Ann asked
I was traveling and forgot my birth control, which was Tri-Cyclen. I missed a day in my third week, but I alec my doctor and got a prescription filled at a nearby pharmacy, where they gave me Tri-Nessa instead of my usual brand. I ultimately took the pill of the day I missed and the next day in the week three section instead of restarting a pack. I am day 5 into the placebo pills, and I have not gotten my period. Can my brand switching play into a missed period? Should I worry about pregnancy?
Answer
Ortho Tri-Cyclen and Trinessa contain the same active ingredients (and same amounts) of ethinyl estradiol and norgestimate to help prevent pregnancy. Ortho Tri-Cyclen and Trinessa are considered equivalent by FDA standards and can legally be switched between one another and other brand names containing the same active ingredients.
Some pharmacies will switch to carrying different brand names of birth control pills and will switch between them depending on what they have in stock. This is fine as long as they have the same amount of active ingredients, are considered bioequivalent, and the doctor does not specify they cannot be switched.
It is important to note that while the active ingredients are the same for both Ortho Tri-Cyclen and Trinessa, they do have different inactive ingredients, which is why the tablets look different.
Both Ortho Tri-Cyclen and Trinessa and "tri-phasic" birth control pills, meaning they contain different amounts of estrogen and progestin each week. "Tri-phasic" birth control pills are thought to more closely mimic the natural hormone fluctuations in woman, leading to less side effects.
Below are the ingredients for both Ortho Tri-Cyclen and Trinessa:
Ortho Tri-Cyclen Ingredients
The week one active, hormone pills contain:
- Ethinyl Estradiol 0.035 mg
- Norgestimate 0.18 mg
- Carnauba wax
- Croscarmellose Sodium
- Distilled Water
- Hypromellose
- Lactose
- Magnesium Stearate
- Microcrystalline Cellulose
- Polyethylene Glycol
- Titanium Dioxide
The week two active, hormone pills contain:
- Ethinyl Estradiol 0.035 mg
- Norgestimate 0.215 mg
- Carnauba wax
- Croscarmellose Sodium
- Distilled Water
- FD&C Blue No. 2
- Hypromellose
- Lactose
- Magnesium Stearate
- Microcrystalline Cellulose
- Polyethylene Glycol
- Titanium Dioxide
The week three active, hormone pills contain:
- Carnauba wax
- Croscarmellose Sodium
- Distilled Water
- FD&C Blue No. 2
- Hypromellose
- Lactose
- Magnesium Stearate
- Microcrystalline Cellulose
- Polyethylene Glycol
- Polysorbate 80
- Titanium Dioxide
The inactive, placebo pills contain:
- Distilled Water
- FD&C Blue No. 2
- Ferric Oxide
- Lactose
- Magnesium Stearate
- Polyethylene Glycol
- Pregelatinized Corn Starch
- Talc
- Titanium Dioxide
Trinessa Ingredients
The week two active, hormone pills contain:
- Ethinyl Estradiol 0.035 mg
- Norgestimate 0.18 mg
- Carnauba wax
- Croscarmellose Sodium
- Distilled Water
- Hypromellose
- Lactose
- Magnesium Stearate
- Microcrystalline Cellulose
- Polyethylene Glycol
- Titanium Dioxide
The week two active, hormone pills contain:
- Ethinyl Estradiol 0.035 mg
- Norgestimate 0.215 mg
- Carnauba wax
- Croscarmellose Sodium
- Distilled Water
- FD&C Blue No. 2
- Hypromellose
- Lactose
- Magnesium Stearate
- Microcrystalline Cellulose
- Polyethylene Glycol
- Titanium Dioxide
The week three active, hormone pills contain:
- Ethinyl Estradiol 0.035 mg
- Norgestimate 0.25 mg
- Carnauba wax
- Croscarmellose Sodium
- Distilled Water
- FD&C Blue No. 2
- Hypromellose
- Lactose
- Magnesium Stearate
- Microcrystalline Cellulose
- Polyethylene Glycol
- Polysorbate 80
- Titanium Dioxide
The inactive, placebo pills contain:
- Distilled Water
- FD&C Blue No. 2
- Ferric Oxide
- Hypromellose
- Lactose
- Magnesium Stearate
- Microcrystalline Cellulose
- Polyethylene Glycol
- Pregelatinized Corn Starch
- Talc
- Titanium Dioxide
Changing Birth Control Pill Brands
Although Ortho Tri-Cyclen and Trinessa are technically interchangeable, the differences in inactive ingredients can certainly cause small changes in how the medications are tolerated. It is fairly common for some women to complain of changes to their menstrual cycles and an increase in side effects such as spotting or breakthrough bleeding when changing birth control brands. The severity of side effects is often mild, but can still be worrisome if they haven't occurred before. Fortunately, these side effects tend to resolve after one or two cycles.
