Birth Control

I've been on the pill since I was 18, and haven't really considered any of the other methods. My doctor has asked me if I wanted to, but... eh. The pills are cheap (I still get mine through the Planned Parenthood), I get them mailed to me, and its not that hard to remember a single small pill before going to bed.

What I've noticed about what some folks are saying here actually differs a bit from what my doctor told me. Yeah, taking it around the same time every day/night helps, but its not necessary to be all MILITARY about it. I take mine before I go to bed every night, whether its 10pm or 2am. And if you miss a pill? Take it when you realize you've missed it, or with the next night's pill. If you miss 2 or more pills, thats when you're supposed to start using a condom for the next week. Its been 6 years- no babies.

And I'm not sure if other birth controls have all of the same benefits, but with the pill you get regulated periods (pretty standard), controlled cramps (much needed in my case, my cramps would echo into my legs before), reduced acne, and sometimes lighter periods. Oh yeah, and your boobs may grow a bit.

As for the loss of menstruation on some birth controls... I understand why some women do it, but as for me, I know I couldnt. Maybe its silly reasoning, but if said birth control fails (god forbid), the first signal of that failure would be the lack of a period. I'm sure morning sickness could be soon after, but really, I've started seeing my period as a monthly confirmation that my birth control is doing its job.

Good on you for getting involved with your girlfriend's choice, Ence. I'm really surprised she hasnt looked into it before this. I think I was the latest of my sisters to start it at age 18. Its admirable of you, and I'm sure she appreciates it. Only one of my boyfriends had ever offered to help pay for my pills, and while I refused, it was still a pleasant surprise.

There's nowhere I can't reach.

Originally Posted by Shorty

Mine were close to $50 per vial.

Depending on your prescription plan, your co-pay may differ, but I can tell you that in most cases a generic will cost nowhere near $50. Most co-pays are $5, $10 or $15 for generics and $10, $20, $30, and sometimes higher for the next tier up. However, since the MPA shot is good for three months, it may just be that your insurance is being billed for a three-month supply (generally, triple the base tier co-pays, e.g. $30 for a generic that would be $10 for one month). Either way, the generic is just as effective as the brand and is generally cheaper.

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Originally Posted by Temari

What I've noticed about what some folks are saying here actually differs a bit from what my doctor told me. Yeah, taking it around the same time every day/night helps, but its not necessary to be all MILITARY about it. I take mine before I go to bed every night, whether its 10pm or 2am. And if you miss a pill? Take it when you realize you've missed it, or with the next night's pill. If you miss 2 or more pills, thats when you're supposed to start using a condom for the next week. Its been 6 years- no babies.

Not sure which pill you're on. I'd guess ortho tricyclen based on my own experience with Planned Parenthood. (They mail pills to you? Wow, that's convenient. Have they been doing this since you were 18? I never got this option )

In my case, I'm on Camilla (Chris says it's a generic, and here in Massachusetts, I think you have to take the generic if it's available). I have very high blood pressure, and at the time it was prescribed for me, I was smoking too, so I need to take these pills, which took some serious adjusting to.

On the package, it says to take it at the same time every day. My doctor told me that with this particular birth control, it's imperative to do it within a 1-2 hour window. Not sure why, but I was never told this while on the ortho tricyclen. I figured I should probably follow it if I don't want any kids.

I found that the pill also regulated my period VERY effectively (when I was on the ortho tri, not so much now). I have no issues with the pill. I love it.

I am a dolphin, do you want me on your body?

Dope: Thanks for answering my question. I'm not going to cry over spilled milk, but that was interesting to find out.

I was speaking idiomatically.

Without knowing the laws in California, I can only guess that they are similar to those in Massachusetts, where if the generic for a drug is available the pharmacy by law must dispense it, regardless of personal wishes or doctor's orders (unless the prescriber includes "do not substitute" on the prescription). But every state has different laws: I think in Connecticut a patient may request the brand if it is available (regardless of whether it is covered) and the same was the case in New Hampshire when I worked there.

