Anne Szarewski
`
`and John Guillebaud
`
`OXFORD UNIVERSITY
`
`PRESS
`
`1998
`
`Pantffs Exhbft
`1O4$JAPTJ
`zip-rm
`PTX 093
`
`WC_LP0405723
`
`Mylan v. Warner Chilcott IPR2015-00682
`WC Ex. 2020, Pg. 1
`
`

`
`mayalsooccurduringthefirstcoupleofmonthsifyou
`
`Side-effects
`
`periodtoallowforsuchadaptation
`
`threemonthsis
`
`About
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`newsenseofbalance
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`the
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`
`intimeas
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`
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`changes
`
`pillcertain
`
`progestogen-duminant
`
`tobeingoestrogendominantandarethen
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`Equallyifyouareused
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`andnegativeeffectsisalsopossible
`
`combm
`hasimproved
`
`insex
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`andyouhavemoreinterest
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`islessgreasy
`
`thatyouracne
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`sideyoumaydiscover
`
`whileFeelingsofbloatingareanotherpossibilityOn
`thoughthismay
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`outodevelopbreast
`
`tenderness
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`oneFheoestrogen
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`progestogen-dominant
`
`to
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`ifyouchangetoanoestrogen-dominant
`
`iousthingsmayhappen
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`gotsuchsorebreastscouldhardlywearbra
`howgoodherskinwasButwhenwentonit
`shecommented
`JanewasgivenOvysmenaridwasabsolutelyfineonitinfact
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`tobeusingdifferent
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`tomuchlesserextentby
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`desogestrelgestodeneandnorgestimate
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`thenewprogestogens
`Theseeffectsarenotcausedorarecaused
`
`vaginaldr3ness
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`weightgainduetoincreasedappetite
`hirsutismexcesshair
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`are
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`Effects
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`acne
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`47
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`side-effects
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`todoabout
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`What
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`amount
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`
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`reasonable
`bodyachieves
`spotsinmanycasestheseproblemswilldisappear
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`given
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`pillalterbeingused
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`theseside-effects
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`Sointact
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`triiaiside-effect
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`theyarefedupwithsonic
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`because
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`pillnotbecause
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`progestogen
`thereforeaccustomedtoitsownnaturaloestrogen
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`pillstopsmostofherownhormoneproduction
`hormonalbalance
`everyone
`thefirstplaceeverywomanwillreact
`tothepill
`findthat
`
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`
`calledminor
`
`in
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`sexwhileImusingit
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`timelookedinthemirror
`spotsonmyfacebut
`itdidseemsillywantingtocomeoffthepillbecause
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`What
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`WhichPillwillSuitmeBest
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`CHAPTER
`
`in
`importanceinmostcasesthebalanceofoestrogen
`nagging
`abouthealthiisksbutprecisely
`themIndeedwomenoftendostoptiw
`thepillwhichareofcoursenotatallminortothosewhoexperience
`Inthischapteiwewillconsidertheso
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`thetwoarecombinedin
`inthe
