Anyone who has seen the infamous episode of Seinfeld, where Elaine's birth control of choice, "the sponge," gets taken off the market, knows that women are very attached to their birth control. She spends the episode buying up all the sponges in New York and then carefully rationing them. When you find a birth control method you really like, you want to stick with it. So, it can be a little unsettling to try a generic version of our birth control pills.
Yes, generic drugs are supposed to be equivalent to the brand name version, but can you really trust generic birth control pills? On one hand you want to save money, on the other hand, you want to stick with what’s tried and true. Let’s face it, the stakes are high: If your generic rash cream isn't the right dose, you might just itch for a few extra days; but if your generic birth control pill doesn't work, you might end up with a baby.
What is a generic birth control pill?
According to the U.S. Food and Drug Administration (FDA), generics are “copies of brand name drugs that have exactly the same dose, intended use, side effects, route of administration, risks, safety, and strength as the original drug.” However, a generic version may have different colors, or inactive ingredients. The FDA estimates that 50% of generic drug production occurs in the same plants used to manufacture the brand name drugs (Office of Generic Drugs, FDA, 2009), but active ingredients can vary by up to 10%.
The American College of Obstetricians and Gynecologists published an opinion statement, “Brand versus generic oral contraceptives.” It supports patient or clinician preference in choice of BCPs as brand and generic are considered medically equal.
Why use a generic BCP?
Generic birth control pills are often cheaper or even free on many insurance plans. The great majority of women do well on generic birth control pills. The variations in active and inactive ingredients are not enough to impact effectiveness for pregnancy prevention.
What about differences in side effects between generic and brand name BCPs?
Generic drugs, by law, are required to look differently than their brand name counterparts — despite having the same effects. This has to do with trademark protection. Often a generic BCP will have different colors and/or different inactive ingredients (i.e., fillers) than the brand name version. The different fillers and the slight variations in active ingredients do not affect the effectiveness of the pills for preventing pregnancy, but they can definitely affect the side effect profile.
Some women will get break through bleeding, mood changes, acne, or other side effects when they switch from name brand to generic. Others say they simply "feel off" on different pills. What really throws some women for a loop is when their insurance or pharmacy frequently changes their generic brands. There are now several different generics for the same formulations and some patients find that they are getting a different brand each month.
The birth control has many other benefits besides preventing pregnancy. It is often used to treat heavy menstrual bleeding, cramps, and PMS. For women who are more sensitive to hormonal variations may find that do better on branded pills than generics.
It is important to remember that side effects can be a common issue for BCP users. In a group of 1657 women who were either new to birth control pills, or switching birth control methods, 46% of those who discontinued BCPs cited side effects as the cause. Even without a change from a brand to generic version, BCP side effects may arise over time.
What should you do if it seems that a generic BCP is causing problems?
Ask to be switched back, or even switched to another generic version of the same formula. If you find a generic version that you are doing well on and your pharmacy no longer provides it then you may need to call around to several pharmacies and find the exact generic you want. Additionally, if your insurance stops covering your favorite generic, it may be worth paying out of pocket as generic birth control pills can be very inexpensive (sometimes $10/ month or less).
When I start patients on birth control pills, I usually prescribe a generic low dose birth control pill. Generics pills are often up to 80% less expensive, and if they work well for the patient then that is definitely the best option. If the generics have side effects, or if the patient needs to be on birth control pills for reasons other than contraception (abnormal bleeding or PMS), then they may need a name brand option. No woman is the same, so we cannot expect them to react the same to each pill. Luckily we have over 70 different options of generic and branded pills to choose from. If the birth control pill is your contraceptive of choice, your doctor can probably find one that works for you.