His and Her Health

I asked this question a few days ago, but I only got one response. I was hoping to get a few opinions. Here is what my original post said:<P>Hello,<BR>I am currently on Ortho Evra the bc patch. I am going to try switching to the Ortho TriCyclen-Lo pill. The patch has caused me to be sick at my stomach, so my question is...what is the best time of day to take the pill if bc has previously given you problems with nausea? I am assuming it would be best to take it with food. Is that right? Would it be better to take it in the morning or evening? Anyone who has experienced this please feel free to offer your opinion.<P>Some additional info that might help: I have been on the patch for over a year. The first 4 or 5 months it was causing me to throw up and then it stopped. Then all the sudden last month I got sick again from it. So I'm wanting to try something else. My main question is what I asked earlier....when is the best time to take the pill?<P>Thanks<P>------------------<BR>~Holly~

Holly,<BR>Your gynecologist, and any literature you read, will suggest you take the pill at bedtime with food. Nausea is a common side effect. If nausea persists, try a pill with lower progesterone. I had mild nausea when I took it in the morning. I was advised to switch to evening and that did the trick for me.<p>[This message has been edited by Owner (edited 24 September 2003).]

Owner,<BR>I guess you are the only one interested in offering advice on this. Therefore, I will take that advice. I know the instructions say to take the pill at the same time everyday...is that mainly for a remembering device? Like if you always take it at the same time you won't forget. I'm wondering because my husband and I don't always eat dinner at the same time every evening, so would it matter if I took the pill some evenings at 7 and others at 8?<P>I know I'm being picky about this, I just want to make sure it is effective and I have the least side effects possible. Thanks for your advice!<BR><P>------------------<BR>~Holly~

Some of the reasoning behind taking it at the same time each day is because the levels of estrogen, esp in certain pills is very low. If the pill isn't taken at the same time each day, the levels of hormones may fluctuate enough to increase the chances of an unintended pregnancy.<P>I'm sure the remembering thing is important too though.<P>Generally, what I've heard is that some people are just more sensitive to the particular hormone and hormone conbinations in a particular pill. Often switching pills, and no other changes will fix things for most people. It may take a few switches to find one that works, but it's often resolvable.<P>One suggestion. I think that Evra has a higher incidence of GI upset etc than other methods. Have you considered the Ring (nuvaring)? It is a fair bit more expensive, last time I checked. ~$45 or so a month. But, the serum E levels are lower - this I suspect will probably be better tolerated. Also, oral estrogens drive up SHBG levels, which depresses free T levels, and this seems to cause problems for some. Thus, the ring, seems to be the only form that avoids many of the pitfalls of other methods. Depo, Norplant, OC's etc.<P>I'd certainly consider that.<P>If you want to switch to an OC (oral contraceptive) you might try Alesse. It's one of the lower dose pills.<P>Cheers,<BR>Greg

Greg,<BR>I'm assuming by GI you mean gastro-intestinal...? If so, I have experienced that. I didn't even think about the fact that it was caused by the Ortho Evra. I was starting to think I had what is called Irritable Bowel Syndrome. Maybe it is the bc. ? Well I think first I will try the Ortho Tri-Cyclen-Lo. My doctor gave me samples of it so I'll just try it and see how it works. <P>Forgive my ignorance, but are you saying that oral estrogens tend to lower libido? My Ortho Evra has done that to me. I was also hoping that switching might help that some. I don't know. The Nuva Ring sounds interesting. I've read some about it. The main reason I decided not to try it was because from what I understood it is like Ortho Evra...being that it is not oral. I don't know if it would be considered transdermal since it is not on your skin like Evra is. But that is why I was going to try an oral first. <P>Do you agree with taking it in the evening or at night as opposed to morning?<P>Thanks!<P>------------------<BR>~Holly~<p>[This message has been edited by Love2Sing (edited 27 September 2003).]

You asked a few questions...<P>GI = gastro-intestinal (Sorry, I should have made it clear.)<P>Evra, at least in the PDR (physicians desk reference) is noted for GI upset. Perhaps it's more problematic for this than others, but perhaps not.<P>Oral vs Transdermal.<P>Oral estrogens tend to raise SHBG (sex hormone binding globulen) levels. SHBG binds very tightly to testosterone, one of the hormones that is responsible for libido, sensation, and other sexual function issues in women. (It's not the only important hormone, but it is quite important.)<P>Transdermal, any method that goes through the skin, including NuvaRing, doesn't have these same problems. We may find other issues, but for now at least it appears to be a better delivery method.<P>Nuvaring also, if I recall correctly, produces lower serum estrogen levels vs Evra. Thus, if this is part of your sensitivity issue, it could help significantly. (This may not be your issue however, so it might not help at all.)<P>Evra: Perhaps your libido loss is from some other reason than SHBG rise. You should know that all the estrogens in hormonal birth-control is not like your *natural* estrogen. It's obtained from pregnant horse urine (yuck) - but the reason for this is the drug companies can patent a non-natural hormone. (There's more facets to this debate too, but this post is getting long.)<P>The exact molecular structure of each "estrogen" and "progesterone" is often different from product to product. There are also different levels of each hormone etc. So, one pill might cause havoc with you, but another won't. Perhaps oral estrogens will not cause you problems, etc.<P>I can't say with any certainty that one will be better than another. I'm just giving an opinion on what methods seem to be best. Nuvaring has one other advantage. You don't have to remember to take it every day, and thus are probably less likely to get pregnant from mis-using the product. (Though the ring could get expelled and if you didn't realise it, that could be problematic.)<P>Anyway, I think you'll find that this is a trial and error process.<P>As far as when to take the pill, I've never really heard any hard and fast rules. I'm not sure if it will make any difference in your situation though it's probably worth a try. <P>Most people I know of tend to take it in the morning, as it's often part of getting ready for the day. At the end of the day, it's easy to forget.<P>Best of luck!<BR>Greg<P>------------------<BR>See the icons at the top of this post for my profile and more information.<BR>Also note, I am *not* a doctor, and this is not intended as medical advice - Please talk to your doctor about your concerns.<BR><p>[This message has been edited by distressed_12345 (edited 28 September 2003).]

