Dear Dr. Kate,
A few months ago, I read (on a reputable website) that generic birth control pills can sometimes not be as effective as their name brand counterparts because they do not always contain the same amount or combination of hormones. I am a poor college student, so $5 for pills each month sounds way better than $30, but not if I’m not getting the same amount of protection. I’d gladly pay the extra $25 if it meant significantly higher protection from pregnancy. Is it true that generic pills are less effective? And if they are, are there any generics that are better than others?
— Scared of Generics
The FDA mandates that brand-name drugs and their generic versions need to be chemically the same drug. Generic pills have to have the same active ingredients, the same dosing, and the same kind of absorption. What’s different? Colors, shapes, imprints, and preservatives…but the medication is the same.
So why do some women claim to see huge differences when they switch to the generic form of their favorite pill? It may be a reaction to the inactive ingredients in the new pill; these ingredients don’t affect how the pill works to prevent pregnancy, but intolerance of them may cause side effects. The other reason is a bit more high-school-chemistry, and is related to the bioavailability of the drug. Bioavailability is the amount of time it takes the drug to be metabolized by the body. The makers of generic pills must show that the bioavailability of their generic is not significantly different (plus or minus 20%) from that of the name brand. So generics have the same amount of hormones, but it may take a different amount of time for your body to absorb it. This difference shouldn’t change the efficacy of the pill, either, but it may cause side effects in women who are sensitive to small changes in hormone levels.
All pill manufacturers have to guarantee that the hormone doses in each pill are what they claim they are, plus or minus this 20%. So that gets a little scary with any pills, especially the ultra-low-dose ones (with 20mcg of estrogen), because what if you get a batch that has a bunch of pills that err on the low side? That’s one of the reasons I’m not a fan of the ultra low dose pills…but the same concerns apply to generics and brands.
My advice is that if the cheaper generic pills don’t cause any crazy bleeding or other side effects, stick with them. And if one generic pill makes you feel bad, you can always try another — I’d hate for anyone to stop using the pill simply because of cost.
— Dr. Kate
Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.