Question | Answer |
First Generation Progestins | Norethindrone (Nora-BE)
Ethinylodiol diacetate |
Second Generation Progestins | Norgestrel
Levonorgestrel (Plan B, Mirena, Skyla) |
Third Generation Progestins | Norgestimate (Ortho)
Desogestrel |
1st vs. 2nd vs. 3rd Gen Progestins - Differences? | 1st - mildly androgenic, most breakthrough bleeding
2nd - most androgenic, less bleeding than 1st gen
3rd - least androgenic, least weight gain, least acne |
Estrogen - side effects of too much vs. too litte | Too much: nausea, breast tenderness, HA, bloating
Too little: spotting, breakthrough bleeding early/mid-cycle |
Progestin - side effects of too much vs. too little | Too much: Breast tenderness, HA, fatigue, mood swings
Too little: breakthrough bleeding late cycle |
Androgenic side effects | weight gain, acne, hair growth, dyslipidemia |
Ring vs. patch vs. pill | Ring - least estrogen side effects (lower exposure)
Patch - most estrogen side effects (highest exposure) |
Dealing with acne | Switch to COC with 3rd gen progesterone, increase estrogen dose, switch to continuous regimen |
Dealing with breakthrough bleeding | Early or mid-cycle: increase estrogen dose
Late cycle: Increase progestin dose |
Dealing with migraines | Switch to progestin-only pill |