As I mentioned, generics must have some degree of bio-equivalence to the brands before being approved by the FDA. The common argument I sometimes hear is that people don't believe that the generic is as effective as the brand and that is a slippery slope discussion. Long story short, you can always ask your pharmacist whether you're being dispensed the brand or the generic and, if you're on the brand, what it would take to go to the generic.

I'm willing to bet you've been dispensed the generic. Since medication co-pays have become a major issue in the last 10-15 years, a number of changes have been made to ensure that generics do become available and they are required to be less expensive by law, and your pharmacy likely benefits more from dispensing the generic than the brand.

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Originally Posted by The Dopefish

generics must have some degree of bio-equivalence to the brands before being approved by the FDA.

Some degree of bio-equivalence? 99.9% of the time, generic medicine is exactly the same as branded stuff. Hell, in the UK they're normally made in the same factory on the same production line. The only difference is that half fall down one chute to have Nurofen stamped on and the other half stay plain for supermarket branding. The only difference between branded stuff and generics is a placebo effect brought about by marketing.

Then again, over here you always get generic drugs when you're filling a prescription since it's a flat fee, rather than paying for what you're having (Or in fact free for a lot of people) so you only choose between branded or not when you buy non-prescription stuff. Still makes me laugh when people say that only a certain brand of pain killer works for them since they are literally all exactly the same thing.

FELIPE NO

Originally Posted by Shin

Some degree of bio-equivalence? 99.9% of the time, generic medicine is exactly the same as branded stuff.

I realize I'm picking nits here (and me admitting it is far better than what you did), but an FDA study done between 1996 and 2007 demonstrated that the "average difference in absorption into the body between the generic and the brand name was only 3.5 percent". Furthermore...



...FDA regulations regarding approval of generics require a generic drug to meet two pharmacokinetic parameters between boundaries of 80% and 125%. You can read it here:

Spoiler:

The standard bioequivalence (PK) study is conducted using a two-treatment crossover study design in a limited number of volunteers, usually 24 to 36 adults. Alternately, a four-period, replicate design crossover study may also be used. Single doses of the test and reference drug products are administered and blood or plasma levels of the drug are measured over time. Pharmacokinetic parameters characterizing rate and extent of drug absorption are evaluated statistically. The PK parameters of interest are the resulting area under the plasma concentration-time curve (AUC), calculated to the last measured concentration (AUC(0-t)) and extrapolated to infinity (AUC(0-inf)), for extent of absorption; and the maximum or peak drug concentrations (Cmax), for rate of absorption. Crossover studies may not be practical in drugs with a long half-life in the body, and a parallel study design may be used instead. Alternate study methods, such as in-vitro studies or equivalence studies with clinical or pharmacodynamic endpoints, are used for drug products where plasma concentrations are not useful to determine delivery of the drug substance to the site of activity (such as inhalers, nasal sprays and topical products applied to the skin).

The statistical methodology for analyzing these bioequivalence studies is called the two one-sided test procedure. Two situations are tested with this statistical methodology. The first of the two one-sided tests determines whether a generic product (test), when substituted for a brand-name product (reference) is significantly less bioavailable. The second of the two one-sided tests determines whether a brand-name product when substituted for a generic product is significantly less bioavailable. Based on the opinions of FDA medical experts, a difference of greater than 20% for each of the above tests was determined to be significant, and therefore, undesirable for all drug products. Numerically, this is expressed as a limit of test-product average/reference-product average of 80% for the first statistical test and a limit of reference-product average/test-product average of 80% for the second statistical test. By convention, all data is expressed as a ratio of the average response (AUC and Cmax) for test/reference, so the limit expressed in the second statistical test is 125% (reciprocal of 80%).

For statistical reasons, all data is log-transformed prior to conducting statistical testing. In practice, these statistical tests are carried out using an analysis of variance procedure (ANOVA) and calculating a 90% confidence interval for each pharmacokinetic parameter (Cmax and AUC). The confidence interval for both pharmacokinetic parameters, AUC and Cmax, must be entirely within the 80% to 125% boundaries cited above. Because the mean of the study data lies in the center of the 90% confidence interval, the mean of the data is usually close to 100% (a test/reference ratio of 1). Different statistical criteria are sometimes used when bioequivalence is demonstrated through comparative clinical trials pharmacodynamic studies, or comparative in-vitro methodology.

