Oral contraceptive tolerance: does the type of pill matter?

To examine the frequencies of reported symptoms by oral contraceptive pill (OCP) composition among French women.

A population-based cohort of 2,863 women studied between 2000 and 2004 was used to compare the frequency of reported symptoms (weight gain, nausea, breast tenderness, lower frequency of menstrual periods, breakthrough bleeding, painful and heavy periods, swollen legs) by type of OCPs (classified by estrogen dosage, progestin component, and sequence of administration).

Results show little variation in the frequency of symptoms by type of OCPs, with the exception of progestin-only pills being associated with higher frequencies of breakthrough bleeding and lower frequencies of menstrual periods. We found no decrease in the reporting of symptoms with the reduction of estrogen dosage, nor with the use of third-generation OCPs compared with second-generation OCPs. Likewise, we found little variation by sequence of administration of OCPs (monophasic versus triphasic).

In the absence of sufficient evidence-based data to support the existence of differences in the tolerance profile of low-dose combined OCPs, future well-designed randomized trials are needed to guide providers in their choice of OCPs. However, research should also assess the effectiveness of counseling on the tolerance of OCPs, an intervention that may prove to be more rewarding than basing the choice of OCPs on their theoretical properties.