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Progesterone only pill

Shieva Ghofrany: [00:00:00] All right. We are gonna talk about progesterone only pills because I'm in the office and I just saw that we have a sample of the newer progesterone only pills. So I thought we would talk about the progesterone only pill, the p o p. You guys probably know this, but I'm gonna give you a quick primer. 

Primer, primer, because actually many of you don't know it when you take birth control pills. Traditional combined birth control pills, combined hormone contraception, and when I say combined pills, I typically mean pill, patch, or ring. Cuz as it stands right now, the vaginal ring and the VA and the patch that you put on for birth control. 

Are like traditional birth control pills, a combination of two hormones, estrogen and progesterone. The estrogen in all of these, for the most part, is ethanol, estradiol. There is one new birth control pill with a different est estrogen, but everything else has ethanol, estradiol, but in different doses. 

Okay, so every pill patch ring, if there are combined hormones, ethanol, estradiol, different doses, potentially [00:01:00] progesterone can change from pill to pill to pat, to pill to patch, to patch to ring. There are a few different types of progesterones, lever, orge nor decimate, um, nor thin. Um, what is this one? 

Sperone. Those are the ones I can think of. Bioidentical progesterone. There's another progesterone I'm not thinking of, but those are the main progesterones that different companies use in their birth control pills. And why? Well, they each kind of started by birth control pill companies. Using specific progesterones that conferred certain properties that were more or less androgenic, which is the word for the more what we will consider, the more traditionally testosterone like or male like, um, sides effects and symptoms like acne and mood and things like that. 

So the. Birth control pills kind of create their more proprietary birth control, and this is how they get patents by having a certain dose of the fnl estrodiol and then varying changes to their [00:02:00] progesterones, and then each company will have different generics and things like that. Traditionally, there has been only one. 

um, progesterone only pill, it was initially called micro, nor was the brand by the company called Ortho, and it was Nora Syndrome and it was a very specific dose and its mechanism for causing birth control was really by thickening the cervical mucus to make the sperm harder to get up into the cervix and making it therefore harder for you to get pregnant. 

But it didn't have properties that would suppress ovulation. So even though it. Stomach hormone, meaning you take it by mouth, absorbs into your stomach, through your stomach, into your first past metabolism, through your liver, and is meant to alter the hormonal situation so that you don't get pregnant. 

Traditional birth control pills will do that by systemically suppressing ovulation. Same thing with the ring and the patch, but the traditional progesterone only, pill only state changed pregnancy rates by really thickening the cervical mucus and maybe having a side [00:03:00] effect on the lining of the uterus. 

But that's secondarily and not necessarily as effective, but it did not effectively stop ovulation. Why is this important? Well, because it's not as effective for birth control, but also if you are having signs and symptoms of. Painful periods, painful ovulation, endometriosis or mood changes, things that you want to suppress ovulation because you believe it's that ovulation that's causing these changes, then that traditional progesterone only pill is not necessarily gonna help you. 

And in fact, some people get a little moodier. Um, and because the pregnancy rates aren't so, so amazing on it, meaning we would normally say 99.7% of patients will not get pregnant with perfect use on the regular birth control pill. But with a progesterone only pill, it can be as low as like 96% won't get pregnant. 

So it's not so. that said, it was the only progesterone only pill we had, and it was great for those populations that couldn't take combined hormone comp contraception, for example, we traditionally believe that you can't be on regular dose pills if you were nursing. That's now found to not really be true. 

If you're taking a low dose pill, [00:04:00] maybe any birth control pill that's combined with any dose, it probably won't affect your milk. But that's still controversial. I still hear some lactation consultants, some doctors, some patients say, you know, I use the estrogen and it did affect my milk supply. Data shows it doesn't. 

Patients and and lactation consultants sometimes feel it does conversation to have with your doctor. What about if you can't take the birth control pill because you're smoking in, you're over 35, which really increases your risk of. , blood clot, heart attack, stroke. You should not be on a combined birth control pill over age 35 with smoking. 

Frankly, if you're younger in smoking, you should really question. You're allowed to be on it and it's certainly better than getting pregnant cuz that will increase your risk of a heart attack, stroke, or a blood clot as well if you're smoking. But it's really something to consider because it does increase your risk. 

Certain patients who fear example, have very high BMI might be at higher risk. And if you have a family history or certainly a personal history of blood clot at early ages especially, but any blood clo. For example, that go to your lungs of pulmonary embolism. It's something to consider as to whether or not you should use estrogen because the estrogen component of the combined hormone pill can [00:05:00] cause blood clots. 

Now they come out with a new one called Slim. It's a very strange, weird name. This is not an advertisement for Slim because they're not paying you to do anything, but the beauty is that it is dressed barone. It's one of those forms of progesterone that we talked about, and it's got 24 active pills, four placebo. 

And it's different than the other com. The other progesterone only pill, the other p o p, cuz this one actually does systemically suppress ovulation, which again, will improve a lot of those symptoms that you get. Maybe moodiness, maybe ovarian, cys, maybe painful periods, and it is easier to effectively skip your period. 

The problem with the traditional mini pill, we called it the mini pill because it was progesterone only, was that it was 28 days of the same dose of hormones, but because it didn't suppress ovulation, it was harder to purposely skip your period. You sometimes might not get a period, especially if you're nursing on the mini pill, but if you're a regular person on the mini pill, because it's not suppressing ovulation, it will not reliably stop you from getting your period. 

sometimes it [00:06:00] causes that, but its main mechanism is cervical mucus changes for your sperm. So this particular brand will suppress ovulation and you can skip the four placebo pills and skip your period safely. Those are the two progesterone pills. There's also the progesterone injection. called Depo-Provera that you get every three months and there's a progesterone implant called Nexplanon that you get every three years. 

Those are only progesterones. So those are safe for people who are smoking or safe for people who have had blood clot and heart attack and stroke to a degree that you have to talk to your hematologist because some of the guidelines have changed, and even those people who have had blood clots who used to safely be able to take progesterone, it's now a little bit on the fence because it may increase the risk of blood clots. 

In the hormonal fashion that the hormones do. Um, but those particular forms are great because you don't have to remember to take 'em. You get a shot once every three months, or you get the implant in three years. But the side effects of sometimes irregular bleeding can last longer. Sometimes weight gain because progesterone can [00:07:00] make you hungrier and sometimes mood changes because progesterone can be known to change some of the mood stabilizing features of the birth control pill. 

Um, and so I can't say that all of my patients really love the Depo-Provera shot or the Nexon worldwide. It is a wonderful form of birth control because again, if you don't wanna be pregnant, any of the side effects often is better than pregnancy. Okay, I hope that makes sense. Bye.