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`eftect
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`specific
`
`wesawinhdptCm
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`progestogen
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`thesehormones
`formulation
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`pill
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`ontheface
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`breast
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`geiiare
`thetwohormonesisdominating
`thepill
`bodyalthough
`
`thesearemodifiedwhen
`
`Mylan v. Warner Chilcott IPR2015-00682
`WC Ex. 2020, Pg. 2
`
`

`
`foryoutouseoneofthe
`throughbleedingInthatcaseNoriutinorfrinovummightbetried
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`
`youmayheofferedoneofthefollowing
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`newerpills
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`reasonwhyitwouldbebetter
`
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`
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`Microgynoin
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`these
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`namesOf
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`hastwodifferent
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`one
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`each
`
`ismore
`twoformulation
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`
`but
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`control
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`twodifferentmanufacturers
`
`500megnoiethisterofle
`megeihinyloestradiol
`150nicglevonorgestrel
`
`30nageihinyloesuadiot
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`Eachpill
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`iysnlenSrevinor
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`150nit
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`30megethinyloesiradiol
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`35nugeihinylotstradiol
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`
`isilliii
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`theolderpillstheirformulationsareguenbelow
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`Chapter
`
`commonchoicewillbeMicrogynoil
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`reason
`
`unlessthereis
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`choice
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`pillsasfirst
`todootherwisesee
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`1995
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`
`.s
`
`reasonsuch
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`specific
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`unlessthereis
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`35microgramsofoestrogen
`
`pill
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`seeChapter
`
`drug
`
`aninteracting
`
`thepillprescribedforyoudoesnotcontainmorethan
`youshould
`isnotiervtinporlantwhichpillyouaregiven
`
`although
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`younghealthynon-smoker
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`that
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`
`check
`
`atfirst
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`
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`infamilyplanningmaynothe
`theyaremost
`choiceofpills
`
`large
`
`thereisnow
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`lanitharafterall
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`49
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`hattodoaboutside-effects
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`re1atiel
`
`leieiswhenineasujedafter
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`
`threefold
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`ifyougive
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`uithewaythatdifferentwomenabsorbthepill
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`foldsariation
`
`thexeisathree
`
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`isillbevalu
`
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`
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`
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`Anyprciuusexperience
`
`atfirstAnother
`
`them
`
`tenderness
`
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`
`pillmayimprove
`
`dominant
`
