Move Right for Less Prostogenic Effects
THE PILL TABLE
Move
down
For
Less
Oestrogenic
Effects
down
For
Less
Oestrogenic
Effects
Ethinyloestradiol
Mestranol
Levonorgestrel
Norethisterone
Norgestimate
Gestodene
Desogestrel
Drospirenone
Ethinyloestradiol
Ethinyloestradiol
Ethinyloestradiol
Norethisterone
Ethinyloestradiol
Ethinyloestradiol
In Table Above,
The first column is the micrograms of oestrogen.
The three left hand columns are more progesterone dominant
The four right hand columns more oestrogen dominant pills:
For LESS oestrogenic activity then move across ladders to the LEFT
For LESS progestogenic activity then move across ladders to the RIGHT
The first column is the micrograms of oestrogen.
The three left hand columns are more progesterone dominant
The four right hand columns more oestrogen dominant pills:
For LESS oestrogenic activity then move across ladders to the LEFT
For LESS progestogenic activity then move across ladders to the RIGHT
Examples
if a woman is experiencing acne and mood swings on a progesterone dominant pill such as Microgynon, it is worth moving right across the ladders to a more oestrogen dominant pill such as Cilest
if a woman is experiencing nausea and breast tenderness on an oestrogen dominant pill such as Femodene, it is worth moving left across the ladders to a more progesterone dominant pill such as Ovranette. A possible alternative move is to a pill containing less oestrogen but the same progestogen, e.g. Femodene to Femodette
in general with breakthrough bleeding, it is worth trying a higher dose of oestrogen (of course pathology such as a cervical problem or a sexually transmitted inf ection (STI) needs to be excluded first). Certain progesterones are associated with better cycle control than others (LNG better than NET, GSD better than DSG) but if a woman finds a particular progesterone suits her, for example DSG, but she experiences beakthrough bleeding with a low dose 20 mcg EE (Mercilon), then you can try moving up the same ladder staying with the same progesterone but increasing to a 30 mcg EE pill (Marvelon)
if a woman is experiencing acne and mood swings on a progesterone dominant pill such as Microgynon, it is worth moving right across the ladders to a more oestrogen dominant pill such as Cilest
if a woman is experiencing nausea and breast tenderness on an oestrogen dominant pill such as Femodene, it is worth moving left across the ladders to a more progesterone dominant pill such as Ovranette. A possible alternative move is to a pill containing less oestrogen but the same progestogen, e.g. Femodene to Femodette
in general with breakthrough bleeding, it is worth trying a higher dose of oestrogen (of course pathology such as a cervical problem or a sexually transmitted inf ection (STI) needs to be excluded first). Certain progesterones are associated with better cycle control than others (LNG better than NET, GSD better than DSG) but if a woman finds a particular progesterone suits her, for example DSG, but she experiences beakthrough bleeding with a low dose 20 mcg EE (Mercilon), then you can try moving up the same ladder staying with the same progesterone but increasing to a 30 mcg EE pill (Marvelon)
Notes:
completely separating unwanted effects of oestrogen and progestogens is very difficult
progestogens have varying degrees of progestogenicity (wanted effect, for contraception), androgenicity (unwanted effect , leading to spotty skin, greasy hair and hirsuitism) and oestrogenicity. This can actually add or subtract from the 'apparent' level of oestrogenicity in the combined formulation. So, for example Cilest, although a 35 mcg pill, has, biologically the same long term effects as the 30 mcg pills, because it has very little oestrogenic activity
completely separating unwanted effects of oestrogen and progestogens is very difficult
progestogens have varying degrees of progestogenicity (wanted effect, for contraception), androgenicity (unwanted effect , leading to spotty skin, greasy hair and hirsuitism) and oestrogenicity. This can actually add or subtract from the 'apparent' level of oestrogenicity in the combined formulation. So, for example Cilest, although a 35 mcg pill, has, biologically the same long term effects as the 30 mcg pills, because it has very little oestrogenic activity
Reference:
The Practitioner (1999); 243:462-72.
Update (1998); 56(8): 751-8.
Morgan S, Evans A. The Pill Ladder. Avon GP Education (Accessed July 25th 2013).
The Practitioner (1999); 243:462-72.
Update (1998); 56(8): 751-8.
Morgan S, Evans A. The Pill Ladder. Avon GP Education (Accessed July 25th 2013).