7 Birth Control Pill Brands You Need To Know

Seasonale and Seasonique, Jolessa and Quasense, Lybrel, Yaz and Loestrin. Between the squirrely brand names, the different types of regimens and the presence or absence of a placebo (hormone-free) interval, knowing which of these newer birth control pill brands is which can get a bit confusing.

To help you figure out which Pill brand might be the one best suited for your needs here's a brief comparison guide of 7 Pill brands you need to be familiar with.

First, an overview.

Type of pills: All these brands are combination pill brands because they have active pills (the pills containing hormones) in the pack with a combination of two hormones--an estrogen [ethinyl estradiol (EE)] and a progestin [either levonorgestrel (LNG), drospirenone (DRSP), norethindrone acetate (NEA) or desogestrel (D)].

Most of the brands are monophasic--each active pill in the pack has the same amount of hormones. Some brands are biphasic--most active pills contain the same hormone amounts, but a few pills have a different amount of only one hormone, EE.

Regimens: With some brands you take the active pills on a regular monthly regimen, other brands have an extended regimen (84 days), and two brands are continuous-use, meaning you take an active pill every day throughout the year.

Placebo interval: The hormone-free interval ranges from the regular one (7 days), to a shortened one (4 or 2 days), to none.

Second, the brands.

Seasonale, Jolessa, and Quasense
(Extended regimen, regular placebo interval.)

These brands have an 84-day active pill cycle, followed by a regular 7-day placebo interval.

Seasonale (Barr Labs)

One active pill [0.03 mg EE/0.15 mg LNG] for 84 days, followed by 7 days of placebo pills.

Seasonale

Jolessa (Barr Labs)

Same as Seasonale, 84 days of active pills [0.03 mg EE/0.15 mg LNG] followed by 7 days of placebo pills.

Jolessa (via)

Quasense (Watson)

Same as Seasonale, 84 days of active pills [0.03 mg EE/0.15 mg LNG] followed by 7 days of placebo pills.

Quasense (via)

TIP #1
Both Jolessa and Quasense are the generics for Seasonale.

Seasonique and Lybrel
(Continuous regimen, no placebo interval.)

These brands have a continuous active pill cycle; one active pill each day of the year. There's no placebo interval.

Seasonique (Barr Labs)

One active pill [0.03 mg EE/0.15 mg LNG] for 84 days, followed by another active pill [0.01 mg EE] for 7 days.

TIP #2
Addition of low-dose EE during the placebo interval provides greater egg development suppression in the ovary.

Seasonique

Lybrel (Wyeth)

One active pill [0.02 mg EE/0.09 mg LNG] taken daily with no placebo interval.

Lybrel (via)

TIP #3

Seasonique and Seasonale may sound alike, but they're not. Note that only Seasonique and Lybrel do away with the placebo pills. And just so we're clear, despite the media hysteria surrounding Lybrel's recent FDA approval, Seasonique was the first approved Pill brand to completely eliminate the placebo interval, not Lybrel.

Yaz and Loestrin 24 Fe
(Monthly regimen, shortened placebo interval.)

These brands have a 24-day active pill cycle, followed by a shortened 4-day placebo interval.

Yaz (Bayer)

One active pill [0.02 mg EE/3 mg DRSP] for 24 days, followed by 4 days of placebo pills.

Yaz

Loestrin 24 Fe (Warner Chilcott)

One active pill [0.02 mg EE/1 mg NEA] for 24 days, followed by 4 days of iron-containing placebo pills.

Loestrin 24 Fe

And as a bonus, two more shortened placebo interval brands you should be familiar with:

Kariva (Barr Labs)

One active pill [0.02 mg EE/0.15 mg D] for 21 days, a placebo pill for 2 days, followed by another active pill [0.01 mg EE] for 5 days.

Kariva

Mircette (Organon/Barr Labs)

Same as Kariva (and Azurette), one active pill [0.02 mg EE/0.15 mg D] for 21 days, then 2 days of placebo, followed by another active pill [0.01 mg EE] for 5 days.

Mircette

TIP #4

Kariva is the generic for Mircette.

Bottom line: If you're familiar with the characteristic features of these newer brands you can better judge which type of Pill will suit you. Use this guide as a starting point when you discuss Pill option with your Ob/Gyn.

The Demise of the Placebo Week

Instructive editorial by Dr. Sulak in support of altering the current 21/7-day (placebo week) Pill regimen:

Oral contraceptives are the most common method of reversible contraception, with the majority of women using them sometime during their reproductive life. Modifications have primarily involved lowering hormone content and utilizing new progestin components.

The 21/7-day OC regimen (21 days active/7 days hormone-free) was arbitrarily created to mimic the average spontaneous menstrual cycle of 28 days. After more than 40 years of use, the traditional 21/7-day OC regimen is undergoing necessary, overdue changes in design. Numerous studies over the last decade have documented that lowering the doses of hormones in OCs without altering the standard 7-day hormone-free interval (HFI) compromises suppression effects and can induce hormone withdrawal symptoms.

Although today's low-dose OCs are very effective in preventing pregnancy, studies have confirmed incomplete inhibition of pituitary-ovarian function with follicular growth and resultant endogenous hormone production and potential for follicular cysts and ovulation. With a standard 7-day HFI, follicle-stimulating hormone begins to increase on day 3–4 of the HFI, allowing follicular recruitment and estradiol production. While uncommon, pregnancy can occur because of this escape ovulation, even in perfect users. Low-dose OCs have also been shown to provide little to no protection from the development of functional ovarian cysts because of the 7-day HFI. Unfortunately, most of our patients do not take their pills perfectly, increasing the chance of ovarian cysts and pregnancy.

