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.

Kariva

Kariva is a birth control pill with a shortened placebo interval--2 days vs. the regular 7 days.

I mentioned before that some combination birth control pill brands have a shortened placebo interval.

Using a brand like Kariva helps if you suffer from problems related to your period or withdrawal bleeding episode (the fake period) like painful periods, migraines, endometriosis, etc. If you recall, these problems tend to be caused/exacerbated by hormone fluctuations.

If you're on the Pill, you have less hormone fluctuations than a nonuser, at least for 3 weeks out of the month (the 3 weeks with active, hormone pills). Unfortunately, during the hormone-free week (the 7 days with placebo pills) the hormone levels start to fluctuate again, and the problems recur. So, shortening the placebo interval, for example, from 7 to 2 days, helps. But wait, there's more! [Obviously, I'm watching too much late-night TV.]

Another advantage of using a brand with a shortened placebo interval is better "real life" pregnancy protection. In real life, it's common for women to miss the first few pill days of a new pack, because they aren't able to get the new pack in time. Coming off of a placebo week, this is quite risky. Why? Because there's a danger of a mature egg being released from the ovary. [Mature egg + sperm = possible bebe.] So, after a placebo week, the more days you miss before starting a new pack, the higher your risk of an unintended pregnancy. Ideally, all combination Pill brands should be packaged with 21 days of active pills and only 2-3 days of placebo pills. This way, even if something happens and you are unable to start a new pack right away, you are still protected.

In the U.S., there is only one type of biphasic Pill with a shortened placebo interval: an estrogen (ethinyl estradiol or EE)/progestin (desogestrel or D) combination. The dosage is 21 days of 0.02 mg EE/0.15 mg D, 2 days of placebo, followed by 5 days of 0.01 mg EE. Because this type of Pill can be very useful for many women, I wanted to alert you to some [confusing] changes in the brand names.

Initially, there was Mircette, manufactured by Organon. Then Barr came up with a generic, Kariva. Now, Organon is no longer manufacturing Mircette, however they are allowing another pharma company, Prasco, to market a generic versions of Mircette (don't know the name for this version yet; it's supposed to be available next year). So, if you're interested in using a brand with a shortened interval, ask for Kariva, not Mircette.

Mircette



Kariva

ETA: Mircette is now registered to Duramed Pharmaceuticals, Inc., a subsidiary of Barr.

Not Your Mother's Birth Control Pill Placebo Interval

Mircette

For women using the combination birth control pill (the Pill), fewer placebo days can reduce side effects and increase pregnancy protection:

MONTREAL — Limiting the hormone-free portion of OC regimens can reduce side effects and may improve contraceptive effectiveness, according to two studies presented at the World Congress on Fertility and Sterility.


“For a lot of women, the hormone-free days are when they have their PMS, their pain, and their heavy bleeding. That's also when many women have their headaches, and sometimes that's when their acne flares. It's amazing that the 7-day hormone-free interval [HFI] has lasted this long,” said Dr. Patricia Sulak, a researcher, consultant, or speaker for Berlex Inc., Barr Laboratories Inc, and Wyeth, all of which market OCs.


In a separate presentation, Angela Baerwald, Ph.D., of the University of Saskatchewan reported evidence of follicular development, endometrial development, increased serum estradiol, and even ovulation during the HFI in women compliant on certain OC regimens.


“The loss of endocrine suppression during this interval provides the rationale for a reduction in the traditional 7-day hormone-free interval and/or the use of continuous hormonal contraception,” she said.

Most Pill brands have a 7 day placebo interval--an interval when no pills, or no hormone-containing pills are taken.

Contrary to popular belief, during this time your body doesn't take a "hormone break". Before the placebo week, your body's hormone levels are low, and more importantly, they're steady. And the same is true for the Pill hormones--steady levels. As soon as you withdraw the Pill hormones, during the placebo week, your body revs up its hormone production, and the levels start to fluctuate.

The problem is that these fluctuations can cause side effects like headaches, pain, or PMS. They can also allow an egg to start maturing inside the ovary (this increases the likelihood of an inadvertent pregnancy).

Minesse

Reducing the number of placebo days offers a solution to these problems. Two Pill brands, Minesse and Mircette, already have a shortened placebo interval built-in (4 days and 2 days, respectively).

Of course, you can shorten the hormone-free pill interval even if your Pill brand is a 7 placebo days one. You do this by starting a new pill pack sooner. For example, instead of waiting for 7 days between pill packs, or taking 7 placebo pills, you start the new pack after 3 or 4 days (or after taking only 3 or 4 placebo pills).

Bottom line: Because the duration of the placebo interval was arbitrarily selected (it's 7 days because of "designer" reasons, not medical or health ones), its length is not written in stone. You can adjust it--2, 3, 4, etc. days--to fit your unique needs.

