PCOS-MEDICATION Messages for November, 2001: Re: Monophasic vs. Triphasic OCs

Re: Monophasic vs. Triphasic OCs

From: jodi (anonymous@obgyn.net)
Wed, 7 Nov 2001 08:36:23 -0600 (CST)

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The easy to understand rationale for this belief is that tri-phasic BCPs do not give us the continuous level of hormonal surpression that we need to handle the PCOS. The varying levels of hormones are thought to be more natural and mimic the body's normal rhythyms, so for healthy women they might be a good thing. I think that since it is generally thought that the lower the dose BCP you can get away with, the better off you are... using tri-phasics allows you to take in less hormones overall by providing you with lower doses initially and higher doses when you need them.

In Samuel Thatchers book he says "Multiphasic OCs tend to lower the overall steroid used, but may not be useful in PCOS patients, where a flat-line ovarian and uterine supression is desired." (p. 351, first edition)

I think the "may not be useful" bit is key. I know that a lot of women say they have had bad luck with triphasics and PCOS, and I have as a result joined the anti-triphasic BCP camp myself... but to be honest? the first BCP I was ever on was ortho-tricyclin and in retrospect it was probably the BCP i had the least problems with! no headache, no moodiness or depression, no weight gain, no spotting, and I had bleeds when I was supposed to. of course, it did nothing about the unwanted hair, which was my main complaint at that time... but I don't think any BCPs I've been on have really done anything for the hair.

the only problem is, I have no idea what my blood work was like or what sort of state my ovaries were in at this time... no one said anything about PCOS at that time. i was simply suffering from "idiopathic hirsuitism..." and I have since learned that the ob/gyn I was seeing at that time is a moron. (I saw her last fall after getting my PCOS diagnosis and she told me PCOS is no big deal, doesn't cause infertility, and only really obese women have serious problems with it so I had no cause to worry.)

My current doc (an endocrinologist) recently suggested ortho-tricyclen, which made me gasp and re-evaluate my impression of her. I could not believe that someone who is with it enough to treat PCOS with glucophage would suggest a tri-phasic BCP. I didn't want to question her judgement so I just said I'd tried it and didn't like it, which was a lie... but now I have the triphasic fear, you know? On the other hand, I am not having much luck with BCPs in general... one gave me migraines, one made me cry every day for three months before I gave up, one made me spot all the time, one didn't give me bleeds at all and killed my sex drive, one made me want to slit my wrists... all caused some degree of weight gain. At the present time I am losing hope that glucophage alone will bring on my periods, and I am tired of the hassel of using condoms when there's no chance in hades of me getting pregnant anyway... so I am still searching for a BCP that works without making me miserable. I'm almost ready at this point to think maybe my doctor knows something we don't know and try OTC again... but I think I'm gonna rule out a few more monophasics first.

I think the truth is that all BCPs work differently for different people... maybe the fact that some PCOSers have had bad luck with tri-phasics doesn't mean after all that those results can be generalised to the PCOS population as a whole. I really don't know... (For what it's worth, the BCP that gave me migraines was a tri-phasic. however, I had only been on it two or three days when that happened, so I don't think its being a triphasic had anything to do with the migraines... I think I just did not react well to that pill. I had never had a migraine before that time and I have never had a migraine since.)

- Jodi

At Tue, 6 Nov 2001, Chris wrote: >
>Hi-
>
>I have actually responded myself to questions about monophasic vs.
>triphasic oral contraceptives. I think it has been well established on
>this board that monophasic pills are preferable to triphasic pills for
>PCOS patients.
>
>I have gone to a new endocrinoloigst, and she prescribed spironolactone
>plus Estrostep, a triphasic oc. I hesitated when she gave it to me and
>asked her if a monophasic wouldn't be more desirable. She told me a
>triphasic is better. (And gave no explanation.)
>
>My question is, what is the scientific evidence that monophasic pills
>are more beneficial to PCOSers? As I mentioned, it has been established
>on the board that monophasics are preferred, but *why*? (I could not
>find this info in the archives.)
>
>Thanks so much,
>Chris

Next message: Muriel: "Re: maybe Dr. Sam can help - On Glucophage and weight loss"
Previous message: ANGEL: "New Question for Dr. Sam"
In reply to: Chris: "Monophasic vs. Triphasic OCs"
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