The bioequivalence methodology and criteria described above simultaneously control for both, differences in the average response between test and reference, as well as the precision with which the average response in the population is estimated. This precision depends on the within-subject (normal volunteer or patient) variability in the pharmacokinetic parameters (AUC and Cmax) of the two products and on the number of subjects in the study. The width of the 90% confidence interval is a reflection in part of the within-subject variability of the test and reference products in the bioequivalence study. A test product with no differences in the average response when compared to the reference might still fail to pass the bioequivalence criteria if the variability of one or both products is high and the bioequivalence study has insufficient statistical power (i.e., insufficient number of subjects). Likewise, a test product with low variability may pass the bioequivalence criteria, when there are somewhat larger differences in the average response.

This system of assessing bioequivalence of generic products assures that these substitutable products do not deviate substantially in in-vivo performance from the reference product. The Office of Generic Drugs has conducted two surveys to quantify the differences between generic and brand name products. The first survey included 224 bioequivalence studies submitted in approved applications during 1985 and 1986. The observed average differences between reference and generic products for AUC was 3.5% (JAMA, Sept. 4, 1987, Vol. 258, No. 9). The second survey included 127 bioequivalence studies submitted to the agency in 273 ANDAs approved in 1997. The three measures reviewed include AUC(0-t), AUC(0-inf), and Cmax. The observed average differences between the reference and generic products were + 3.47% (SD 2.84) for AUC(0-t), + 3.25% (SD 2.97) for AUC(0-inf), and + 4.29% (SD 3.72) for Cmax (JAMA, Dec. 1, 1999, Vol. 282, No. 21).

The primary concern from the regulatory point of view is the protection of the patient against approval of products that are not bioequivalent. The current practice of carrying out two one-sided tests at the 0.05 level of significance ensures that there is no more than a 5% chance that a generic product that is not truly equivalent to the reference will be approved.

Or you could understand that while there is a small likelihood that a generic that isn't completely bioequivalent could be approved, the likelihood is still there. Nevertheless, "99.9%" bioequivalence isn't far off from 96.5%, but there's always people out there who'll take that 3.5% average (meaning there is a likelihood of variance) and run with it.

(Coincidentally Shorty, there is a study being worked on by Columbia University regarding self-administered vs. clinician-administered intramuscular injections.)

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Originally Posted by The Dopefish

(Coincidentally Shorty, there is a study being worked on by Columbia University regarding self-administered vs. clinician-administered intramuscular injections.)

Oh.
Spiffy.

Thanks for the info! =)

Jam it back in, in the dark.

Quote:

Nevertheless, "99.9%" bioequivalence isn't far off from 96.5%, but there's always people out there who'll take that 3.5% average (meaning there is a likelihood of variance) and run with it.

Well, this is where precision and accuracy come into play as two separate things to be concerned about with quality control. Sure, the average may be on the mark, but if their precision is poor that could result in a large variation between dosages. I imagine for medicines where you're supposed to keep a fairly level amount in your system this could matter if you, say, get a batch that's at the 80% level and then your next refill is at the 125% level. If you're taking two pills a day, your prescription pretty much went up by over 50%.

Quote:

Still makes me laugh when people say that only a certain brand of pain killer works for them since they are literally all exactly the same thing.

Not sure if you're talking about, like, Advil versus Tylenol, but they are pretty different since they have different active ingredients in them.

There's nowhere I can't reach.

I assumed he was referring to opioids (like MS Contin versus OxyContin, or whatever the UK equivalent is).

How ya doing, buddy?

