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Alesse

Oral contraceptives come in a variety of formulations. The main division is between combined oral contraceptive pills, containing both estrogen and progesterone, and progesterone only pills (mini-pills). Combined oral contraceptive pills also come in varying types, including varying doses of estrogen, and whether the dose of estrogen or progesterone changes from week to week. more...

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Combined oral contraceptive pills

All contain the estrogen ethinyl estradiol, although in varying amounts, and one of a number of different progesterones. They are taken for 21 days with then a 7 day gap during which a withdrawal bleed (often, but incorrectly, referred to as a menstrual period) occurs. These differ in the amount of estrogen given, and whether they are monophasic (only one dose of estrogen and progesterone during the 21 days) or multiphasic (varying doses).

Monophasic

These are given as 21 tablets of estrogen and progesterone, followed by 7 tablets of placebo. Different formulations contain different amounts of estrogen and progesterone:

  • 20 mcg estrogen
    • 0.1 mg levonorgestrel (Alesse®, Levline®)
    • 1 mg norethindrone acetate (Loestrin 1/20®Fe)
  • 30 mcg estrogen
    • 0.15 mg levonorgestrel (Levlen®, Levora®, Nordette®)
    • 0.3 mg norgestrel (Lo-Ovral®)
    • 0.15 mg desogestrel (Desogen®, Organon; Ortho-Cept®, Ortho-McNeil)
    • 1.5 mg norethindrone acetate (Loestrin® 1.5/30)
    • 3.0 mg drospirenone (Yasmin®)
  • 35 mcg estrogen
    • 0.25 mg norgestimate (Ortho-Cyclen®)
    • 0.4 mg norethindrone (Ovcon-35®, Warner Chilcott)
    • 0.5 mg norethindrone (Modicon®, Brevicon®)
    • 1 mg norethindrone (Ortho-Novum 1/35®, Necon®, Norethin®, Norinyl 1/35®)
    • 1 mg ethynodiol diacetate (Demulen 1/35®, Zovia 1/35E®)
  • 50 mcg estrogen
    • 0.4 mg norethindrone (Ovcon-50®, Warner Chilcott))
    • 1 mg norethindrone (Necon 1/50®, Norinyl 1/50®, Ortho-Novum 1/50®, Ovcon-50®)
    • 0.5 mg norgestrel (Ovral®)
    • 1 mg ethynodiol diacetate (Demulen 1/50®, Zovia 1/50E®)

Multiphasic

  • Desogestrel 0.15 mg and ethinyl estradiol 0.02 mg x 14 tablets, followed by ethynil estradiol 0.01 mg x 2 tablets, followed by 5 tablets of placebo (Kariva®, Barr Laboratories; Mircette®, Organon)
  • Desogestrel 0.1 mg ethynil estradiol 0.025 mg x 7 tablets, followed by desogestrel 0.125 mg and ethynil estradiol 0.025 mg x 7 tablets, followed by desogestrel 0.15 mg and ethynil estradiol 0.025 mg x 7 tablets, followed by 7 tablets of ferric oxide (Cyclessa®, Organon; Velivet®, Barr Laboratories)
  • Norethindrone 0.5 mg and ethinyl estradiol 0.035 mg x 7 tablets, followed by 0.75 mg of norethindrone and 0.035 mg of ethinyl estradiol x 7 tablets, followed by 1 mg of norethindrone and 0.035 of ethinyl estradiol, followed by 7 tablets of placebo (Ortho-Novum 7/7/7®)
  • Norethindrone 0.5 mg and 0.035 mg of ethinyl estradiol x 10 tablets, followed by 1 mg norethindrone and 0.035 ethinyl estradiol x 11 tablets, followed by 7 tablets of placebo (Ortho-Novum 10/11®)

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Randomized controlled study: low-dose OC relieves pain, dysmenorrhea in adolescents
From OB/GYN News, 6/15/04 by Mitchel L. Zoler

PHILADELPHIA -- A low-dose oral contraceptive was effective for relieving dysmenorrhea in adolescent girls in a controlled study with 76 patients.

"This is the first randomized controlled trial to examine the efficacy of a modern, low-dose oral contraceptive for dysmenorrhea in adolescent girls," Dr. Katharine J. O'Connell said while presenting a poster at the annual meeting of the American College of Obstetricians and Gynecologists.

The results were expected, but it's good to get data to back up the anticipated effect, added Dr. O'Connell of Columbia University in New York.

The study used a standard low-dose formulation. Each daily pill contained 20 [micro]g ethinyl estradiol and 100 [micro]g levonorgestrel, the formulation that is marketed as Alesse by Wyeth. Both the active medication and matching placebo pills were supplied for the study by Wyeth.

Dysmenorrhea is a common problem among teenage girls and causes severe pain in 15%. The study enrolled a demographically diverse group of girls who were 19 years old or younger and had moderate to severe dysmenorrhea. The average age of the 76 girls enrolled was 17 years. Their average body mass index was about 24 kg/[m.sup.2].

Dysmenorrhea symptom severity was self-rated by each patient using the Moos Menstrual Distress Questionnaire (MDQ). Baseline assessment showed that 42% had moderate symptoms and 58% had severe dysmenorrhea. The overall average baseline MDQ score was 11.05 among the 38 girls in the active-drug group and 11.82 among the 38 girls in the placebo group.

Patients were asked to take their medication for three cycles, after which they retook the MDQ and were told to answer the questions based on their most recent cycle. The average MDQ scores on the second questionnaire were 2.78 among the girls on active drug and 5.49 among those using placebo, a statistically significant difference.

The difference in dysmenorrhea severity between the two study groups was also clinically significant. The patients on active drug reported having significantly fewer painful days and fewer hours of severe pain on their worst-pain day, compared with the patients in the control group. Despite the large placebo effect in this study, "subjectively, the girls on the oral contraceptive felt a lot better," she said.

Regular use of an oral contraceptive can provide other benefits for adolescents, including improvements in acne, a reduced risk of anemia, fewer ovarian cysts, and a reduced risk of later developing endometrial or ovarian cancer, Dr. O'Connell told this newspaper.

BY MITCHEL L. ZOLER

Philadelphia Bureau

COPYRIGHT 2004 International Medical News Group
COPYRIGHT 2004 Gale Group

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