Combined pill: list, effectiveness, what disadvantages?

1st, 2nd, 3rd and 4th generation. There are different types of estrogen-progestin pills Or “combined” (because they combine two hormones). Which is efficiency of these pills? For which women? What are the pros and cons ? What are the contraindications? List combined pills, prescription, mode of action… Everything you need to know about combined pills.

Definition: what is a combined pill?

“There estrogen-progestin pill combines the two types of female sex hormones, estrogen (ethinyl estradiol or EE most of the time) and synthetic progesterone (levonorgestrel, norethistherone, desogestrel, norgestimate, gestodene)” indicates Dr. Odile Bagot, gynecologist. estrogen dose in this type of pill is quite low, generally between 15 and 35 micrograms per tablet. Some of these pills may have a higher estrogen dosage, up to 40 micrograms per tablet. The first pills marketed in the 60s and 70s contained 50 mcg of EE. To reduce the cardiovascular risks linked to these pills, manufacturers have worked to reduce the dose of estrogen. Gradually, they marketed pills containing between 30 and 40 µg of EE, then recently between 15 and 20 µg of EE.

► If the dosage of EE is constant in the blister, the pill is said to be monophasic

► If the dosage of EE varies, the pill is biphasiceven triphasic, the dosage of progestin also varies in these 3 types of pill. The objective is to “reproduce” the variations in estrogen and progesterone concentrations observed during a physiological cycle. “The combined pill is taken during 3 consecutive weeks for 1 week of interruption (or placebo) during the period of withdrawal bleeding (similar to periods). When the pill is very low in dosage, women may not bleed or very little” specifies the gynecologist.

List of combination pills

In case of gastroenteritis, the pill may not be absorbed and it is then possible to become pregnant

• Adepal
• Daily
• Evanecia
• Jasminelle
• Belara
• Harmonet
• Moneva
• Jasmine
• Cilest
• Varnoline
• Minulet
• Trinordiol
• Optilova
• Minidril

How do combined pills work?

Combination pills work to three levels.

1. They block the development of follicles and ovulation.
2. They modify the uterine lining, making it unsuitable for implantation.
3. They modify the mucus secreted at the cervix and make it thickerwhich prevents sperm from passing through the cervix.

“The effectiveness is better than a copper IUD”

How effective are combination pills?

“She is more than 99% as long as the pill is taken correctly, i.e. when the first tablet of the first pack is taken no later than the third day after the start of the period” indicates Dr Bagot. Protection is then immediate. When using a pill for the first time (or if you restart treatment), you should know that the contraceptive action of the combined pill is only effective after the first 7 days, it is only from that moment that it blocks ovulation. “Effectiveness is better than a copper IUD” remarks the gynecologist. “In case of vomitingif the pill was taken in the previous 3 hours, we take a pill again“ recommends Dr. Bagot. “In the same way, in case of gastroenteritisthe pill may not be absorbed and it is then possible to become pregnant. warns the specialist. Furthermore, certain medications such as treatments for Narcoleptics may interfere with the effectiveness of the pill.

What are the advantages of the combined pill?

• The combined pill is generally well tolerated.
• She makes the periods less painful, less heavy, and shorter.
• She makes the regular cycles.
• She is completely reversible (as soon as you stop it, you return to a normal cycle and can therefore become pregnant).
• “It offers the possibility of not having periods when taking continuously.”
• “She reduces the risk of ovarian, endometrial and colon cancers.”
• “It rules out certain pathologies linked to the menstrual cycle such as endometriosis, fibrosis, polyps or PCOS.”
• “It has a rather beneficial on acne“explains the gynecologist.

What are the disadvantages of the combined pill?

Some can lead to slight weight gain“even if this is also linked to the new lifestyles of young women entering adolescence or adulthood” nuance Dr Bagot. During the first 3 months of taking, the body must adapt and it may appear:

• phenomena of spotting (2 to 3% of women),
• nausea,
• a little tension in the breasts and back.

In the long term, the effects fade or disappear completely, hence the importance of “do not stop and then restart the pill too often.” Moreover, “according to the latest study on the subject, the risk of breast cancer is increased in women who take the combined pill after age 40” remarks the gynecologist. The pill increases the risk of blood clots and the risk of cardiovascular accidents (phlebitis, pulmonary embolism, stroke, infarction). “But the increase in these risks is especially valid for women who are already at risk (smoker, overweight, sedentary) and who are over 35 years old” specifies the expert.

What are the contraindications?

Combination pill use increases the risk of venous thrombosis (phlebitis, pulmonary embolism) and arterial (stroke, myocardial infarction). During the medical consultation, an interview prior to the prescription is essential, as is a blood test. The prescriber must inform the patient of the risks of complications linked to the pill. The combined pill is contraindicated :

• at the women who have suffered a stroke, angina or myocardial infarction, phlebitis (whatever the cause) or pulmonary embolism;
• in women with acquired hereditary predisposition to arterial or venous thrombosis (formation of clots) confirmed by coagulation abnormalities in the blood test;
• in women suffering from severe diabetes with vascular complications (damage to the retina, kidneys or arteries);
• in women whose voltage is greater than 160/95;
• at the smokers;
• in women with very high levels of lipids in the blood (cholesterol or triglycerides);
• among women victims of intense migraines accompanied by neurological signs (visual disturbances, paralysis of a hand or face, etc.);
• in women who have or have had inflammation of the pancreas;
• in women with serious illness or liver tumor;
• in women suffering from severe or acute renal failure;
• in women who have or have had breast or uterine cancer;
• among women victims of vaginal bleeding of unknown origin.

The contraceptive pill is dispensed in pharmacies and planning centers, only on medical prescription. The pill can be prescribed by a midwife, a general practitioner or by a specialist doctor (obstetrician-gynecologist, medical gynecologist) working in an office or in a health establishment (hospital or private clinic).

How much does a combined pill cost and is it reimbursed?

The cost of a pack of pills varies between 1.88 and 14 euros per month (indicative public price). “The pills 2nd generation are reimbursed while those of 3rd generation are not” indicates Dr Bagot. The reimbursed pills can be delivered free on medical prescription, in pharmacies, minors of at least 15 years old Socially insured persons or beneficiaries.

Thanks to Dr Odile Bagot, medical gynecologist.