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`pillmightsuit
`Doouoften
`
`teudenc
`
`longbreakit
`
`alter
`
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`versaConsequently
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`to
`
`pill
`
`progesrogen-doiflhliant
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`
`oestrogen-dominaflt
`
`fromrelatively
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`change
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`incBest
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`WhichPillwillSuit
`
`48
`
`progeswgen-Ouliiinaflt
`
`tenderbreastsifso
`
`have
`
`toconsideryourpersonalcharacteristics
`
`important
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`timeorrestarting
`
`forthefirst
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`thepill
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`starting
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`thatshouldbetakenintoaccount
`
`factor
`youmaypaytheprice
`greasyhairanoestrogen
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`
`medical
`
`non-cancerous
`lumps
`pillwouldbemoreappropriate
`fustor1-or
`
`itagainandthespotswentbutmybreasts
`
`theyeverfindonethatsuitsmeImgetting
`
`got
`lotofbleedingSothey
`
`thebleedingbutthen
`
`wasonthepillIgot
`
`sofedup
`wereverysoreWill
`spotsSotheychanged
`changedmybrandwhichstopped
`Yearsagowhen
`
`dilleient
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`isquitelikelythatyouwillbeghen
`
`fromthoseofyourfiendsandacquaiittaflces
`aredifferentsoft
`
`andcharacteristics
`
`breast
`
`orfibroidsEachwomanshistory
`
`historyofbenign
`
`progestogen-dominailt
`
`endometriosis
`
`forwomenwith
`example
`
`Oneimportantdiscoveryhasbeen
`
`theyhadonyouitwillbeeasier
`
`effect
`
`inthefuture
`
`theyaretakingexactly
`
`eenthough
`
`lowerdose
`
`levels
`
`as
`
`estblood
`pillitmaybebetter
`varyingside-effects
`thesametimeinterialThesewomenisillcorisequeiltly
`oneswiththelrnsestandlnghestblood
`timeofdaythereislikelytobe
`meansthat
`
`thesetwo
`ofpillwhilethewomanwhohasthe
`resulttogriethewomanwhohasthehigh
`thesame
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`ofpillAlthough
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`higherdose
`
`pillswithwhich
`
`introduce
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`doctor
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`leelsthe\
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`havesimilarblood
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`theirownfavourite
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`strengthpills
`
`doctorshave
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`c-n
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`
`cD
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`cD
`
`ableDifferent
`
`rhepersonalpreferences
`
`factbetakingdifferent
`womenwillthenpresumably
`lowest
`
`levelsmayneed
`
`Mylan v. Warner Chilcott IPR2015-00682
`WC Ex. 2020, Pg. 3
`
`

`
`now
`levelhasbeenreachedeenityou
`
`is
`
`factorsareverysimilaiIt
`
`dose
`andclotting
`
`certain
`
`fatssugars
`
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`totake
`therisksotstaylug
`30-microgrampillaiid
`
`itisanysafer
`
`higherdoseThereisinfactnoevidence
`
`thosewomenwhoaregiven
`
`Whatabout
`
`andsimplydecidetostop
`teethandcarryonbutothersfeel
`of
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`
`toimprovewithin
`
`couple
`
`change
`
`that
`
`wouldbasenochoicebuttoputupwiththesituation
`Martelonandthereisnolower-dose
`iou
`whatoptionwouldyouhaveYoucouldhardlychangeupwaidsto
`youmightwell
`30-microgrampillbut
`IfhoweveryouhadbegunwithMercilon
`allyandpsychologically
`bothphysic
`quiterapidlyYoufeelbetterquicklyandarereassured
`nowAtthispaint
`changingdownwardstoMercilonusuallyhelps
`tosomethingdifferentandprelerab1
`thepillTheywant
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`monthsSomewomengrittheir
`thingsarelikely
`reassured
`Whenyougoandseethedoctorhowwillyoufeel
`
`available
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`
`thesameason
`
`befeeling
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`thepillwassupposedtomakeyourfifeeasier
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`
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`
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`thethirdpacket
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`51
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`Yourjirsttimeonthepill
`
`togisethemthelow