Today's standard low-dose 21/7-day OCs have also been responsible for the occurrence of nuisance side effects in many patients. Published data document an increased incidence of menstruation-related symptoms during the 7-day HFI in patients on standard 21/7-day low-dose OCs, with increases reported in headache, pelvic pain, bloating/swelling, breast tenderness, and use of pain medication during this placebo interval. Menstruation-related symptoms including headache, mood swings, abdominal cramping, bloating, and breast tenderness are long-recognized side effects associated with OCs and often lead to untimely discontinuation and resultant unintended pregnancy.

The question is not "Should the current 21/7-day OC be altered?" but instead "How is the 21/7-day OC to be altered?" Modifications are necessary to address the issues of increased symptomatology and follicular development. We need to set women up for success rather than failure.

Currently, several approaches alter the typical 21/7-day OC regimen. Shortening the 7-day hormone-free interval of today's low-dose OCs can provide greater pituitary-ovarian inhibition, reducing the risk of ovulation, ovarian cyst formation, and common hormone withdrawal symptoms. Two OC products that utilize 24 days of active hormones and a 4-day HFI (24/4) have been approved by the FDA in 2006: ethinyl estradiol 20 mcg/drospirenone 3 mg (Yaz, Berlex) and ethinyl estradiol 20 mcg/norethindrone acetate 1 mg (Loestrin 24 Fe, Warner Chilcott).

Extending the number of active pills beyond the standard 3 weeks to 6, 9, 12, or more weeks is also common practice. A recent survey of health care providers in the United States revealed that the majority thought extended regimens should be offered to women who desired elimination of monthly withdrawal bleeding and associated symptoms.

The first approved extended regimen became available in the United States in 2003 (Seasonale, Barr Laboratories), and consists of 84 days of 150 mcg of levonorgestrel and 30 mcg of ethinyl estradiol followed by a 7-day HFI. But, a 7-day HFI with an extended regimen can lead to the same problems seen with a 21/7-day regimen.

A new OC approved in May 2006 both extends combination active therapy to 84 days and adds low-dose estrogen to the usual 7-day HFI (ethinyl estradiol 30 mcg/levonorgestrel 150 mcg for 84 days plus ethinyl estradiol 10 mcg for 7 days; Seasonique, Barr Laboratories). By doing so, it becomes the first approved OC to completely eliminate the HFI. Addition of low-dose ethinyl estradiol during the HFI provides greater pituitary-ovarian suppression, preventing an increase in follicle-stimulating hormone, follicular development, and endogenous estradiol production.

Continuous OC regimens that entirely eliminate the HFI are being extensively studied. While these extended, continuous regimens decrease scheduled bleeding, they can cause irregular, nuisance bleeding or spotting. Breakthrough bleeding with continuous OCs has been shown to be effectively managed by institution of an abbreviated 3-day HFI.

As more modifications of the 21/7 regimen are approved, it is important to ascertain from each patient her desired menstrual frequency. As in the movie, we must find out “What Do Women Want?” Whether she wants to bleed once a month, once every 3 months, or never will determine what regimen we should recommend. Today, we can give women what they want and decrease side effects, increase compliance, and decrease unintended pregnancy. No matter what the menstrual frequency, the 7-day HFI needs to be eliminated.

Today's low-dose 21/7-day contraceptive regimens have documented design flaws that can result in discontinuation and unintended pregnancy. Modifications of the standard 21/7-day design seen in today's vaginal contraceptive ring, transdermal patch, and OCs can greatly improve the side effect profile and continuation rates. Shortening the HFI, adding estrogen to the standard HFI, and extending the active component are all effective improvements that provide greater ovarian suppression, and will eventually lead to the demise of low-dose 21/7-day regimens. The sooner, the better.

Skip Your Period and Period Control Options

Good AP article on the available options for period control, as well as some coming attractions.

Among the existing methods:

- Seasonale: 30 μg of estrogen (ethinyl estradiol, or EE)/150 μg of progestin (levonorgestrel), taken continuously for 84 days, followed by 1 week off.

- Ortho Evra patch: 0.75 mg estrogen (EE)/ 6.00 mg progestin (norelgestromin) [20 μg estrogen/150 μg progestin per day], one patch per week for 8 or 12 weeks in a row, followed by 1 week off.

- NuvaRing vaginal ring: 2.7 mg estrogen (EE)/11.7 mg progestin (etonogestrel) [15 μg estrogen/120 μg progestin per day], one ring in place for 3 weeks at a time, for 6 or 12 weeks total in a row, followed by 1 week off. [Alternatively, one ring can be left in place for 4 weeks at a time.]

- Depo-Provera [and Depo-subQ provera 104] shot: 150 mg progestin (medroxyprogesterone acetate) [104 mg progestin], one injection four times a year.

One more existing brand worth mentioning is Loestrin 24 Fe. The innovation here is the shortened placebo interval--one estrogen/progestin pill taken for 24 days, followed by one iron-containing placebo pill taken for 4 days. [Of course, if you're already taking the Pill, and you want a shorter placebo interval, you can use your existing brand to do that. Just take 4 placebo pills, instead of the usual 7, followed by a new pack.]

And some newer developments:

- Seasonique: 30 μg of estrogen [EE]/150 μg of progestin [levonorgestrel]), and 10 μg EE, one estrogen/progestin pill taken continuously for 84 days, followed by one estrogen-only pill for 7 days; no placebo interval.

- Lybrel: 20 μg ethinyl estradiol/90 μg levonorgestrel, one estrogen/progestin pill taken daily with no placebo intervals.

- Implanon*: 68 mg progestin (etonogestrel) [~40 μg progestin per day], one-rod implant lasting up to 3 years.

*Just like so many other methods before it (Mirena, Depo-Provera), Implanon has been available for over a decade outside the U.S.. This pretty much insures Implanon's status as a "cutting edge" method over here.