Originally Posted by Sassafrass

Not sure which pill you're on. I'd guess ortho tricyclen based on my own experience with Planned Parenthood. (They mail pills to you? Wow, that's convenient. Have they been doing this since you were 18? I never got this option )

I'm not sure if the Planned Parenthood in my hometown mails them out, honestly. I started out there, then moved my files to the office in Keene, where I went to college. I was just more comfortable with the doctors there; in Keene they're used to seeing girls that want to prevent a pregnancy, while in Meriden they seemed surprised that I wasn't there to get rid of one. There's always been an option to have it mailed with Keene, so after I moved back, I had them do just that. The trip once a year usually gives me an excuse to see friends anyways.

As for what pill I'm on, it's been changing lately. From the beginning until about a year ago, I was on Ortho Tri-Cyclen Lo, and absolutely loved it. Then some rule went into effect where they couldn't bill insurance companies for anything but generic brands, so I was put on... Trinessa? I think that's what it was. Apparently I was in the minority who hated the switch... My PMS got worse and I felt like crying over stupid little things. So I told my doctor at my yearly exam, and she put me on plain old Ortho Tri-Cyclen, which has been working well. And now I have one month before my prescription has been switched to Levora, because of another bullshit rule about billing insurance. We'll see how that goes.

I am a dolphin, do you want me on your body?

Originally Posted by DieSeLFueLeD

Paco, you and your girlfriend should go discuss this with a doctor who is up to date on the current options, their drawbacks/side effects and any recent studies on any of the drugs.

Yeah, we decided this as well because she was given so many options, she thought she'd be better off with both of us there so we're seeing the doctor tomorrow evening after I'm off work. She's pretty sure she wants the injections and, ultimately, it will be her choice but she wants my input as well so I'm OK with all this.

I was speaking idiomatically.

Originally Posted by RacinReaver

Not sure if you're talking about, like, Advil versus Tylenol, but they are pretty different since they have different active ingredients in them.

No, I'm talking about buying Nurofen Ibuprofen tablets for £2.99 a pack or Tesco own-brand Ibuprofen tablets for 89p a pack when both are just 200mg Ibuprofen tablets that were made on the same production line but idiots will swear the expensive ones work better.

What kind of toxic man-thing is happening now?

I understand the idea of wanting there to be a period every month for reassurance, but when you're on the pill is it not just a withdrawal bleed from the medication not being supplied during that week? I didn't think it was a real one.

I used to be on the pill, but I don't have insurance anymore so I decided against it for now. I haven't looked into going to one of those women's clinics yet, but I imagine I could get it cheaper there. without insurane it's kinda ridiculous. I don't need it to regulate anything but the prevention of babby.

FELIPE NO

Ava, when I was without insurance my state had a service to give birth control & women's health services (pap smears, probably pregnancy health checks too) for poor folks. I didn't find out about it until I went to a free clinic; so, it would be worth your while looking into it.

I don't know what you mean about "real" menstruation. It's not like the blood coming out is from a wound the pill gave you; it's still the same stuff you would have if you weren't on it.

What, you don't want my bikini-clad body?

You could try pulling out.

Jam it back in, in the dark.

6 years running now with no birth control and no babies. Technically 7 years and some change but I've been away now for 18 months.

There's nowhere I can't reach.

Originally Posted by Gumby

6 years running now with no birth control and no babies. Technically 7 years and some change but I've been away now for 18 months.

So exactly how long did you have to keep your balls in the microwave to pull that off?

This thing is sticky, and I don't like it. I don't appreciate it.

No, he just hasn't has sex for 7 years.

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Or he nails dudes exclusively. Or women but only up the butt because they're mormon. HMMM the possibilities are much broader than I initially thought.

I was speaking idiomatically.

Being 6000 miles away works rather well too.

What kind of toxic man-thing is happening now?

Not when Skills is involved.

FELIPE NO

When you're packing this kind of heat, 6000 miles ain't an issue baby~

How ya doing, buddy?

LOL!

Never been with a guy and I've never been with a Mormon. Either I have the best luck ever or I'm shooting blanks.

Jam it back in, in the dark.

So 4 minutes then you stir and remove the cellophane then put them back in for an additional minute and a half?

There's nowhere I can't reach.