What are the differences in potential side effects between Blisovi (Norethindrone/Ethinyl Estradiol) and Ortho Tri-Cyclen Lo (Norgestimate/Ethinyl Estradiol), and which factors influence the choice between these two oral contraceptives?

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Last updated: May 10, 2025 • View editorial policy

From the Guidelines

When choosing between Blisovi and Ortho Tri-Cyclen Lo, it is essential to consider the potential side effects and individual health needs, as both medications have different compositions and effects, with Ortho Tri-Cyclen Lo being a better option for those sensitive to androgenic side effects like acne due to its lower androgenic activity compared to Blisovi 1.

Comparison of Blisovi and Ortho Tri-Cyclen Lo

Both Blisovi and Ortho Tri-Cyclen Lo are combination hormonal contraceptives containing estrogen and progestin. However, they differ in their progestin components, with Blisovi containing norethindrone and Ortho Tri-Cyclen Lo containing norgestimate in a triphasic formulation.

  • Blisovi may be preferred for individuals who experience breakthrough bleeding with triphasic pills or desire consistent hormone levels throughout their cycle.
  • Ortho Tri-Cyclen Lo might be a better option for those sensitive to androgenic side effects, such as acne or hair growth, due to norgestimate's lower androgenic activity.

Potential Side Effects

Both medications share common side effects, including:

  • Nausea
  • Headaches
  • Breast tenderness
  • Mood changes However, Blisovi may cause more breakthrough bleeding initially, while Ortho Tri-Cyclen Lo is FDA-approved for acne treatment 1.

Medical History Considerations

It is crucial to discuss personal health history with a healthcare provider before making a decision, as factors such as:

  • High blood pressure
  • Migraines with aura
  • Blood clotting disorders
  • Smoking status
  • Age can affect the risk profile and influence the choice between Blisovi and Ortho Tri-Cyclen Lo 2, 3.

From the FDA Drug Label

The relative risk of heart attack for current oral contraceptive users has been estimated to be two to six (4 to 10). The risk is very low in women under the age of 30 Smoking in combination with oral contraceptive use has been shown to contribute substantially to the incidence of myocardial infarction in women in their mid-thirties or older with smoking accounting for the majority of excess cases (11) A positive association has been observed between the amount of estrogen and progestogen in oral contraceptives and the risk of vascular disease (31 to 33)

The FDA drug labels for Blisovi and Ortho Tri-Cyclen Lo do not provide a direct comparison of the two in terms of potential side effects. However, both drugs are oral contraceptives that contain estrogen and progestogen, which have been associated with an increased risk of vascular disease and myocardial infarction, particularly in women over 35 who smoke.

  • Key factors to consider when choosing between the two drugs include the patient's age, smoking status, and underlying risk factors for cardiovascular disease.
  • Minimizing exposure to estrogen and progestogen is recommended, and the dosage regimen prescribed should contain the least amount of these hormones that is compatible with a low failure rate and the needs of the individual patient [4] [5].
  • New acceptors of oral contraceptive agents should be started on preparations containing 0.035 mg or less of estrogen.
  • It is essential to weigh the potential benefits and risks of each drug and consider the individual patient's needs and medical history when making a decision.

From the Research

Comparison of Blisovi and Ortho Tri-Cyclen Lo

  • Blisovi and Ortho Tri-Cyclen Lo are two oral contraceptive options that have been compared in terms of their efficacy, safety, and cycle control.
  • A study comparing Ortho Tri-Cyclen Lo with Loestrin Fe 1/20 found that Ortho Tri-Cyclen Lo had better cycle control, with a lower percentage of participants experiencing breakthrough bleeding and spotting 6.
  • Another study found that Ortho Tri-Cyclen Lo had comparable efficacy and safety to Ortho Tri-Cyclen, with a lower dose of ethinyl estradiol 7.

Potential Side Effects

  • Common side effects of oral contraceptives like Blisovi and Ortho Tri-Cyclen Lo include nausea, vomiting, breast tenderness, and mood changes.
  • A study found that women taking Ortho Tri-Cyclen Lo had a lower incidence of breakthrough bleeding and spotting compared to those taking Loestrin Fe 1/20 8.
  • Another study found that Ortho Tri-Cyclen Lo had a favorable effect on lipid and androgen metabolism, with an increase in high-density lipoprotein and a decrease in free testosterone 9.

Choosing Between Blisovi and Ortho Tri-Cyclen Lo

  • The choice between Blisovi and Ortho Tri-Cyclen Lo may depend on individual factors such as medical history, lifestyle, and personal preferences.
  • Women who experience breakthrough bleeding and spotting with other oral contraceptives may prefer Ortho Tri-Cyclen Lo due to its better cycle control 6, 8.
  • Women with concerns about lipid and androgen metabolism may also prefer Ortho Tri-Cyclen Lo due to its favorable effects on these parameters 9.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.