GENERIC NAME: Oral Contraceptives or OCs (also known as Birth Control Pills or BCPs)

DRUG CLASS AND MECHANISM: Oral contraceptives (OCs) are medications that prevent pregnancy. They are one type of birth control. OCs may contain combinations of estrogen and progestin or progestin alone. Combinations of estrogen and progestin prevent pregnancy by inhibiting the release of the hormones LH and FSH from the pituitary gland in the brain. LH and FSH play key roles in the development of the egg and preparation of the lining of the uterus for implantation of the embryo. Progestin also makes the uterine mucus that surrounds the egg more difficult for sperm to penetrate and, therefore, for fertilization to take place. In some women, progestin inhibits ovulation (release of the egg).

The combination OCs are called “monophasic,” “biphasic,” or “triphasic.” Monophasic OCs deliver the same amount of estrogen and progestin every day. Biphasic OCs deliver the same amount of estrogen every day for the first 21 days of the cycle. During the first half of the cycle, the progestin/estrogen ratio is lower to allow the endometrium to thicken as it normally does. During the second half of the cycle, the progestin/estrogen ratio is higher to allow normal shedding of the lining of the uterus to occur. The triphasic OCs have constant or changing estrogen concentrations and varying progestin concentrations throughout the cycle. There is no evidence that bi- or tri-phasic OCs are superior to monophasic OCs, or vice-versa.

PRESCRIBED FOR: OCs are prescribed for the prevention of pregnancy. When taken as directed, OCs fail in less than 1 in every 200 users over the first year of use. OCs also are prescribed to treat mid-cycle pain which some women experience with ovulation. OCs, while regulating the menstrual cycle, reduce menstural cramps and heavy bleeding, and, because of the reduced bleeding, they may prevent the anemia that can develop in some women. Doctors sometimes prescribe higher doses of OCs for use as “morning after” pills to be taken up to 72 hours after unprotected intercourse to prevent fertilization and pregnancy.

DOSING: Many of the OCs come in easy to use dispensers in which the day of the week or a consecutive number (1, 2, 3, etc.) is written on the dispenser with a corresponding tablet for each day or number. For example, some Ortho-Novum dispensers are labeled “Sunday” next to the first tablet. Thus, the first tablet is to be taken on the first Sunday after menstruation begins (the first Sunday following the first day of a woman’s period). If her period begins on Sunday, the first tablet should be taken on that day. For OCs that use consecutive numbers, the first tablet (#1) is taken on the first day of the menstrual period (the first day of bleeding). Tablet #2 is taken on the second day, and so on. Still other packages instruct women to begin on day 5 of the cycle. For such products, women count from day 1 of their menstrual cycle (day 1 is the first day of bleeding). On the fifth day, the first tablet is taken. Tablets then are taken daily.

DRUG INTERACTIONS: Estrogens can inhibit the metabolism (elimination) of cyclosporine, resulting in increased cyclosporine blood levels. Such increased blood levels can result in kidney and/or liver damage. If this combination cannot be avoided, cyclosporine concentrations can be monitored, and the dose of cyclosporine can be adjusted to assure that its blood levels do not become elevated.

Estrogens appear to increase the risk of liver disease in patients receiving dantrolene through an unknown mechanism. Women over 35 years of age and those with a history of liver disease are especially at risk.

Estrogens increase the liver’s ability to manufacture clotting factors. Because of this, patients receiving warfarin (Coumadin) need to be monitored for loss of anticoagulant (blood thinning) effect if an estrogen is begun.

Birth Control and Acne: How Does It Work?

The link between birth control and acne is surprisingly simple. Birth Control Pills prevent pregnancy by changing the level of certain hormones in your body. One of these hormones is androgen, which stimulates oil production and increases acne. If you’re taking birth control pills that lower your androgen levels, you should see a reduction in the number of breakouts you experience.

Generally, it takes between six and eight weeks to see results when using birth control to treat your acne. While most topical medications work to treat existing inflammation, the pill will prevent new outbreaks from happening.

According to researchers who have studied the link between birth control and acne, using birth control pills to treat your blemishes should produce results similar to that of treatment with benzyl peroxide and topical or systemic antibiotics.

What Prescription Do I Need?

Unfortunately, not every type of birth control pill will help you control your acne. While all birth control pills will work to prevent pregnancy, each pill has slightly different hormone levels.

The FDA has approved Ortho Tri-Cyclen and generic norgestimate/ethinyl estradiol for acne treatment. The FDA believes these low-dosage birth control pills are an effective treatment for mild to moderate acne. In clinical studies, nearly 90 percent of women taking Ortho Tri-Cyclen noticed an improvement in their skin.

Other birth control pills that are thought to improve acne in most women include Desogen, Demulen, Brevicon, Nelova 1/35, Ovcon 35, and Ortho Novum 7/7/7. However, there is some evidence to suggest these pills are more effective in younger women who have fluctuating hormone levels that are the primary cause of their acne.

Older brands of birth control pills that contain estrogen and progestin hormones with higher androgen levels may in fact make your acne worse. This includes birth control pills such as Loestrin1.5/30, Loestrin1/20 Fe, Estrostep Fe, Levlen, Alesse, Ovral, and Norlestrin1/50.

ide Effects of Birth Control Pills

You must be aware of any potential side effects when you considering using birth control pills to treat your acne. For example:

• Some researchers who study birth control and acne report certain women may experience a weight gain of up to 12 pounds.
• If you smoke, using the birth control pill may increase your risk of developing cancer.
• Certain women may experience dangerous blood clots.
• Some pill users report adnominal pain, fatigue, headaches, breast tenderness, mood swings, and irregular periods.