Contraceptives (for slim girls)

[blackion]

Hello,

My girlfriend is about 36-37 kg of weight. I have noticed, that when she is on the pill she is irritable. I would say, her behavior resembles that of pregnant girl. Like, "Honey, it's too cold switch off the air.. No, it's too hot, switch on the air." And it accompanies with her easily get really angry, even breaks things about small issues. When she is not on the pill, she hasn't got this kind of behavior.

She has switched the brands and types of the pills several times, seemingly the same.

1) All medicines are dose-weight related. I would assume that pill was designed to ensure that woman who is 80+kg is protected. Perhaps she should be receiving 1/2 or even 1/3 of the dose? So, are there any pills with low dosage of the active ingredients?

2) I have been to Watson and there are 3rd generations pills. I think she haven't tried them yet. They do look a bit expensive like 200-300 baht. Where could I buy generic versions of the 3rd generation?

[thepool]

Why not just pay for her to consult with a Gynecologist ?

There many contraceptive options available

Swapping and changing "pills" is unlikely to provide a solution.

[h90]

I know many medications will be calculated as mg/kg body weight.

She might need just half the dose.....

Maybe ask the moderator if it is suitable to post it at the ladies subforum. Here it seems are mostly grumpy old fat men.....who most probably don't know too much about it.

[Sheryl]

It would be wise for a woman that thin to take a pill with the lowest amount of estrogen which would be 20mg. Several brands with this in Thailand:

Annylynn

Meliane

Mercilon

Minny

Novynette

Yaz

All of the above contain 20mcg of ethyinlestradial. Most contain as progestin gestodene; some have 75 mcg of it (Mercilon, Meliane, Annylynn) but some have 150 mcg (Novynette, Minny). Yaz has an altogether different progestin, Drospirenone 3 mg.

Birth control pills contain 2 different hormones: an estrogen and a progestin. Adverese side effects can be due to either one. In my experience the symptoms you describe are more likely to be due to the progestin than to the estrogen component. (Though it would still be prudent for a woman of low body weight to take a lower dose of the estrogen, on health grounds).

If you can tell me which brands of pill she has already taken I may be able to make a suggestion as to what to try instead

Some women react badly to any syntehtic progestin,if that proves to be the case she would do better with a non-hormonal type of contraception such as an IUD. But let me know first which brands she has already tried.

One important caveat: with lower does pills the risk of pregnancy if a single dose is missed is much greater.

[firefox999uk]

see...just ask a woman they know most things.....good post Sheryl.

[HerbalEd]

Re. the OP's "They do look a bit expensive like 200-300 baht."

Wow! Your gf is willing to suffer the side-effects of the pill but you're resistant to paying a bit more for better meds? Then I guess you paying for her to see a qualified gynecologist is out of the question.

[slipperylobster]

Her behavior is probably more than just a chemical imbalance. She might have some other issues.

[SunnyBkk]

Just use condoms.

[godden]

Want to know something ask a teenager

[natway09]

Well done Sheryl, Great reply, although think an appointment with a Dr would be a good idea.

[monkeycountry]

"They do look a bit expensive like 200-300 baht. Where could I buy generic versions of the 3rd generation?"

I think I know why she is irritable/angry

[Always18]

When I first met my dear lady many years ago she was taking a very cheap (early generation) Thai contraceptive pill which I did a bit of research about and decided there were probably much safer later gen versions.

In the UK my GP prescribed Yasmin tabs for her and she continues to take them now - about 300-400 Baht, but I wouldn't consider the price to be at all relevant to the health of the one I love...............

BTW - my wife weighs about 50Kg and I would welcome any updated info from Sheryl or others about the choice of Yasmin for her today - are there any later gen options she might be wise to try?

Thanks in advance.

[BigSkip]

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Why not just pay for her to consult with a Gynecologist ?

There many contraceptive options available

Swapping and changing "pills" is unlikely to provide a solution.

Re. the OP's "They do look a bit expensive like 200-300 baht."

Wow! Your gf is willing to suffer the side-effects of the pill but you're resistant to paying a bit more for better meds? Then I guess you paying for her to see a qualified gynecologist is out of the question.

WOW Can't agree more with these 2 posts, Stop being so cheap and get her to a good Doctor, what a tight ass

[tracker1]

see...just ask a woman they know most things.....good post Sheryl.