I think you may be getting sick because you are currently getting too much hormones from the patch. I had norplant (BIG mistake) & I felt the same way. I have taken Ortho Tricyclen for some time now & it doesn't make me sick at all. I worked in a doctor's office & asked him about when was best to take the pill & he said at bedtime. It is metabolized more slowly & will less likely make you feel sick. Try that & see if that works. <P> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2">Originally posted by Love2Sing:<BR><B>I asked this question a few days ago, but I only got one response. I was hoping to get a few opinions. Here is what my original post said:<P>Hello,<BR>I am currently on Ortho Evra the bc patch. I am going to try switching to the Ortho TriCyclen-Lo pill. The patch has caused me to be sick at my stomach, so my question is...what is the best time of day to take the pill if bc has previously given you problems with nausea? I am assuming it would be best to take it with food. Is that right? Would it be better to take it in the morning or evening? Anyone who has experienced this please feel free to offer your opinion.<P>Some additional info that might help: I have been on the patch for over a year. The first 4 or 5 months it was causing me to throw up and then it stopped. Then all the sudden last month I got sick again from it. So I'm wanting to try something else. My main question is what I asked earlier....when is the best time to take the pill?<P>Thanks<P></B></font><HR></BLOCKQUOTE><P>

Well today is the day! This evening I will take the first pill in my Ortho Tri-Cyclen-Lo pack. Thanks for everyone's advice! I will keep you posted on how I do with it. <P>Thank you again.<P><P>------------------<BR>~Holly~

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2">Originally posted by distressed_12345:<BR><B>Evra: Perhaps your libido loss is from some other reason than SHBG rise. You should know that all the estrogens in hormonal birth-control is not like your *natural* estrogen. It's obtained from pregnant horse urine (yuck) - but the reason for this is the drug companies can patent a non-natural hormone. (There's more facets to this debate too, but this post is getting long.)</B></font><HR></BLOCKQUOTE><P>Whoa. The estrogens in hormonal birth-control are NOT from horse urine. It's usually ethinyl estradiol, which is a synthetic form NOT made from horse urine.<BR>

I agree, DGJenkins. Holly should notice a big difference with the new prescription, and taking it at night.<p>[This message has been edited by Owner (edited 28 September 2003).]

Owner and DGJenkins--I hope you are right. I am really hoping that this form of bc will work well for me. I have grown so tired of the effects that the patch had on me. It is a very good form of bc, but I personally just had too many unpleasant side effects which have lead me to try something else. <P>Anyway, if you guys are interested I will let you know how everything goes.<P>------------------<BR>~Holly~

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>Whoa. The estrogens in hormonal birth-control are NOT from horse urine. It's usually ethinyl estradiol, which is a synthetic form NOT made from horse urine.<BR></font><HR></BLOCKQUOTE><P>You're right...<BR>However, the estrogens in several products are, specifically, Prempro etc. <P>However, the point that these estrogens are NOT bio-idential still holds. (Bio-identical means that the molecular structure is the same as the estrogens in the body.)<P>This isn't exactly the same case in OC's, however the potential problems may be similar. It would be really nice to see some real data on what difficulties or, more likely IMHO, *lack* thereof would result from using bio-identical hormones for birth-control as well as HRT.<P>Cheers,<BR>Greg<P>------------------<BR>See the icons at the top of this post for my profile and more information.<BR>Also note, I am *not* a doctor, and this is not intended as medical advice - Please talk to your doctor about your concerns.

Greg,<P>Since you seem to know quite a bit about Nuvaring I'll ask you this question.<BR>I started the Nuvaring yesterday and had sex later that evening (with condom). I was able to get wet enough but totally unable to orgasim. Do you think the Nuvaring had something to do with this? I normally have no problems climaxing.

I think it's pretty unlikely that NR caused your issue. However... I hate to make blanket statements. What I don't want to do, is imply that since 99.999% (this is a hypothetical number) of people have no problems, that you must not either.<P>Your reaction might be a one time affair, a real side effect or something else.<P>I don't think it's likely, but if it continues then you'll have to see.<P>IIRC, you're on an SSRI anti-depressant, right? Perhaps this is a side effect of the combination? (Perhaps not too. *grin*)<P>I think the point here, is that on a whole lot of issues, both mental and physical, we don't know much at all. Most drugs, viagra being an example, we found mostly by accident. We thought we were developing for one thing, and it didn't work very well. But it did create erections. Hmmm... Oops.<P>So, when we try to give probabilities, we're just guessing - wildly. Use your own brain to look at the issues and decide what makes sense for you. Don't let us "tell" you what's up. (I know you will do this anyway, but thought I'd elaborate a bit.)<P>Cheers,<BR>Greg<P>------------------<BR>See the icons at the top of this post for my profile and more information.<BR>Also note, I am *not* a doctor, and this is not intended as medical advice - Please talk to your doctor about your concerns.