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Long term OC usage and pill changes

I am 27 and have been taking OC continuously for 9 years.  For 8 years I took Ortho-Tri-Cyclen, and was then switched to Femodette, a low-dose monophasic UK pill with 20 mcg of ehinylestradiol and 75 mcg of gestodene.  Ortho-Tri-Cyclen is not available in Europe.  I requested that my GP prescribe a new pill anyway, as towards the end of 8 yrs on Ortho-Tri-Cyclen I was experiencing moderate mood swings with frequency.  I have 2 concerns:

(a) Is my new pill safe?  Femodette is a 3rd generation pill with a progestin (gestodene), not FDA approved in the US.  It carries a higher risk of DVT.  I am a healthy slender female that exercises regularly and have been experiencing strange side effects that started 4-6 months into taking this new OC.  I occasionally get mild chest pain & pinching around my sternum, ribs and breastbone at random intervals, which my GP has dismissed as stress.  Could this be caused by the pill?  The new pill has also caused spotting between periods, something I also never experienced before.  The “side effects” are not horrible but seem to come and go.  For years I took Ortho-Tri-Cyclen with no side effects other than minor mood swings, some bloating and swelling in my breasts before my period.  My GP has now suggested that I try Loestrin 20 (Ethinylestradiol 20 mcg, norethisterone acetate 1 mg).  Do I even need to be on a low-dose pill and why?  Is Loestrin 20 a good pill and what would you recommend doing given the above?  I’m afraid my GP is not as well informed on OC.  I don’t think I tolerate OC poorly given my history, but won’t a higher dosage of a synthetic progestin just make mood swings worse?  Can you suggest a reliable OC available in Europe?

(b) Will long term OC usage affect my breast cancer risk?  I have a family history of post-menopausal breast cancer: Aunt, Great Aunt and Great Grandmother in their early 50's.  There is also a history of luteal phase defect in my family and I'd like to plan for a pregnancy in 2 years.
1 Responses
242596 tn?1192429549

Gestodene appears to be as safe as other progestins that are in other oral contraceptive pills.  The dose-potency ratio of different progestins is not equal from pill to pill, so you cannot compare the dose between two different types of progestins.  

Loestrin 20 is a fine pill.  You'll likely do well on it.  If you do have spotting or more breakthrough bleeding on it I'd change you to a pill with a higher estrogen component (a 30 or 35mcg of ethinyl estradiol pill).  I don't know all the pills available in Europe so you'll have to ask your GP about that.

There is no definitive evidence OC usage increases a woman's risk of breast cancer.  We do know greater than five year use does decrease your risk of endometrial and ovarian cancer.  

Best wishes,

Dr. Downing
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