Chelsea Well Woman Care

An Unfortunate Side Effect of the Pill

Isn't it funny that in taking the birth control pill we make the need to take the birth control pill unnecessary? Decreased libido is a known side effect of the birth control pill. However, it was always assumed that once a woman discontinued the pill, her libido would return to normal. Now it is found that it can take some time for her libido to return. Exactly how long is has not been documented yet. While the effectiveness of the pill makes it a very attractive choice, some women might want to reconsider alternative methods because of this unwanted side effect.

Ortho Evra Patch Warning

Johnson & Johnson, parent company of Ortho McNeil, announced in a press release yesterday new warnings for its birth control patch Ortho Evra. It reports that steady state concentrations of the synthetic estrogen used in the patch are 60% higher in women using the patch versus a 35 mcg pill such as the popular Ortho Tri-Cyclen.

The Ortho Evra Patch, on the market since 2002, delivers synthetic estrogen into the blood stream directly through the skin. This bypasses the breakdown that the estrogen in oral contraceptives undergo as they pass through the digestive system. While the patch and pill contain similar amounts of estrogen, there is less breakdown of the estrogen released by the patch. This estrogen is continuously released throughout the day, in contrast to estrogen that is taken orally, which peaks an hour after taking it and declines over a 12 to 24 hour period. This continuous release is what is thought to increase a woman's esposure to estrogen long term.

The language of the press release states that "it is not known if there are changes in the risk of serious adverse events based on the differences in pharmacokinetic profiles of ethinyl estradiol in women using ORTHO EVRA® compared with women using oral contraceptives containing 35 micrograms of EE."

While J&J is not saying that women using the patch have an increased risk of blood clot, it is known that a higher dosage of estrogen in birth control pills increases risk of adverse events. Women in the 1970's and 80's had a higher rate of adverse events such as blood clot related to the higher dosage of ethinyl estradiol in birth control pills that were available at that time. Over time, the dosage of estrogen in the pill has been reduced to a new low dose of 20 mcg resulting in dramatically reduced risk of blood clot.

At this point Beverly and I will be talking to our patients who use Ortho Evra individually to assess their risks and discuss other birth control options. If you have an immediate concern, please don't hesitate to call the office.