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 Effects and How to Treat Them
| Side effect | Estrogen | Progestin | Androgen | Notes |
| Acne | Higher estrogen | – | Lower androgenicity | |
| Break Through Bleeding (BTB) | Higher estrogen | Higher progestin potency | Lower androgenicity | |
| Absent or too light menstrual flow | Higher estrogen | – | – | Lower progestin potency |
| Depression, moodiness, irritability | – | Lower progestin potency | – | Monophasic |
| New or worsening headaches | Lower estrogen | Low progestin potency | – | If neurologic symptoms or migraine with aura – STOP estrogen containing OCP ASAP |
| Breast Tenderness/ Soreness | Lower estrogen | Lower progestin potency | – | If related to menses, consider skip placebo/bleeds. |
| Severe Menstrual Cramps | – | Higher progestin potency | – | |
| Endometriosis | Lower estrogen | Higher progestin potency | Higher androgenicity | – |
| Nausea | Lower estrogen | – | – | First try taking it with largest meal of day or right before going to bed |
| Libido | Lower estrogen | – | Higher androgenicity |
Table of Androgen potency and Progestin potency of most birth control pills here.
| Progestin | Progestational Activity (relative to 1 mg of norethindrone) | Androgenic Activity (relative to 1 mg of norethindrone) |
| Norethindrone 1 mg | 1.0 | 1.0 |
| Norethindrone acetate 1 mg | 1.2 | 1.6 |
| Ethynodiol diacetate 1 mg | 1.4 | 0.6 |
| Levonorgestrel 1 mg | 5.3 | 8.3 |
| dl-norgestrel 1 mg | 2.6 | 4.2 |
| norgestimate 1 mg | 1.3 | 1.9 |
| norelgestromin 1 mg | 1.3 | 1.9 |
| desogestrel 1 mg | 9.0 | 3.4 |
| drospirenone 1 mg | 1.5 | 0.0 |
Birth Control Pills and Hormone Dosages
From least progestin activity to most
| Medication | Progestin | Mg of progestin | Androgenic Activity | EE | Progestational Activity |
| Xulane | Norelgestromin | 0.15 | 0.29 | 20 | 0.20 |
| Estarylla, Orthocyclen, Sprintec, Mono-Linyah, Previfem, Estarylla, Norgestimate / Ethinyl Estradiol, Femynor, Mononessa, Mili | Norgestimate | 0.25 | 0.48 | 35 | 0.325 |
| Errin, Jolivette, Jencycla, Lyza, Norethindrone, POP, Sharobel | Norethindrone | 0.35 | 0.35 | – | 0.35 |
| Balzivia, Briellyn, Gildagia, Philith, Ovcon 35 | Norethindrone | 0.40 | 0.40 | 3 | 0.4 |
| Brevicon; Modicon; Necon 0.5/35; Nelova 0.5/35; NEE 0.5/35 | Norethindrone | 0.50 | 0.50 | 35 | 0.50 |
| Ortho novum 10/11, necon 10/11 [biphasic 0.5/35 and 1/35] | Norethindrone | 0.50 | 0.50 | 35 | 0.50 |
| Aviane, Levlite, Lutera, Alesse(off market) Camrese Lo/ Loseasonique | LNG | 0.10 | 0.83 | 20 | 0.53 |
| Cyclafem 777, Pirmella 7/7/7, Dasetta 7/7/7, Alyacen 7/7/7, Nortrel 7/7/7, Necon 7/7/7 | Norethindrone | 0.75 | 0.75 | 35 | 0.75 |
| Lo Ovral, Low Ogestrel | Norgestrel | 0.30 | 1.26 | 30 | 0.78 |
| Altavera, Chateal, Jolessa, Kurvelo, Levlen, Levora, Lillow, Marlissa, Nordette, Portia, Seasonale, Seasonique | LNG | 0.15 | 1.25 | 30 | 0.795 |
| 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 1/35 | Norethindrone | 1.00 | 1.00 | 35 | 1.00 |
| 1/50, norinyl 1/50, orthonovum 1/50, ovcon 50 | Norethindrone | 1.00 | 1.00 | 50 | 1.00 |
| NuvaRing | Etonogestrel* | 0.12 | 0.41 | 15 | 1.08 |
| Blisovi, Gildess, Junel 1/20, Junel Fe 24, Larin, Loestrin 1/20, Microgestin 1/20 | Norethindrone acetate | 1.00 | 1.60 | 20 | 1.2 |
| Kariva, Mircette, Viorele | Desogestrel | 0.25 | 0.51 | 20 | 1.35 |
| Apri, Desogen, Emoquette, Enskyce, orthocept, Reclipsen | Desogestrel | 0.15 | 0.51 | 30 | 1.35 |
| Demulen, Zovia, kelnor | Ethynodiol diacetate | 1.00 | 0.60 | 35 | 1.4 |
| Blisovi, Gildess, Junel 1.5/30, Larin, Loestrin 1.5/30, microgestin 1.5/30 | Norethindrone acetate | 1.50 | 2.40 | 10 | 1.80 |
| Gianvi, Loryna, Nikki, Vestura, Yaz | Drosperinone | 3.00 | 0.00 | 20 | 4.50 |
| Ocella, Syeda, Yasmin, Zarah | Drosperinone | 3.00 | 0.00 | 30 | 4.5 |
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.