Ortho Tri-Cyclen Lo Birth Control Pill

Triphasic Birth Control Pill

Ortho Tri-Cyclen Lo
Ortho Tri-Cyclen Lo. Photo © Dawn Stacey

Ortho Tri-Cyclen Lo is a brand of combination birth control pills. This is a triphasic birth control pill -- this means that Ortho Tri-Cyclen Lo has three different doses of hormones during the three weeks of active pills in each pack. Triphasic pills are different from traditional monophasic pills -- which are made up of the same dose of both estrogen and progestin.

What's in a Pack of Ortho Tri-Cylcen Lo?

Each monthly pack of Ortho Tri-Cylcen Lo contains 28 pills.

The active pills are made up of ethinyl estradiol and the progestin, norgestimate. Each week of an Ortho Tri-Cyclen Lo birth control pill pack has a different combination of these hormones:

  • Week 1: Each of these seven pills are white and contain 0.025 mg of ethinyl estradiol and 0.180 mg of norgestimate.
  • Week 2: Each of these seven pills are light blue and contain 0.025 mg of ethinyl estradiol and 0.215 mg of norgestimate.
  • Week 3: Each of these seven pills are dark blue and contain 0.025 mg of ethinyl estradiol and 0.250 mg of norgestimate.
  • Week 4: Each of these seven pills are dark green; theses are placebo pills and do not contain any hormones.

The amount of progestin in Ortho Tri-Cylcen Lo slowly increases each week of the pill pack, but the amount of estrogen stays the same. Triphasic birth control pills, like Ortho Tri-Cyclen Lo, are meant to more closely mimic the hormonal changes of your natural menstrual cycle.

Ortho Tri-Cyclen Lo comes with a DIALPAK Tablet Dispenser which is preset for a Sunday Start. But, you can also use Ortho Tri-cyclen Lo with a Day 1 Start.

Ortho Tri-Cyclen Lo Side Effects:

As with any type of hormonal contraceptive, you may experience some side effects if you use Ortho Tri-Cyclen Lo -- but, it may be good to know that these side effects usually go away after the first 3 months.

The most common reported side effects of the Ortho Tri-Cyclen Lo birth control pill are:

  • Nausea and/or vomiting
  • Spotting or irregular bleeding
  • Difficulty wearing contact lenses
  • Fluid retention 
  • Weight gain and/or change in appetite
  • Spotty darkening of the skin (usually the face)
  • Elevated blood pressure
  • Breast tenderness
  • Headache and/or dizziness
  • Depression and/or nervousness
  • Hair loss

Research has shown that the hormone combination in Ortho Tri-Cyclen Lo tends to be well-tolerated by most women. In a study of 1,723 women who used this birth control pill, only 4% (69 women) stopped using Ortho Tri-Cyclen Lo because of its side effects. 

Another study looked at the bleeding rates of healthy, sexually active Ortho Tri-Cyclen Lo users from across North America. The results showed that women using Ortho Tri-Cyclen Lo had a lower amount of unscheduled bleeding/spotting for the first six cycles of use.

Does Ortho Tri-Cyclen Lo Offer Any Noncontraceptive Benefits?

In general, combination birth control pills have been found to help regulate cycles, decrease painful menstrual cramps, help with menorrhagia (heavy bleeding), and lower the risk of colon, ovarian, and endometrial cancer.

It is thought that Ortho Tri-Cyclen Lo can be especially helpful in decreasing disruptive spotting and breakthrough bleeding -- which tends to be a typical birth control pill side effect during the first three months of use.

A nationwide study compared women who used Ortho Tri-Cyclen Lo for 13 cycles to women who used Loestrin Fe (another birth control pill with lower hormone levels). The results showed that -- when compared to women who used Loestrin Fe, women using Ortho Tri-Cyclen Lo reported:

  • Lower breakthrough bleeding per cycle.
  • A lower rate of spotting/breakthrough bleeding during the first 3 months.
  • Lower discontinuation rate due to irregular bleeding.

Some combination birth control pills can also help treat acne. In 1997, Ortho Tri-Cyclen (NOT Ortho Tri-Cyclen Lo) received FDA approval to help treat moderate acne in females who are at least 15 years old. Ortho Tri-Cyclen Lo does not have FDA approval to help fight acne -- but research suggests that lower estrogen pills (like Ortho Tri-Cyclen Lo) are effective in the treatment of acne.

What Happens if I Miss Taking an Ortho Tri-Cyclen Lo Pill?

Because the hormone levels are different in each week of an Ortho Tri-Cyclen Lo pill pack, you will need to follow different directions depending on which week you forget to take a pill. The following is a good rule of thumb to follow (but you should always check with the pill prescribing information that comes with each monthly pack).

