Switching from injection to pill

Dear Dr Mitchell,

I would love to have your advice and confirmation on how I should switch from the Mesigyna shot to the contraceptive pill Yasmin. I have been taking Mesigyna for almost a year now, seven months to be exact. My last Mesigyna shot was on the 21st of December and I am due for another shot on the 20th of January. On January 8 I felt crampy and upon going to the bathroom, I had a little bleeding that simply looked like spotting. I assumed this was my period. I was advised that I could start taking the pill on that day, considering it was the first day of my period, and it would take immediate effect. Can I be assured that this is so? I took the pill as suggested.

Secondly, with the Mesigyna, I was often a little confused about whether I was having my period or simply having breakthrough bleeding because it was so light and the pain is bearable. Have I taken the pill at the right time? What is the right way to switch from Mesigyna to the pill, with immediate effect?

Mesigyna is an injectable contraceptive preparation that contains both oestrogen and progesterone. It is given once monthly (every 28 days). It offers a convenient alternative to the combined oral contraceptive pill since it replaces taking a birth control pill every day for 21 days, with a single injection every 28 days. The side effect profile is similar to that of the combined oral contraceptive pill since it contains both oestrogen and progesterone (50mg Norethisterone Enanthate and 5mg Estradiol Valerate). If there is a contraindication to using oestrogen-containing preparations, then Mesigyna should not be used.

Women who use Mesigyna get their regular monthly periods and for some women this is an important factor since they consider this more natural. The other alternative to the Mesigyna is the Depoprovera injection which contains progesterone only, which is given every 90 days. Over prolonged usage and usually within a year, there is no monthly period. This is an advantage for women who usually have heavy periods and are anaemic, since it prevents blood loss and allows time to replenish iron stores.

If you would like to switch over to the oral contraceptive pill Yasmin, you should take the first pill when the next Mesigyna injection is due and take a pill every day for 21 days. You will then take a seven-day break and then start a new pack. During the seven-day break (pill-free interval) you will get a menstrual period.

Yasmin is a combined oral contraceptive pill that contains 30 micrograms of Ethinyl Estradiol, and three milligrams of Drospirenone as the progesterone component. Yaz is similar to Yasmin except that it contains 20 micrograms of oestrogen and comes in a packet with 28 pills. There are 24 active pills and four placebo (iron pills). You take one every day and just go on to the next pack. During the last four pills in the packet (iron or placebo pills), you will get a menstrual period. The presentation with 28 pills helps you to remember when to take the next pack of pills since you take one pill daily and start another pack on completion. It has fewer side effects since the dose of oestrogen is less than Yasmin and gives you the same benefits since both contain Drospirenone. It is a better option, especially in women who get bloating, weight gain and pre-menstrual syndrome with the associated mood changes and depression.

You have to be disciplined and remember to take a pill every day once you have decided to switch to the combined oral contraceptive pill Yasmin or Yaz. If you miss a pill, take it as soon as you remember and take the next one when it is due. If you miss as many as three pills you will get breakthrough bleeding and your risk of unwanted pregnancy is increased. You should use a condom if this happens and consider an alternative form of contraception if this happens frequently.

Remember, the use of the oral contraceptive pill or the contraceptive injection does not prevent sexually transmitted infections. Safe sexual practice with condom usage, male or female, should be practised while using the birth control pills.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.

DISCLAIMER

The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.