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`wedotendtorer
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`moreuestrogenicpillsincethisislikelytognethemvery4pud
`areextremelysmallManywomenmaalso
`shghth
`loweritfurtherthereisnodifferenceinhealthriskswhich
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`pillsonblood
`MerciloninthelongtermthantotakeMarvelon
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`havenoproblemswithitYoumaywonderabout
`
`commononesfirst
`side-effectswhichstilltroubleyouWewilldiscussthe
`theparticular
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`two
`
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`
`pill
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`itseemsreasonable
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`toMercilonHowever
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`side-eftects
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`behappyon
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`estdosepossibledespite
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`artificialdrugIntheflrstmonthIhadquitealotofIwudaciws
`helpedbymymothertelliagme
`itmustbetotake
`WhenIstarte4takingihepillwasprettyworriedanditwasnt
`
`howunhealthy
`
`youtolerateside-effects
`
`itisduetothepillandallthisworrydoesnothingtohelp
`youmaybeuncertain
`fear
`firststartthepillsinceyoudonotknowwhattoexpectandtendto
`bitanxiouswhenyou
`process
`makeanydifferenceThesignificant
`ismerelytheadaptation
`factor
`startedoffwith20microgramsofoestrogen
`or30doesnotseemto
`greatdiscomfortduringthefirstcoupleofmouthsandwhether
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`andthisisequallytrueforthepillbutsomewomensuffer
`months
`allysettledown
`twoorthree
`makingthebrainthinkthewomanispregnantSuchproblemsusu
`thisishardlysurprisingsinceaswehaveseenthepillworksby
`
`headache
`
`youhave
`
`theworstWhenever
`
`whether
`
`tobeinganthepillYoumayalsobe
`
`thefirst
`
`pregnantwomanafter
`
`in
`
`inearlypregnancy
`
`heseareyouwillrealize
`
`totheproblemswomenoftenhave
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`
`similar
`
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`
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`
`These
`
`sinceit
`
`asMarelonYou
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`
`containsonly20microgramsoloestrogen
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`Mercion
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`
`inMinuletl
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`inMarvelon
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`the150microgramsofdesogestrel
`
`Infact
`
`soitcanbedis
`
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`
`contain30micro
`which
`
`andMinuletlFemodene
`
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`
`progestogens
`
`incombination
`
`levelofthedoseofprogestogen
`gramsofoesirogen
`
`150megdesogesnel
`
`20megethnyloeadol
`
`justmadebydifferent
`listshowsthatMarvelon
`
`areidentical
`
`heabove
`
`Mercilon
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`WhichPillwillSuitmeBest
`
`50
`
`thantothe75microgramsofgestodene
`morecomparable
`thenewprogestogens
`thetimetheprogestogen
`between30and35microgramsissosmallastobemeaningless
`FemodeneCilesthas35microgramsofoestrogen
`notquiteasstrongasthe75microgramsofgestodene
`regarded
`
`to150microgramsoldesagestrel
`isprobably
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`norgestimatewhichatthisdose
`
`instrength
`
`littlebloatedodd
`luststartthepillhave
`goodideaforthetollowing
`
`thisisnotalwa
`
`side-effects
`reasonsManyifnotmostwomenwhenthey
`lowerdoseinfact
`maywonderwhyyoushouldnotstartwithMercilon
`withthesameamountandtypeofprogestogen
`
`Mylan v. Warner Chilcott IPR2015-00682
`WC Ex. 2020, Pg. 4
`
`

`
`thiswasatthecost
`the
`severalpillswithouteitherbleedingorbecomingpregnantalthough
`pillswerebeingusedwomencouldforgt
`bleedingWhenhigh-dose
`missedforgetting
`thjoftenoccursseveral
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`
`impossibletoknowinadvance
`rates
`
`indifferent
`lheenzymesintheliverwhichdestroythepillworkatdifferent
`
`ishowever
`
`peopleIt
`
`havebothbeengivenMarvelonSues
`
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`fast
`
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`newpillUnlesstheconditionisreallyunbearableyou
`bleedingtooccurwhenyou
`
`isprobable
`
`toolittlehormoneit
`
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`
`enough
`shouldtrytowaitforittosettledownacoupleofmonths
