Better Progesterone

Getting the perfect birth control pill has been a 50 year quest by the makers of this remarkable medicine. The right pill can cure acne, stop PMS, prevent cancer of the ovary and halt endometriosis. The formulations have various benefits, and yes, inherently some of the formulations have some risk. Whether you have a gynecologic condition you are treating or whether you are seeking to control side effects of the contraception you are on currently, you should know there are a lot of choices out there for contraception. And several pieces of new evidence point to the progesterone as being the source of both great benefit and many side effects.

It's important to work with your gyne on your choice of birth control pills. There are many on the market, and they have some important considerations. Sometimes small differences can make for increased tolerance of the side effects. For instance birth control pills have both estrogen and progesterone in them. But the progesterone are actually derivatives of testosterone and not a true progesterone. Because of the type of compound the progesterone in birth control it can be metabolized to other hormones, and in the case of some of the progesterone compounds in the pill it can be metabolized to extra estrogen in your system. This is true of pills with norethindrone and norethindrone acitate and ethynodiol diacetate as well as those that contain norethynodrel. It has been controversial as to how much estrogen the different compounds produce but we think it's about a 2/1 ratio. So if your pill is supposed to have 20 mcg of estrogen, but it also has 1 mg of noretheindrone acetate which gets metablized to 2 mcg of an estrogen, making the estrogen about 10% higher in reality. if you are on a 10 mcg estrogen pill then the extra 2 mg makes your estrogen dose about 20% higher. On the other hand this bit of a difference can be better cycle control for some women, so it's not always a negative, it can be a positive. So if you are having what your physician thinks are estrogenic side effects, don't just look to the specific estrogen in your pill, you also have to consider the progesterone in your pill!

For many women therie primary concern in a pill is weight gain and water retention. With this in mind pills have been designed with the compound drospirenone as the progestin (Yasmin). Unlike the progestin mentioned above, drospirenone is not derived from testosterone but from a compound called 17-alpha-spirolactone. This unique progestin has progestogenic and something called antimineralocorticoid activity which makes it have the properties of a water pill.. This kind of progesterone can cause salt loss with water loss which should be able to result in both a lower blood pressure and some weight loss as well. 

Something else to gab to your gyno about!


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