Amethyst (Formerly Lybrel)

Amethyst and Lybrel are brands of birth control pills designed to prevent ovulation and pregnancy. They are the first continuous-cycle birth control pills ever manufactured. This type of  birth control pill is taken everyday without any break periods for an entire year. This seemingly minor change comes with the added effect of suppressing menstruation for as long as the pill is taken.

What is Lybrel?

Lybrel is a discontinued combination birth control pill, like Seasonique, designed to be taken all year round without a placebo or pill-free interval. Unlike other combination birth control pills, Lybrel was the first continuous-cycle birth control pill intended to be taken everyday.1 This means that Lybrel reduces or completely eliminates menstruation for as long as it is taken. Lybrel suppresses menstruation by altering the body’s estrogen and progestin hormone levels. These hormones can increase the risk of blood clot complications , so anyone with a family history of blood clots is discouraged from taking Lybrel. Non-hormonal and progestin-only forms of birth control are equally effective alternatives that do not carry the same risk.2 Since Lybrel and other combination birth control pills do not protect against sexually transmitted infections (STIs), a male or female condom should be used in conjunction with Lybrel. 

How Continuous-Cycle Pills and Extended-Cycle Pills Work

Lybrel, like other combination birth control pills, contains estrogen and progestin.2 Increasing levels of estrogen and progestin in the body suppress ovulation, and prevent pregnancy. Lybrel thickens the cervical mucus, making it harder for sperm to enter the uterus. It also alters the endometrium, making it harder for the users to sustain an embryo.3 Females who take birth control pills with a placebo phase still experience a monthly period. However, this bleeding is not a result of normal menstruation, during which the body sheds its uterine lining. Instead, the pills work to prevent ovulation from occurring and, as a result, the uterine lining is never formed. Because of this, the monthly bleeding is a result of hormone withdrawal rather than menstruation.3 The unnecessary monthly bleeding experienced because of this hormone withdrawal is preventable through birth control methods such as Lybrel.3 The continued menstrual suppression from extended-cycle and continuous-cycle birth control pills is both safe and easily reversible.2

The Difference Between Continuous-Cycle Pills and Extended-Cycle Pills

Continuous-cycle birth control pills, like Lybrel, differ from extended-cycle birth control pills, like Seasonique, in that they are able to stop menstrual bleeding for an entire year.4 A Lybrel package contains 365 pills, one pill for each day, without any breaks or placebo phases in between.1 Each Lybrel pill contains lower doses of estrogen and progestin than traditional birth control pills. This allows the body to maintain stable hormone levels for longer lengths of time and severely reduces monthly bleeding. However, Lybrel works differently on every individual and may result in unpredictable bleeding.3 Lybrel may therefore seem unappealing to some when compared to the more predictable, but also more frequent, bleeding from combination birth control pills and extended-cycle birth control pills. 

How to Use Lybrel

Each Lybrel pack is separated into 12 groups that come with 28 pills each. One tablet should be taken by orally (with or without food) every day, at the same time each day. As soon as one group is finished, the next group begins.

If you miss any pills:

  • One Missed Pill- Take it as soon as you remember, and take the next pill at its regular time. (two pills in one day)

  • Two Missed Pills- Take the two pills as soon as you remember, and then take two more the next day. Following that, take one pill per day,  as usual.

  • Three+ Missed Pills- Contact your healthcare provider. Meanwhile keep taking one pill each day.

For extra protection, use a separate form of birth control (like a condom) for the seven days following a missed pill.5

Effectiveness

Clinical studies of Lybrel and its generic version, Amethyst, have a typical use failure rate of about 2.3%.6 This means that approximately two out of every one hundred typical females taking Lybrel will unintentionally become pregnant over the course of  a year. Typical use accounts for human error, as people may occasionally fail to take the pill at the same time each day, or at all. With perfect use, the failure rate drops down to 1.6%.

Side Effects

One of the most common side effects of taking Lybrel, or its generics, is unpredictable vaginal spotting or bleeding for the first few months of use.7 Some individuals continue to have these symptoms even after a year of use. After thirteen weeks of using Lybrel, 52.9% of females reported amenorrhea (no menstrual period), and 79% of females reported minimal to no bleeding. In clinical studies, females experienced fewer mood swings with Lybrel than with traditional birth control pills, since their hormone levels remained more balanced throughout the year. Females over the age of 35 who smoke are also discouraged from using hormonal birth control methods due to an increased risk of blood clots and stroke.5 Nausea, headache, cramps, swelling, weight change, breast tenderness, and vomiting have also been reported, but these symptoms are typical with many other forms of hormonal birth control. Discuss with your doctor the risks and benefits of any hormonal birth control before making a decision.

Amethyst and Generics

Since 2014, Lybrel has been discontinued and is no longer being manufactured by Wyeth Pharmaceuticals, Inc.3 This does not mean that Lybrel was recalled, or found dangerous in any way. It is very common for pharmaceutical companies to discontinue the production of a drug after their patent has expired and generic versions of that drug begin to appear on the market. This inevitably leads to confusion and frustration for consumers as a drug that they had been taking suddenly disappears for seemingly no reason. While Lybrel is gone, its legacy as the first continuous-cycle birth control pill was inherited by the generic version, Amethyst. While the term “generic” might make the product seem subpar or suspicious, most generic drugs are exact copies of the name-brand drug. 8There is no reason to be concerned about taking Amethyst instead of Lybrel, as Amethyst was designed to be the exact same drug as Lybrel with all of its benefits (as well as all of its side effects). Before taking Amethyst, discuss the potential benefits and side effects with your doctor to make sure it is your best option.

Overview

Amethyst, the generic version of Lybrel, is a continuous-cycle birth control pill intended to reduce or completely eliminate menstruation for as long as it is taken. By supplying a constant, low-dosage of the hormones estrogen and progestin, Amethyst keeps the body at a stable hormone level that both prevents pregnancy and stops menstruation.  Common side effects of taking Amethyst include: nausea, headache, cramps, swelling, weight change, breast tenderness, and vomiting. These side effects, as well as the main effects of birth control and menstruation suppression, are easily reversed when the pills are no longer consumed and fertility will return to normal levels approximately one month after the user has stopped taking Amethyst.

 

References

  1. Stacy, Dawn. “Lybrel Birth Control Is Now Discontinued.” Verywell, 26 June 2017.

  2. Jacobson, Janet C., et al. “Extended and Continuous Combined Contraceptive Regimens for Menstrual Suppression.” Journal of Midwifery &Amp; Women’s Health, Blackwell Publishing Inc, 6 Dec. 2012.

  3. Monson, Kristi, and Arthur Schoenstadt. “Lybrel.” Women Home Page, EMedTV, 13 Jan. 2017.

  4. Bonnema, Rachel A., and Abby L. Spencer. “The New Extended-Cycle Levonorgestrel-Ethinyl Estradiol Oral Contraceptives.” Clinical Medicine Insights. Reproductive Health, Libertas Academica, 19 Sept. 2011.

  5. “Lybrel.” The Food and Drug Administration.

  6. McCarthy, Lisa, and Harvinder Brar. “Levonorgestrel/Ethinyl Estradiol (Lybrel) for Continuous Contraception.” American Family Physician, Am Fam Physician, 15 Jan. 2008.

  7. “Lybrel Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing.” WebMD.

  8. Center for Drug Evaluation and Research. “Questions & Answers - Generic Drugs: Questions & Answers.” U S Food and Drug Administration Home Page, Center for Drug Evaluation and Research, 24 Aug. 2017.

Last Updated: 31 October 2017.

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