`
`Ifthmgsdonotimproveandthereisnoobvious
`
`firststart
`
`Itisnotuncommonforbteakthrough
`
`isdis
`butalsogive
`
`pill
`
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`
`forerrorWhatyoushould
`
`cussedfullyinChapter
`littlemargin
`
`ofhormonesproducefewerside-eflects
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`low-doses
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`
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`ofside-effects
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`weekofbreakthrough
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`singlepill
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`takingthemeverydayAndtheironyislvebeenhaving
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`about
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`fullyinChapter
`
`hisisdiscussed
`
`higher-dosepill
`anartificialaccelerationoftheliverenzymes
`totreatepilepsyand
`
`toheon
`
`riced
`
`towhomthisapplieswill
`
`cancause
`
`Women
`tuberculosis
`
`used
`
`those
`
`Certainmedicinesespecially
`
`sinceherbodywillonlybe
`higherdoseshewillnotsuffer
`thesautebloodlevelaswomanwhohasslow
`higherdoseof
`womanhaslastenz%mesorslowonesBotharequitetior
`
`buthasslowerenzymes
`abietouseIncsameamountaswomanvvlioison
`frommoreside-effects
`enzymesEventhoughshemaytake
`hormonetoachieve
`mabutifwomanhasfastenzymesshewillneed
`
`orhealthrisks
`
`whether
`
`lower-dosepill
`
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`
`if
`
`even
`
`thepillhasbeen
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`bleedingresulting
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`weekafter
`
`daysoreven
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`commoncause
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`Forgettingtotakeoneormorepillsisanothet
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`bleeding
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`Breakthrough
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`c-n
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`cD
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`
`theantibiotics
`
`finished
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`causeswillstopwhenyouarerecoveredorhave
`
`bleedingresulting
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`Breakthrough
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`containsfull
`
`courseofantibioticsChapter
`
`stomach
`
`betakenifyouhave
`
`precautionsshould
`
`fromsuch
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`upsetoraretaking
`contraceptive
`
`levelsAdditional
`fewerofthesebacteriasotheysometimes
`
`blood
`
`adequate
`
`togive
`
`strongerpill
`
`require
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`tonotethatvegetar
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`alongwiththerestitisinteresting
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`iansalsoseemtohave
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`
`gutbacteria
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`onessothesehelpful
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`tokillasmanybacteriaaspossibleregardlessofwhethei
`
`theyarehelpful
`designed
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`oestrogenwhichisabsorbedbutbroad
`Certainbacteriainthegutnormallyhelptoincreasetheamountof
`cycline
`
`inthenextchapter
`
`detaileddiscussionofthisappears
`
`spectrumantibiotics
`
`ortetra
`stomachupset
`fromthegutormoreisbeingdestroyed
`
`likepenicillin
`
`orifyoutakebroad
`intheliverAbsorptionmayhereducedifyouhave
`
`spectrumantibiotics
`
`lessisbeingabsorbed
`
`either
`
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`threefoldvariadon
`
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`above
`
`for
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`
`explanationisthatyourpill
`
`levelsbetweendifferentwomenwhichmeansthat
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`mostobvious
`
`tobeinsutficiently
`
`causesyourhormonelevels
`
`What
`
`pregnancy
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`totakepillsortakeinteractingmedicinesyouniightwdllbeatriskof
`smallermarginforerrorsoifoushouldthenforget
`thatyouhave
`breakthrough
`sign
`
`takeplaceHowever
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`bleedingdoes
`
`thelatteris
`
`toavertpregnancy
`
`hormonepresent
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`sothereissufficient
`theendometriumquietthanthoserequiredtopreventovulation