Thats true whether right or wrong !!!!!

[Chupup]

<script type='text/javascript'>window.mod_pagespeed_start = Number(new Date());</script>

Why not just pay for her to consult with a Gynecologist ?

There many contraceptive options available

Swapping and changing "pills" is unlikely to provide a solution.

[Sheryl]

When I first met my dear lady many years ago she was taking a very cheap (early generation) Thai contraceptive pill which I did a bit of research about and decided there were probably much safer later gen versions.

In the UK my GP prescribed Yasmin tabs for her and she continues to take them now - about 300-400 Baht, but I wouldn't consider the price to be at all relevant to the health of the one I love...............

BTW - my wife weighs about 50Kg and I would welcome any updated info from Sheryl or others about the choice of Yasmin for her today - are there any later gen options she might be wise to try?

Thanks in advance.

With OCs, the concerns (assuming the woman has no contraindications to their use over all) are: 1) the dose of estrogen and 2) the choice of progestin.

Yasmin contains Drospirenone 3 mg (a progestin) amd 30 mcg of ethinylestradiol (estrogen).

Estrogen doses in pills on the market today range form 20 mcg to 50 mcg. 30 mcg is the most common and is comparatively low dose though not the very lowest available. For a 50 kg woman 30 mcg should be fine. A switch to 20 will mean a greater risk of failure even if taken regularly (not a huge increase, but a few percentage point increase) and absolutely would have to use another form of contraception for the rest of the cycle if she ever forgot a dose.

As to choice of progestin, that is somewhat idiosyncric and varies with the woman. If she feels well on the Yasmin, then nothing to be gained by changing.

In the OP's case, where the woman weighs less than 40 kg, changing to 20mcg estrogen is advisable on health grounds, and as she is having mood swings etc, a change of progestin should also be tried.

Re consulting a doctor, unless there is concern that she may have risk factors that would make oral contraceptives unadvisable, you frankly aren't going to gain much. Would have to see an unusually well trained gyn to find a doc really knowldgable about OCs in Thailand and they aren't going to have any more to tell you than I already have.

BTW I recently conducted research on side effects of OCs in Cambodian women and linkage to nutritional status. Most side effects were indeed more common in women of low weight (independent of socioeconomic status) and some side effects -- not all -- significantly improved with Vitamin B6 supplementation. Specifically, nausea and depression improved, especially in thinner women. 10 mg daily of the B6. There have been studies in Western women as well that also found B6 to help reduce mental depression associated with OC use.

[LaraC]

Sheryls reply should be your focus OP.

I am estrogen dominant during certain times of the month.

I try to counteract that naturally by eating foods which are (supposed to be) estrogen inhibitors such as kale, broccoli etc, and staying away from foods high in estrogen such as soy.

The difficulty is that many foods these days are grown with synthetic estrogen hormones, which we end up eating (chicken feed etc.)

Obviously as Sheryl said, you should find out what her sensitivity is first via a doctor, then I suggest looking into natural methods to try counteract.

Personally I think doctors want to use creams and medicines that may have side effects in themselves that may be damaging to health..which I don't think should be a first approach.

Would be good to know Sheryl's thoughts on that though, as she will have more professional knowledge.

[LaraC]

..oh and of course then choose a contraceptive pill based on those results. Or ask the doctor what is recommended based on her sensitivity levels.

[akentryan]

I'm not a gynecologist but I'll take a look at it.

Just joking, saw that on a tee-shirt recently.

[Sheryl]

Sheryls reply should be your focus OP.

I am estrogen dominant during certain times of the month.

I try to counteract that naturally by eating foods which are (supposed to be) estrogen inhibitors such as kale, broccoli etc, and staying away from foods high in estrogen such as soy.

The difficulty is that many foods these days are grown with synthetic estrogen hormones, which we end up eating (chicken feed etc.)

Obviously as Sheryl said, you should find out what her sensitivity is first via a doctor, then I suggest looking into natural methods to try counteract.

Personally I think doctors want to use creams and medicines that may have side effects in themselves that may be damaging to health..which I don't think should be a first approach.

Would be good to know Sheryl's thoughts on that though, as she will have more professional knowledge.

