Side effects of Loestrin A Combined Oral Contraceptive Pill containing Ethinyl Oestradiol and Norethisterone

What is Loestrin?

Loestrin is taken by mouth with the objective of preventing pregnancy.

Each pack of Loestrin contains three strips of 21 tablets.

Loestrin 20 tablets are a type of hormonal contraception commonly known as 'the pill' or combined oral contraceptive pill. Loestrin 20 tablets contain ethinylestradiol and norethisterone. They are synthetic versions of the naturally occurring female sex hormones, oestrogen and progesterone. Ethinylestradiol (spelt ethinyloestradiol in the UK) is a synthetic version of oestrogen and norethisterone is a synthetic form of progesterone.

Combined oral contraceptives like Loestrin 20 work by over-riding the normal menstrual cycle.

Loestrin - There are two strengths - Loestrin 20 and Loestrin 30

Each Loestrin 20 (pale blue tablet) contains the active ingredients norethisterone acetate 1mg and ethinylestradiol 20 micrograms.

Each Loestrin 30 (green tablet) contains the active ingredients norethisterone acetate 1.5mg and ethinylestradiol 30 micrograms.

What side effects could I have whilst taking Loestrin?

The vast majority of patients taking Loestrin feel very well but, as with any medicine that has benefits, some minor side effects are occasionally reported. These include:

What is the effect of birth pills on body weight?

All of us are intermittently gaining or losing weight.

Inevitably some patients find that they gain weight around the time of starting Loestrin but others observe a weight loss.

In a personal computer search of the medical literature from 1966 to date I found exactly fifty papers (articles in medical journals) where weight change in relation to Loestrin had been studied.

• Thirty-six papers indicated no change, eleven found an increase varying from 0.3kg to 2.4Kg.
• Three papers found weight loss with the combined oral contraceptive pill for women who were overweight or who had polycystic ovaries.

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Will Loestrin increase my vaginal discharge?

Cervical ectopy (erosion - cervical erosion) appears to be more common in women taking the combined oral contraceptive pill although the newer lower dose pill seem to cause this less frequently. Cervical ectopy only requires treatment if there are persistent significant symptoms after excluding other problems such as infection. Contrary to popular belief, there is no evidence that Loestrin increases the incidence of candida (thrush).

Does Loestrin increase my chance of pelvic infections?

There is no increase in the incidence of Candida infection in pill users. The incidence is the same as in women with intrauterine devices and those using no contraception. Bacterial infections that gain entry to the pelvis through the cervix are less common in pill users as the progestogen makes the cervical mucus thick. However, there is no protection against viruses or chlamydia.

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What is the relationship between Loestrin and fibroids?

Surprisingly, studies show that the combined oral contraceptive pill reduces the chance of fibroid development. It is a surprise because both oestrogen and progesterone are factors in fibroid development so fibroids shrink after the menopause (HRT-Add-Back). The current presumption is that the total of these hormones provided by the combined oral contraceptive pill in a month must be less than the natural hormone output by the ovaries.

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Will Loestrin increase my blood pressure?

For the majority of women, the blood pressure increases on the combined oral contraceptive pill by an average of 1mm Hg (a tiny amount). An increase of 5-10mm Hg may be of clinical importance but 1mm really does not matter. This is an example of a statistical (mathematical) proven increase that has no consequence from the medical point of view.

The international recommendation is that the combined oral contraceptive pill should not be started or continued if your blood pressure is 160/100 or higher. High blood pressure can be a factor in heart disease and strokes and as a few women (about 1%) may develop clinically significant raised blood pressure, checks should be carried out periodically. Your blood pressure should be measured before you start Loestrin and three months later. If your blood pressure is normal it should be reviewed at six months intervals and after two years it can be reviewed annually.

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Does Loestrin have any effect on the blood?

All chemicals in the blood are eventually removed and eliminated from the body. The liver plays a key role in this process and this is true for oestrogens and progestogens. The oestrogen and progestogens in the combined oral contraceptive pill results in a slight alteration in the fat chemistry of the blood. There is a rise in low-density cholesterol (Q 27.4) and triglycerides and a reduction of high-density cholesterol. These changes have been reduced by the more modern pills.

When we cut ourselves a blood clot forms to seal the wound and stop the bleeding.

• This involves a cascade of chemical reactions in the blood that lead to the clot forming.
• Some people are particularly prone to inappropriate blood clots, which occur within the veins usually in the legs or pelvis.
• If such a blood clot, which is called a deep venous thrombosis, becomes dislodged it can travel to the lungs and causes a pulmonary embolism, which is a serious life threatening condition.
• The combined oral contraceptive pills do have a slight adverse effect on the clotting mechanism. Again, the new low oestrogen dose preparations are less likely to lead to problems.

What is the relationship between Loestrin and thromboembolism (blood clots)?

Deep venous thrombosis and pulmonary embolism are uncommon if you are young (Figure 15.1). There is a slight increased risk of these problems if you are taking a combined oral contraceptive pill and the risk is further increased for those who are overweight or who smoke. The newer and lower oestrogen dose pills probably cause fewer problems. To put the risk in context, a woman taking the combined oral contraceptive pill is more likely to be hospitalised as a result of an accident than from a complication associated with her pill.

Figure 15.1

A study by the World Health Organisation (WHO) published in 1995 provided evidence that the newer pills with their lower oestrogen content are associated with lower incidence of thromboembolism than the earlier higher oestrogen dose pills. This study also brought attention to the relationship between the progestogen in the combined oral contraceptive pill and thromboembolism.

What is the relationship between the combined oral contraceptive pill and heart attacks?

The combined oral contraceptive pill has slight adverse effects on the lipids (“fat” chemicals) in the blood and these changes are known risk factors for heart disease. Heart attacks before the menopause are rare. Studies of patients on the early high dose preparations of the combined oral contraceptive pill found a five-fold increase in the incidence of heart attacks. Further studies demonstrated that there are usually confounding (additional) factors contributing to the attacks. In particular, smoking increases the risks. With the more modern low dose pills the risks are probably lower. The latest evidence suggests that there is no increased risk of heart attacks for oral contraceptive users.

The current recommended advice is that smokers should discontinue the combined oral contraceptive pill at the age of 35years. The best advice is that smokers should stop smoking.

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What is the relationship between Loestrin and strokes?

Strokes are uncommon in young women but there is a marginal statistical increase in those who have taken the combined oral contraceptive pill. Strokes may involve haemorrhage (bleeding) within the brain or reduced blood supply (ischaemia) to part of the brain. In young women it is the bleed variety of stroke that is the more common. One study in Europe found no significant increase in the chance of the bleed variety of stroke in association with the combined oral contraceptive pill. Smoking and high blood pressure are more important risk factors and these confuse any analysis of the risks of the combined oral contraceptive pill.

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Does Loestrin affect the breasts?

Many women find that their breasts are slightly larger when taking the combined oral contraceptive pill. Breast discomfort (mastalgia) may respond to vitamin B 6 (pyridoxine) 50 mg once or twice daily. Otherwise a change of pill should be considered. Should milk production occur (galactorrhoea) investigation of the prolactin hormone level is indicated (hyperprolactinaemia). Benign breast disease (Q 27.16) tends to improve when the combined oral contraceptive pill is taken.

Could I feel depressed as a result of taking Loestrin?

A few women describe a little depression when taking the combined oral contraceptive pill. The pill does not cause severe depression. If a change of pill does not solve the problem, pyridoxine (Vitamin B6) 50mg daily may be beneficial but it can take up to two months to be effective.

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