If you are using Ortho Tri-Cyclen Lo, and you forget to take:

  • ONE White, Light Blue or Dark Blue Pill: Take the pill as soon as you remember, and take the next pill at your regular time (you may take two pills in one day); no backup contraception is needed.
  • TWO White Pills (Week 1) or TWO Light Blue (Week 2) Pills in a Row: Take two pills on the day you remember and two pills the next day. Then take one pill each day until you finish the pack; you could become pregnant if you have sex in the 7 days after you miss these pills, so use a backup birth control method for those 7 days.
  • TWO Dark Blue (Week 3) Pills in a Row: If you are a Sunday Starter, continue taking one pill every day until Sunday. On Sunday, throw out the remainder of the pack and start a new pack of pills that same day. If you are a Day 1 Starter, throw out your current Ortho Tri-Cyclen Lo pill pack and begin a new pack that same day. If you forget to take two pills during Week 3, you may not have your withdrawal period this month, but you could become pregnant if you have sex in the 7 days after you miss these pills; use a back-up method for those 7 days.
  • THREE or More White, Light Blue or Dark Blue Pills In a Row: Sunday Starter -- continue taking one pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new one. Day 1 Starter -- throw out the remainder of the pill pack and start a new pack that same day. When you miss three or more pills, you may not have your period this month, but you are still at risk of getting pregnant if you have sex in the 7 days after missing these pills; use backup contraception.
  • Any of the 7 Dark Green "Reminder" Pills (Week 4): Throw away the pill(s) you missed and continue taking these green pills every day until the pack is finished -- you do not need a backup method.

Ortho Tri-Cyclen Lo Effectiveness:

Combination birth control pills are a highly effective and convenient form of contraception. Ortho Tri-Cyclen Lo birth control pills are 91-99.7% effective. This means that with typical use, 9 out of every 100 women will become pregnant during the first year of Ortho Tri-Cyclen Lo pill use. With perfect use, less than 1 will become pregnant. The type/amount of hormones in combination birth control pills do not change how effective the pill is. All combination pills basically work the same way to prevent pregnancy.

Are you concerned that Ortho Tri-Cyclen Lo is not as effective as other birth control pills because it has a lower amount of hormones? If so, there is no need to worry. Research shows that even though Ortho Tri-Cyclen Lo contains a lower amount of hormones as compared to other combination pills, this brand of birth control pills is still an extremely effective contraceptive method.

Ortho Tri-Cyclen Lo Costs:

It appears that the price for Ortho Tri-Cyclen Lo ranges between $45-$140 per one pack of pills. There is a generic alternative available -- Tri-Lo Sprintec. Under the Affordable Care Act, you should be able to get the generic version of these birth control pills for free. Ortho Tri-Cyclen Lo seems to be covered by over 80% of most health insurance plans. But, if you want to buy Ortho Tri-Cyclen Lo (and not its generic alternative), you are probably going to have a co-pay when buying this birth control pill brand.

Sources:

Burkman R, Fisher AC, Wan GJ, Barnowski E, LaGuardia KD. "Association between efficacy and body weight or body mass index for two low-dose oral contraceptives." Contraception. 2009; 79(6):424-427. Full article accessed via private subscription.

Burkman R, LaGuardia K, Fisher A, Wu SC, Creasy G. "An assessment of Ortho Tri-Cyclen Lo on body weight and study discontinuation." Poster presented at: 51st Annual Clinical Meeting of the American College of Obstetricians and Gynecologists; April 26-30, 2003; New Orleans, LA. Accessed via private subscription.

Hampton RM, Fisher AC, Pagano S, LaGuardia, KD. "Scheduled and unscheduled bleeding patterns with two combined hormonal contraceptives: Application of new recommendations for standardization." Fertility and Sterility. 2009; 92(2):434-440. Full article accessed via private subscription.

Hampton RM, Short M, Bieber E, Bouchard C, Ayotte N, Schangold G, Fisher AC, Creasy GW. "Comparison of a novel norgestimate/ethlnyl estradiol oral contraceptive (Ortho Tri-Cyclen Lo) with the oral contraceptive Loestrin Fe 1/20." Contraception. 2001; 63:289-295. Full article accessed via private subscription.

Huber J, Walch K. "Treating acne with oral contraceptives: Use of lower doses." Contraception. 2006; 73(1):23-29. Full article accessed via private subscription.

Ortho Tri-Cyclen Lo (norgestimate and ethinyl estradiol) kit. [Janssen Pharmaceuticals, Inc.]. Daily Med. Accessed: March 16, 2016. 

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