Missing Birth Control Pills
Not taking your birth control pills at the same time, or missing doses altogether can not only decrease your protection from pregnancy, it can cause significant changes to your menstrual cycle. There may be an increase in breakthrough bleeding and, if you needed to "catch-up", by taking more than one hormone containing pill, you may not experience your period at all. This is known as amenorrhea. Missing your period does not necessarily mean your are pregnant as it is a fairly common occurrence in those who take birth control pills.
Nevertheless, if you do miss your period while taking birth control pills, you always want to rule out pregnancy. Therefore, it is a good idea to take a pregnancy test. Pregnancy tests have the greatest accuracy on or within one day of a missed period. As you mentioned you are late in getting your period, taking a pregnancy test now is a good option. As stated above however, missing your period on birth control pills does happen.
Information About Ethinyl Estradiol / Norgestimate
The two hormones ethinyl estradiol and norgestimate are contained in Ortho Tri-Cyclen and Trinessa and are used to prevent pregnancy. These pills do not prevent sexually transmitted infections (STIs).
How It Works
Birth control pills mostly work by preventing ovulation by maintaining steady hormone levels in the body. However, other changes to the cervical mucus a lining of the uterus can also help. Changes in cervical mucus can make it difficult for sperm to enter the uterus, and a change in the lining of the uterus would reduce the change of implantation.
Norgestimate, the progestin in Ortho Tri-Cyclen and Trinessa, is considered a "third-generation" progestin. These progestins have low androgenic effects compared to earlier generation progestins and therefore are thought to have positive influences on acne, fluid retention, and lipid profiles.
Contraindications
Birth control should not be used in women who have:
- Blood clotting disorders or history of blood clots
- Coronary artery disease
- Cerebral vascular disease
- Known or suspected breast or uterine cancer
- Undiagnosed abnormal genital bleeding Liver disease, liver cancer, jaundice, or previous jaundice with pill use Known or suspected pregnancy
Warnings
Smoking while taking birth control pills can increase the risk of having cardiovascular side effects (heart attack, stroke, blood clot). Smoking should be avoided. This risk increases with heavy smoking and with age. The risk is significantly higher in women over the age of 35 years.
Potential Side Effects
- Nausea
- Cramping
- Bloating
- Vomiting
- Weight gain
- Breast tenderness
- Headache
- Spotting and/or breakthrough bleeding or other changes in menstrual cycle
Other Information
- Consult your doctor when starting any new medications, over-the-counter medications, or supplements.
- Birth control pills may interact with: rifampin, anticonvulsants (phenobarbital, phenytoin, carbamazepine), and some antibiotics (penicillins, tetracycline, griseofulvin).
- If you suspect you might be pregnant, consult a doctor immediately, as this medication may be harmful to a fetus.
- Consult your doctor immediately if you notice symptoms of an allergic reaction, breast discharge or lumps, pain or swelling or unusual redness in your lower legs, chest pain or tightness, numbness or weakness in arms or legs or on one side of the body, dark urine or pale stool, or yellowing of the skin or eye.
