/ Sorenesslower estrogenlower progestin potency
Weight gainlower estrogenlower progestin potencyIf related to menses, consider skip placebo/bleeds.

Most likely due to natural weight gain with age.
Severe Menstrual Crampshigher progestin potency
Endometriosislower estrogenhigher progestin potencyhigher androgenicity
Nausealower estrogenFirst try taking it with largest meal of day or right before going to bed
Libidolower estrogenhigher androgenicity

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

ProgestinProgestational Activity (relative to 1 mg of norethindrone)Androgenic Activity (relative to 1 mg of norethindrone)
norethindrone 1 mg 1.01.0
norethindrone acetate 1 mg 1.21.6
ethynodiol diacetate 1 mg 1.40.6
levonorgestrel 1 mg5.38.3
dl-norgestrel 1 mg 2.64.2
norgestimate 1 mg1.31.9
norelgestromin 1 mg1.31.9
desogestrel 1 mg 9.03.4
drospirenone 1 mg1.50.0
CHART 2: from least androgenic to most
Medicationprogestinmg of progestinAndrogenic activityEEprogestational activity
Gianvi, Loryna, Nikki, Vestura, Yazdrosperinone3.000.00204.5
Ocella, Syeda, Yasmin, Zarahdrosperinone3.000.00304.5
SkylaLNG0.0140.070.12
KyleenaLNG0.0180.090.15
Liletta/Mirena IUDLNG0.0200.170.11
Xulanenorelgestromin0.150.29200.20
Errin, Jolivette, Jencycla, Lyza, Norethindrone, POP, Sharobelnorethindrone0.350.350.35
Balziva, Briellyn, Femcon Fe, Gildagia, Philith, Ovcon 35, zenchent Fe, Zeosa, wymzya Fenorethindrone0.400.40350.4
NuvaRingetonogestrel0.120.41151.08
Estarylla, Norgestimate / Ethinyl Estradiol, Femynor, Mili, Mono-Linyah, Mononessa, Orthocyclen, Previfem, Sprintec, Vylibra,norgestimate0.250.48350.33
Brevicon; Modicon; Necon 0.5/35; Nelova 0.5/35; NEE 0.5/35norethindrone0.500.50350.50
ortho novum 10/11, necon 10/11 [biphasic 0.5/35 and 1/35]norethindrone0.500.50350.50
Kariva, Kimidess, Mircette, Pimtrea, Viorele, Mylan genericdesogestrel0.150.51201.35
Apri, Cyred, Desogen, Emoquette, Enskyce, Isibloom, Juleber, orthocept, Reclipsen, Solia desogestrel0.150.51301.35
Demulen, Zovia, kelnorethynodiol diacetate1.000.60351.4
ethinyl estradiol-ethynodiol 1/50ethynodiol diacetate1.000.60501.4
Cyclafem 777, Pirmella 7/7/7, Dasetta 7/7/7, Alyacen 7/7/7, Nortrel 7/7/7, Necon 7/7/7norethindrone0.750.75350.75
Amethyst, (lybrel, discontinued)LNG0.090.75200.477
Alesse, Aubra, Aviane, Delyla, Lessina, Levlite, Lutera, Orsythia, Sronyx, VienvaLNG0.100.83200.53
Amethia Lo, CamreseLo, LoseasoniqueLNG0.100.83200.53
Estrostep Fe, Tilia, Tril-egestnorethindrone1.001.0020/30/351.00
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 1/35norethindrone1.001.00351.00
Necon 1/50, norinyl 1/50, orthonovum 1/50, ovcon 50norethindrone1.001.00501.00
Chateal, Jolessa, Levlen, Levora, Nordette, Portia, Seasonale, Seasonique, Amethia, Ashlyna, Daysee, CamreseLNG0.151.25300.795
Lo Ovral, Low Ogestrelnorgestrel0.301.26300.78
Blisovi, Blisovi 24, Gildess, Junel 1/20, Larin, Loestrin 1/20, Lomedia, Microgestin 1/20, Minasterin (chewable), Tarina, Taytullanorethindrone acetate1.001.60201.2
Blisovi, Gildess, Junel 1.5/30, Larin, Loestrin 1.5/30, microgestin 1.5/30norethindrone acetate1.502.40301.8
CHART from least progestin activity to most
Medicationprogestinmg of progestinAndrogenic activityEEprogestational activity
Xulanenorelgestromin0.150.29200.20
Estarylla, Orthocyclen, Sprintec, Mono-Linyah, Previfem, Estarylla, Norgestimate / Ethinyl Estradiol, Femynor, Mononessa, Sprintec, Milinorgestimate0.250.48350.325
Errin, Jolivette, Jencycla, Lyza, Norethindrone, POP, Sharobelnorethindrone0.350.350.35
Balzivia, Briellyn, Gildagia, philith, Ovcon 35norethindrone0.400.40350.4
Brevicon; Modicon; Necon 0.5/35; Nelova 0.5/35; NEE 0.5/35norethindrone0.500.50350.50
ortho novum 10/11, necon 10/11 [biphasic 0.5/35 and 1/35]norethindrone0.500.50350.50
Aviane, Levlite, Lutera, Alesse(off market) Camrese Lo/ LoseasoniqueLNG0.100.83200.53
Cyclafem 777, Pirmella 7/7/7, Dasetta 7/7/7, Alyacen 7/7/7, Nortrel 7/7/7, Necon 7/7/7norethindrone0.750.75350.75
Lo Ovral, Low Ogestrelnorgestrel0.301.26300.78
Altavera, Chateal, Jolessa, Kurvelo, Levlen, Levora, Lillow, Marlissa, Nordette, Portia, Seasonale, Seasonique, LNG0.151.25300.795
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 1/35norethindrone1.001.00351.00
Necon 1/50, norinyl 1/50, orthonovum 1/50, ovcon 50norethindrone1.001.00501.00
NuvaRingetonogestrel*0.120.41151.08
Blisovi, Gildess, Junel 1/20, Junel Fe 24, Larin, Loestrin 1/20, Microgestin 1/20norethindrone acetate1.001.60201.2
Kariva, Mircette, Vioreledesogestrel0.150.51201.35
Apri, Desogen, Emoquette, Enskyce, orthocept, Reclipsendesogestrel0.150.51301.35
Demulen, Zovia, kelnorethynodiol diacetate1.000.60351.4
Blisovi, Gildess, Junel 1.5/30, Larin, Loestrin 1.5/30, microgestin 1.5/30norethindrone acetate1.502.40301.8
Gianvi, Loryna, Nikki, Vestura, Yazdrosperinone3.000.00204.5
Ocella, Syeda, Yasmin, Zarahdrosperinone3.000.00304.5

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. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment, and should never be relied upon for specific medical advice. Please consult YOUR doctor/provider before changing, stopping, or starting any medications.

updated 1.27.20