Are You on the Right Birth Control Pill, or Should You Switch?

How we select a pill for a patient to start on, and how we select the pill you should continue on is a very complicated topic. Choosing the right pill for you, however, has certain key elements. Virtually all oral contraceptives have been thought to have  identical effectiveness. If you take the pills faithfully, ovulation is suppressed, and failure rates are quite rare. Based on published data, about 2-3 women out of a hundred taking the pill for a year will become pregnant. Pills from the 70s and 80s that have published rates of only 1 person in a hundred getting pregnant is based on old studies. We have had a bit of pregnancy rate drift in the past few years, and women today have higher pregnancy rates than we used to in the past (obesity?). So, in truth gynos don’t assign pills based on effectiveness, they will all work for you! Since the 1970s safety has driven most of the dosing and type of hormone changes in the pill, and safety is always the first concern. Again, all birth control pills are extraordinarily safe and few women cannot take OCs. But safety is enhanced by selecting the lower doses. Non-contraceptive benefits should now drive many pill decisions for you and your gyno. One of the first concerns is cycle control, and control of menstrual cramps. Another important concern is PCOS effects. Another important concern is prevention of gynecologic cancers and ovarian cysts. Prevention and treatment of endometriosis. A new concern is one for bone health, as we have had lower dosages of the pill, we may need to think in terms of slightly higher doses for some young teens as they are accruing bone mass. Are you suffering from PMS, acne or heavy bleeding? These medical concerns can be addressed by selecting the right pill for you. Side effects are our second concern. If you don’t like the pills you are taking you won’t stay on them, and you may be at risk for unplanned pregnancy. Side effects can also be managed, and pill switching is sometimes necessary.Time to come in and discuss with your gyno.


  1. Hey there, I hope you're still answering questions on this post! I've had a Mirena since October 2014 and was recently diagnosed with stage 4 endo and I have a history with endometrial cysts (I lost my left ovary in June). I'm 28 with no kids yet.

    The more I read up on the Mirena, the more I'm learning that ovary suppression is not a given. It seems like it's actually uncommon. I didn't know this but it all makes sense now as I always thought I felt myself ovulating (I have no periods; just light spotting). My question is; is it worth going back to my gyno to ask to be put on oral birth control as well? I don't want to ovulate, as I am very fearful of cysts on my remaining ovary. I've read some instances where women have been on both but nothing solid apart from forums and whatnot.

    Any advice you can impart would be great; such as questions to ask my gyno and whatnot!

  2. Mirena and other medicated IUDs are not FDA approved for endometriosis therapy, and while helpful in some cases they are not typically considered first line therapy for cases of endometroisis. It's important to establish a correct diagnosis, and then consider all alternatives.


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