Special Considerations for Women Using Birth Control Pills
Birth control pills are often used in HIV to regulate abnormal menstrual cycles or for women entering menopause. The pill comes in many different formulations; some contain progesterone, others contain both estrogen and progesterone. Every woman responds differently to the pill, and you may need to try several types or doses before you find the best fit.
Combined pills contain high amounts of ethinyl-estradiol, a synthetic version of the strongest estrogen in your body. While necessary to prevent pregnancy, high doses lead to side effects in many women and are not safe if you're over 50. If you use the pill to regulate periods rather than to prevent pregnancy, you can consider much lower-dosed tablets.
Many of the currently prescribed anti-HIV drugs interact with ethinyl-estradiol, the main ingredient in most birth control pills. If you're taking Norvir, Kaletra, Viracept, Viramune or, possibly, Agenerase, the pill may be less effective. Crixivan, Sustiva and, possibly, Rescriptor can increase ethinyl-estradiol to levels that are higher than you need. Remember, many women take these drugs in combinations, where the effect on the pill is even less clear.
If you're using the pill with any of these drugs, ask your doctor about whether you need to alter the dose of your pill in order to maintain effectiveness or to reduce side effects from the pill. If a dose adjustment isn't possible and you're using the pill to prevent pregnancy, you'll need to use condoms or another form of contraception.
As you can see, there's the potential for drug interactions in almost every HIV treatment decision. That's why it's so important to tell your provider about any medications, methadone, street drugs, herbs or hormones you're taking along with your HIV regimen. Any time you are prescribed a new medication, be sure to ask your doctor and pharmacist about possible interactions. As part of the drug dispensing service, all pharmacies are required to help you identify potential drug interactions. Don't be afraid to use this service.