Do Different OCP's Cause Different Problems?

Abstract & Commentary

By Frank W. Ling, MD, Clinical Professor, Dept. of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, is Associate Editor for OB/GYN Clinical Alert.

Synopsis: Except for progestin-only pills (more breakthrough bleeding and fewer periods), there is little variation in the frequency of symptoms related to various pill formulations.

Source: Moreau C, et al. Oral Contraceptive Tolerance: Does the Type of Pill Matter? Obstet Gynecol. 2007;109:1277.

Between 2000 and 2004 these French investigators studied 2863 women to determine the frequency of reported symptoms (weight gain, nausea, breast tenderness, swollen legs, fewer periods, breakthrough bleeding, painful/heavy periods) relative to the type of OCP taken (estrogen dose, progestin component, sequence of administration). Because there was little difference in the frequency of these symptoms (except for the progestin-only pills), the authors recommend that future research focus on the effectiveness of counseling as it relates to tolerance of OCPs.

Commentary

Does this resonate with your experience in the office? How good are you picking a pill off the sample shelf that has few, if any, side effects? In this study, each year more than half of the subjects had at least one of the symptoms — the most common being weight gain 25%, painful periods 21%, swollen legs 21%, and heavy menstrual bleeding 16%. Extended regimen pills with low estrogen were more likely to have less frequent symptoms. Lower frequency of symptoms was also more likely with a third generation pill compared with second generation pills.

The authors astutely state that reported symptoms do not necessarily tie that symptom to the pill itself so that assuming that the symptom is due to taking the specific OCP would be an overstatement. As has been reported previously, there are more irregularities when progestin-only pills were taken. There was no evidence that less estrogen resulted in fewer symptoms reported. Also, there was no significant improvement in reported symptoms with newer progestin components, which have been touted to have fewer side effects.

What this study does is further reinforce what most of us have found out in our daily practices, ie, pills are pills and the attempt to find the "best" pill is fraught with pitfalls. This is not to say that there are logical approaches to patients with various symptoms, but the clinician is faced with trying to determine if the symptom is related to the OCP or not as a first dilemma. Then how to address the symptom is next. These data remind us to counsel the patients as completely as possible about potential symptoms, but also to make sure that we do not ascribe symptoms to the pills unless appropriate. Until more specific guidelines are available, each of us need to continue to treat each pill taker as an individual, but also treat each type of OCP as an individual, ie, they don't all act the same ways in all patients.

Confused? No need to be. Just make sure that you continue to keep your ears and mind open to new information as it becomes available, but also trust your clinical judgement and experience. It's potentially more valuable than any data you read.