PMDD (which some believe to be due to estrogen dominance) responds well to natural progesterone. If that is not enough, addition of a low dose of sertraline (and SSRI), sometimes needed just in the last half of the cycle, also helps and the two together are very effective. I suffered badly from this for years so speak from both experience as wel as professional knowledge. Soy does not actually contain estrogens but rather phytoestrogens and research has nto supported the idea that it helps with estrogen deficiency so likewise it may not worsen estrogen dominance. B6 and evening primrose oil have both been advocated but failed to stand in research findings. Food additives are indeed an issue but hard to avoid. My advice for anyone with PMDD: do not use OCs (use non-hormonal contraception, i.e. IUD or barrier method), use a natural progesterone (cream, gel or suppository are best but micronized oral can also be sued) and if that alone is not enough discuss adding sertraline (depends on the severity of course -- mine was really, really bad) with a physician.

But it does not sound like this is the OP's gf's problem since she is fine when off the pills.

I'm not sure what you mean by "sensitivity". There are some specific contraindications to the use of OCs as well as some relative contraindications (e.g. history of stroke or blood clots, hypertension, history of breast cancer) and women with those should not use OCs in any form. Beyond that, as with any medicaton the lowest effective dose is best and for women of average weight that will be 30mcg of the estrogen (maximum 35 mcg if overweight or having problems with break-through spotting) and for a very thin woman, 20 mcg. Women of normal weight can also use 20mcg (AKA the "mini-pill") but they need to understand that there is a trade-off in effectiveness and also that they may have problems with break-through spotting.

Progestins as mentioned are trial and error. Fact is synthetic progestins are a poor substitute for progesterone and cause a lot of unpleasant side effects (and may also be the culprit in some of the health problems identified with long term HRT in post-menopausal women) but to date no-one has manufactured a contraceptive with natural progesterone. It would work as a contraceptive (and there are websites advising women on how to do this) but the necessary research has not been done to establish effectiveness rates and optimal dosage so anyone trying that is doing it at their own risk (in terms of unintended pregnancy - health risks from natural progesterone are minimal).

[thepool]

+1

However finding the "right" pill or other means of contraception is not ,I would suggest, a process of random DIY .

Professional guidance /advice would be very helpful in achieving a satisfactory outcome.

In this instance we are also not told about what the lady herself wishes !

[Always18]

When I first met my dear lady many years ago she was taking a very cheap (early generation) Thai contraceptive pill which I did a bit of research about and decided there were probably much safer later gen versions.

In the UK my GP prescribed Yasmin tabs for her and she continues to take them now - about 300-400 Baht, but I wouldn't consider the price to be at all relevant to the health of the one I love...............

BTW - my wife weighs about 50Kg and I would welcome any updated info from Sheryl or others about the choice of Yasmin for her today - are there any later gen options she might be wise to try?

Thanks in advance.

With OCs, the concerns (assuming the woman has no contraindications to their use over all) are: 1) the dose of estrogen and 2) the choice of progestin.

Yasmin contains Drospirenone 3 mg (a progestin) amd 30 mcg of ethinylestradiol (estrogen).

Estrogen doses in pills on the market today range form 20 mcg to 50 mcg. 30 mcg is the most common and is comparatively low dose though not the very lowest available. For a 50 kg woman 30 mcg should be fine. A switch to 20 will mean a greater risk of failure even if taken regularly (not a huge increase, but a few percentage point increase) and absolutely would have to use another form of contraception for the rest of the cycle if she ever forgot a dose.

As to choice of progestin, that is somewhat idiosyncric and varies with the woman. If she feels well on the Yasmin, then nothing to be gained by changing.

Many thanks Sheryl for that detailed and very helpful response.

[belg]

it might be called bi-pilor and nothing to do with the pill

but 36 kg ? how old is she ?

my daughters weigh more than this woman ?

[Sheryl]

it might be called bi-pilor and nothing to do with the pill

but 36 kg ? how old is she ?

my daughters weigh more than this woman ?

These are well known side effects of the pill, and he states that she is fine when off them.

Presumably she is also quite short.

[mrfaroukh]

Most diet pills are bad news for your health. I tried one of them and after 3 days I taught I am dying and had to rush to the hospital.

[saakura]

36kgs seems very frail unless she is a midget. Feed her with good nutritious food, milk and lots of fruit to increase her weight.