By Dawn Stacey M.Ed, LMHC. Contraception Expert
Dawn Stacey is the Contraception Expert at About.com. She is also a published author, college professor, licensed mental health counselor, and a former family planning specialist, health educator, and pregnancy options counselor for Planned Parenthood.
Updated December 16, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
What is Ortho Tri-Cyclen Lo?
- 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 tablets and do not contain any hormones.
Because the amount of progestin in Ortho Tri-Cylcen Lo gradually increases each week through the duration of the pack, the combination of hormones changes every seven days through.
Triphasic birth control pills like Ortho Tri-Cyclen Lo are meant to more closely mimic the hormonal changes of a woman’s natural menstrual cycle. Ortho Tri-Cyclen Lo comes with a DIALPAK Tablet Dispenser which is preset for a Sunday Start, yet a Day 1 Start is also provided.
Ortho Tri-Cyclen Lo Side Effects:
As with any type of hormonal contraceptive. you may experience some side effects (that usually go away after the first 3 months) if you use Ortho Tri-Cyclen Lo. The most common reported side effects of this triphasic pill are:
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- Nausea and/or vomiting
- Spotting or irregular bleeding
- Difficulty wearing contact lenses
- Fluid retention (that may or may not cause finger or ankle swelling)
- 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. In a study of 1,723 women who used this birth control pill. only 4% (69 women) stopped their pill use due to side effects. Only 1 woman discontinued due to weight gain and less than 1% (
Another randomized, multicenter trial analyzed bleeding data of healthy, sexually active Ortho Tri-Cyclen Lo users (18–45 years old) collected from 221 North American centers. Results showed that women using Ortho Tri-Cyclen Lo had lower incidences of unscheduled bleeding for the first six cycles of use.
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 oral contraceptive side effect during the first three months of use).
A nationwide, randomized 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 researchers found that, as compared to Loestrin Fe, Ortho Tri-Cyclen Lo users reported:
- Lower breakthrough bleeding rates per cycle
- A lower rate of spotting/breakthrough bleeding during the first 3 months
- Lower discontinuation rate due to irregular bleeding irregularities
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; however, research has suggested that lower estrogen pills (like Ortho Tri-Cyclen Lo) are effective in the treatment of acne.
Missing an Ortho Tri-Cyclen Lo Pill:
Because the hormone levels are different each week in these triphasic pills, you will need to follow different directions depending on which week you forget to take a pill(s). 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). When 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 back-up 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 back-up 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 back-up 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 back-up method.
Combination birth control pills are a highly effective and convenient form of contraception. The pill is 92-99.7% effective. With typical use, 8 out of every 100 women will become pregnant during the first year of pill use. With perfect use, less than 1 will become pregnant. Regardless of the type/amount of hormones in the pill, all combination pills essentially work the same way to prevent pregnancy.
One multicenter study that examined the contraceptive effectiveness of Ortho Tri-Cyclen Lo found this triphasic pill to be 98.1% effective (typical use). Of the 1,723 women who used Ortho Tri-Cyclen Lo for 13 cycles in this study, 35 became pregnant. Thus, it was concluded that with typical use, 1.9 out of every 100 sexually active females using Ortho Tri-Cyclen Lo will become pregnant in one year.
In another randomized study of 1,671 women who used Orth Tri-Cyclen, 39 became pregnant. The researchers calculated it's effectiveness to be 97.65%. This means that for every 100 sexually active women who use Ortho Tri-Cyclen Lo, 2.36 will become pregnant in one year.
The research supports that even though Ortho Tri-Cyclen Lo contains a lower amount of hormones as compared to other combination pills, this brand 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 cycle/pack of pills. There is a generic alternative available -- Tri-Lo Sprintec. According to Janssen Pharmaceuticals (manufacturer of Ortho Tri-Cyclen Lo), this pill brand is covered by over 80% of most health insurance plan formularies and is the lowest branded co-pay on most managed care plans.
The company also offers a $15 off coupon: Ortho Tri-Cyclen Lo Coupon
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.
Ortho Tri-Cyclen Lo (norgestimate and ethinyl estradiol) kit. [Janssen Pharmaceuticals, Inc.]. Daily Med. Accessed: March 1, 2013. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=a1cfdb57-58fd-4fbd-ae18-571c97bff2cd