`areatriskofpregnancyHigherhormonelevelsareneededtokeep
`isnotanindicationthatyou
`thewombfirmlyundercontrol
`theendometriumliningof
`hormonespresent
`highlevelof
`Theusualcauseofthisisthat
`Whatcausesbreakthrough
`
`butit
`inthebloodtokeep
`
`thereisaninsuthciently
`
`bleeding
`
`ofdarkapparentlyoldbloodThisisquitemeaningless
`
`anddoesnothaveanysinisterimplications
`appearance
`
`ofanxietyamongwomenseemstobethe
`oritmaybe
`freeweek
`
`justspottingOnecause
`whenyouhaveyourperiodItmaysometimesbeheavy
`Thisisbleedingwhichoccursotherthanduringthepill
`
`Breakthroughbleeding
`
`WhichPillwillSuitmeBest
`
`52
`
`Mylan v. Warner Chilcott IPR2015-00682
`WC Ex. 2020, Pg. 5
`
`

`
`recordofwhatis
`
`careful
`
`specialcasekeeping
`
`beingdoneandwhyandmakingsureyouarehappytodothis
`willbedoingsoas
`aboutprescribinghigherdosesofthenewempillsoratthevery
`
`least
`themedico-legalpointofviewYourdoctormayheworried
`situation
`
`dithcult
`
`hasmadethis
`
`thepositionwithregardtothekEn
`tomakeabsolutelysuretherearenohealthrisks
`
`thereha
`
`itmustbesaidthat
`
`owever
`
`higher-dosepu1whilestillusing
`
`youtake
`
`toreach50micro
`
`takeoneMerulon
`
`orMinulet/l-emodene
`pillOryoucould
`
`youwillhare
`
`day
`
`ofMercilon
`
`ifyoutaketwotablets
`
`that
`
`theolder
`ifyourproblemisnotsolvedbyoneof
`thenew
`higher-dosepillswith
`
`hismeans
`
`slightly
`
`uponthenewpills
`possibilityistodouble
`whichmaygnemisctootherside-effects
`youareleftwithpillscontaining
`
`Thismeansthat
`
`contain
`
`have
`
`thatwedonot
`
`isunfortunate
`
`It
`
`also
`
`should
`
`ofoestrogen
`
`thenthedose
`
`isstillunsatisfactory
`
`Ifthis
`
`unchanged
`
`dose
`
`leavingtheoestrogen
`
`whilst
`
`pragestogen
`
`ruleistoincreasethestrengthofthe
`
`fewguidelines
`
`youwillneedtodiscuss
`isdowntoyourhormone
`been
`
`bleedinghave
`
`it
`
`seemthat
`
`anditreallydoes
`
`causesofbreakthrough
`
`allother
`
`Once
`
`smear
`
`cervical
`
`recently
`tionsperhapsrelatedtoyourcerixhaveyouhad
`
`55
`
`bleeding
`
`Breakthrough
`
`attheendofthischapter
`higherdosebutyoumaythenhaveotheiproblemsseethesection
`pillhelpstosettlethebleedingpatternwithouthavingtoresort
`
`to
`
`triphasic
`
`todropsolowbeforeyourestartSometimes
`
`fourThismeansyourhormonelevelswillnot
`oneoptionwouldbetoshortenthepill-freeweekfrom
`inthefirstweekof
`
`bleedingalwaysoccurs
`
`Ifyourbreakthrough
`
`isnotyetstrongenough
`
`thepill
`
`that
`
`thismeans
`
`foryou
`bleedingsince
`
`aslongasyouarestillgettingbreakthrough
`
`toincreasethedose
`threemonthstoseeiftheproblemhasbeen
`increased
`be
`
`should
`
`ofpill
`
`change
`
`Each
`
`or
`
`be
`
`isquitesafe
`
`It
`
`solved
`
`two
`
`for
`
`triedout
`
`horn
`ber1995pillscareseeChapter
`withthisapproachliiaddition
`notbeenlargestudies
`oneofthenewprogestogens
`gramsThiswouldallow
`togetherwithMarvelon
`oesirugen
`40-microgram
`
`theabovesuggestions
`progestogens
`50microgramsofethinyloestradiolwhich
`
`beallowed
`sevendaystoperhaps
`yourpacket
`
`Thefirstactiontotakeas
`yourindividualcasewithyourdoctorbuthereare
`bloodlevelswhatshouldyoudoObviously
`excluded
`
`bleedingcan
`yourpillordonthaveanyatallyourpillwillbeat
`timei.emorethanfour
`thatdayIf
`higherdose
`
`different
`
`to
`
`itcouldbeconverted
`
`thisishowbreakthrough
`
`lowerdoseand
`
`juicewithinfourhoursof
`
`lotofgrapefruit
`
`calledtlavinoidswhichit
`juicecanhave
`
`this
`
`exactly
`
`ofothersubstances
`
`thatgrapefruit
`
`ithasbeenshown
`
`ever
`
`tobetrueHow
`Moreresearchhasshown
`high-dose
`oestrogen
`one
`4Q0mgiwithinfourhoursofthepillcouldincreasetheabsorptionof
`over
`
`thisduesnotappear
`
`that
`
`into
`
`pill
`
`low-dose
`
`turning
`
`effectively
`
`takinghighdosesofvitamin
`
`that
`
`tohethought
`
`Itused
`
`about
`reallygoodwayofgettingvitaminCamtheresallthisstuff
`tothegymanddrinkinggrapefruitjuicewell
`theysaythats
`coidsandidecidediwasntgoingtobethesameIstartedgoing
`realhealthbingeeveryoneatworkhasbeengoingdownwith
`
`topreventcoldsLsn
`
`takingvitamin
`
`there
`
`rueBest
`
`WhichPillwillSuit
`
`54
`
`condi
`thepossibilityof
`thebleedinghasnoother
`goodideafor
`explanation
`
`thisisunlikelythereisalways
`
`itwouldbe
`
`toexamineyoutoensurethat
`even
`
`changeofpill
`
`after
`
`bleedingoccurswithoutanyobvious
`
`causeAlthough
`yourdoctor
`andpersists
`Ifbreakthrough
`
`forexamplechlamydiaorothergynaecological
`
`03
`
`c-n
`
`cD
`
`cD
`
`infections
`
`ruinedmeshesaidIwasbleeding
`
`differ
`
`seeifneed
`
`Idbetter
`
`thistimejustthought
`
`becauseufaninfection
`entpilLButwhenthedoctorexa
`happened
`
`bleedingonthepilloncebeforesowhenit