Skipping Your Period With a Triphasic Pill, Part I

I've been getting a lot of questions about using a triphasic birth control pill brand and skipping a period. Before we discuss what regimen you use to skip your period with a triphasic Pill brand, let's make sure we're all clear on the differences between the various pill brands.

We'll discuss extended triphasic regimens in a subsequent post.

There are two groups of birth control pills:

A. Nonsteroidal (centchroman)

B. Steroidal (estrogen/progestin)

A. Nonsteroidal Birth Control Pill

This type of birth control pill contains a substance called centchroman.

The pill is taken once-a-week (twice-a-week for the first 3 months of use), the brand names are Centron or Saheli, and its main advantage is that users don't experience the side effects associated with the steroid (estrogen/progestin) pill. Its main side effect is delayed menses (in less than 10% of cycles). Of course, if the reason you're using a birth control pill is to skip your period, this is a feature not a drawback.

In any case, since this pill isn't available in the U.S., let's move on to the other Pill group, the steroidal one.

B. Steroidal Birth Control Pill

Pills in this group contain estrogen and/or progestin. The pill is taken once-a-day, and there are many brand names. More importantly, pills in this group can be further subdivided, based on what type of hormone (estrogen/progestin) they contain.

There are two main types of birth control pills in this group:

B.1. Progestin-only Pill (progestin)

B.2. Combination Pill (estrogen and progestin)

B.1. Progestin-only Pill

As the name implies, these pills have only one hormone, a progestin. A progestin is either a natural or man-made (synthetic) hormone with properties similar to the natural hormone progesterone.

Progestin-only pill brands are divided into "mini" pill brands, and full-dose brands (not available in the U.S.). As a rule, "mini" pill brands come in 28-day packs, and full-dose ones come in 20-day packs.

Progestin-only brands are not your first choice when it comes to skipping your period.

B.2. Combination Pill

These pills have two hormones, a combination of estrogen and progestin.

Combination Pill brands are further subdivided into mono-, bi-, and triphasic; some come in a 21-day pack, others in a 28-day one, and the newer ones, Seasonale and Seasonique, comes in a 91-day pack. Finally, based on the amount of estrogen, brands are classified as very low-dose (15 mcg or 20 mcg), low dose (35 mcg), and high dose (50 mcg).

All the pills in a 21-day pack are active. An active pill is a pill which has hormones. The 28- and 91-day packs have 7 days of inactive or placebo ("sugar") pills. These pills don't have hormones.

The mono-, bi-, and triphasic designation refers to the amount of hormones in the pill pack.

Monophasic

Brevicon

Each active pill in the pack has the same amount of estrogen and progestin. Also, all the active pills are the same color. This color is a different color than that of the 7 placebo pills found in the 28- and 91-day packs.

Biphasic

Mircette

For most brands, all the active pills in the pack have the same amount of estrogen, but two strengths of progestin.

A 21-day biphasic pack has pills of one strength and color taken for seven or 10 days, then a second pill with a different strength and color for the remainder of the cycle.

A 28-day biphasic pack has an extra seven placebo pills of a third color.

For a 28-day brand like Mircette, a pack has 21 pills of one strength [20 mcg ethinyl estradiol (EE)/0.15 mg desogestrel] and color, 2 placebo pills of a different color, and 5 pills with only estrogen, of a different strength [10 mcg (EE)] and color.

Of note, Mircette is one of the few available sequential brands with a shortened placebo interval: 2 days vs. 7 days. The shortened placebo interval has to do with withdrawal bleeding (fake period) which is different from menses (real period). [More on birth control pill brands with no or shortened placebo interval.]

Triphasic

Ortho Tri-Cyclen Lo

The active pills have either the same or varying amounts of estrogen, and varying amounts of progestin.

A 21-day pack has pills with three different colors and strengths. First, pills of one strength and color are taken for five to seven days. Then pills of a different strength and color are taken for the next five to seven days. Finally, a third strength and color pill is taken for the reminder of the cycle.

A 28-day pack (look under triphasics) has an extra seven placebo pills of a fourth color.

So, there you have it. Lots of birth control pill types, and brands. The important thing to remember is this:

To skip a period a monophasic brand is best.

A monophasic combination Pill brand is best because all active pills contain the same amount of hormones. Less hormonal fluctuation, due to the steady hormone levels, means you're less likely to experience nuisance side effects like irregular bleeding (breakthrough bleeding/spotting).

TIP: Regardless of which type of brand you use--monophasic or triphasic--starting an extended regimen at least three months in advance of the time you plan to skip your period allows your body to get used to the new regimen, and minimizes irregular bleeding.

If you use a monophasic Pill brand, to skip a period you take the 21 active pills, discard the 7 placebo pills, and start a new pack right away.

If you use a triphasic Pill brand you have several regimen options. One of them is to use the same regimen used for the monophasic brands--take the 21 active pills, discard the 7 placebo pills, and start a new pack right away. [Note: this regimen is mostly likely to be associated with irregular bleeding.]