`
`hadbreakthrough
`
`controersial
`
`progestogens
`
`the
`
`Taking
`
`tuneswillnothaveanyeffecthere
`thesameeffect
`
`orFlagylmayhave
`
`tabletsatdifferent
`
`metronidazole
`
`antibioticcalled
`youmayfindyougetbreak
`thatmorehormonecanenterthesystemHeretoo
`byslowingdowntheliverenzymes
`
`ispossiblethat
`
`It
`
`bleeding
`
`through
`whenyoustoptakingtheantibiotic
`withtheresult
`ratherdifferentwayItworks
`cystitiscan
`
`in
`
`though
`
`thepill
`
`of
`
`sometimesincreasethedose
`
`totreat
`
`SeptrinCotrimoxazolewhichisoftenused
`
`Theantibiotic
`
`another
`
`juice
`
`withinfourhoursoftakingthepill
`occurThesimplestsolutionisjusttotrynottodrinkgrapefruit
`itsusual
`hoursapartfrom
`nextdayyoudrinkthejuiceat
`takingyourpill
`containsSoifyoudrink
`effectbutbecause
`
`Mylan v. Warner Chilcott IPR2015-00682
`WC Ex. 2020, Pg. 6
`
`

`
`levonorgestrel
`
`ethinyloestradiol
`and10tabletscontaining30meg
`levonorgestrel
`
`125mcg
`
`75mcg
`tabletscontaining40meg
`
`ethinyloestradiol
`
`levonorgestrel
`
`50meg
`tabletscontaining30meg
`
`erhinyloestradiol
`
`TninordiollLogynon
`
`progestogen-domninant
`
`Triphasics
`
`tabletsofeach
`500meg750megandmg
`
`norethisterone
`
`21tabletsof35megethinyloestradiol
`
`Tninovum
`
`oestrogen-domi.nant
`
`Tniphasics
`
`norethisteroneacetate
`20megethinyloestradiolmg
`
`Ievoriorgestiel
`
`Loestnin20
`
`ISOmcg
`
`30megethinyloestradiol
`
`Microgynon/Ovranette
`
`1.5mg
`
`norethisterone
`30megethmnyloestrathol
`
`Loestrin30
`
`Oldertypeofpithprogestogen-duininant
`
`1mg
`
`norethisterone
`35megethinyloestradiol
`
`500meg
`
`norethisterone
`35megethinyloestradiol
`
`NeoconiNorimin
`
`OvysmenBrevinon
`
`Oldertypeofpilloestrogen-dominant
`
`oroestrogen
`
`theyareprogestogen-
`
`listoftheformulanonsofthevan
`
`dominant
`oustypesofpillandwhether
`Toclarifyallthistherefollows
`
`than
`versionofMierogynon/
`
`control
`
`cycle
`
`bettet
`
`ishopedthismighthave
`slightlylower-dose
`
`i.e
`
`Loestrin20
`OvranetteIt
`itspregestogen
`
`20microgrampillcontaining100microgramsoflevonorgestrelas
`canworkupfromthereWithinthenextyeartheremaybe
`new
`tochangetoMercilonhut
`ifnotyou
`Itwillprobablybesufficient
`thispillhasneverbeenverypopular
`
`Sincethisisalmostuniversal
`
`57
`
`bleeding
`
`Breakthrough
`
`higher
`
`firstifthat
`
`ofoeslro
`
`suffers
`
`from
`
`theolder
`
`difference
`
`bleeding
`
`Co
`
`c-n
`
`cD
`
`cD
`
`ethisterone
`Loestrin2020microgramsofoestrogenplusmilligramofnor
`
`acetate
`
`Youmayneed
`
`itwillbestrongenough
`
`that
`
`guarantee
`
`onepossibilityisMinulet/Femodenebutthereisno
`
`Ifthisoccurs
`
`milligramsofnorethisteroneacetate
`
`regimen
`
`dose
`
`orLoestrin30andthen
`asTnMinuletorTriadenemay
`
`orLoestrin3030microgramsofoestrogenplus1.5
`teroneacetate
`Norimin35microgramsofoesirogenplusmilligramofnorethis
`moveontohigherdoses
`beenoughOrtryMinulet/Femodene
`Oneofthenewertriphasicssuch
`TrinovumED
`Oldertriphasic
`
`EDTrinovuini
`
`pillsTrinordiol/LogynonlLogynon
`
`newtriphasicbut
`
`tryLoestrin30or
`
`higher-dosepill
`
`tryMinulet/Femodene
`
`oflevonorgestrel
`
`whichcontalus30micrograms
`
`otherwiseyouwillneed
`doesnotworkyoucan
`Thisisunusualbutifitoccurs
`genplus150micrograms
`Microgynon/Ovranette
`
`isusuallyenough
`
`BTBonMarvelon
`Chest
`
`andifthisisnousefollowtherulesfor
`commonproblemchangetoMarvelonor
`
`inwomenwhohavehadBTBThispill
`
`especially
`
`bleedsisequally
`
`itandthemissingofwithdrawal
`
`itisalmostmorecommontosuffer
`ofnorethisterone
`
`ofoesrogeti
`
`whichcontain35micrograms
`
`thantoescape
`Onthisformulation
`plus500micrograms
`Ovysmen/Brevinor
`
`newpillsapproach
`50-microgramaestrogenpillsoryoumighttrythedoublingupon
`NoriminorLoestrin30Otherwiseyouwillneedoneoftheolder
`pillsgoforMicrogynonlOvranette
`instancethento
`
`inthefirst
`
`totryoneof
`
`sometimeshelpsIfyouwant
`
`ifthisstilldoesnotwork
`
`but
`
`toMinulet/Femodene
`themtowarrantchangingfromMercilontoMarvelon
`
`triphasic
`
`Change
`
`between
`MerdionMarvelon
`
`notenough
`
`there
`
`orCilest
`
`fordealingwithbreakthrough
`
`formulations
`
`FBonspecificpill
`Herearesomesuggestions
`
`WhichPillwillSuitmeBest
`
`56
`
`tenderness
`frombeingveryoestrogenicallybiasedgoodforskinbutbreast
`frequent
`
`isanother
`
`Mylan v. Warner Chilcott IPR2015-00682
`WC Ex. 2020, Pg. 7
`
`

`
`thensuffer
`
`bychanging
`
`Itwouldalso
`
`should
`
`pillwill
`
`moreprogestogendominant
`
`settlewithintwoorthreemonthsotherwise
`
`itshould
`
`fairlycommonside
`
`thisis
`
`womanbegmstotakethepill
`
`When
`
`went
`
`bitsmallerbythethirdmonthbull
`
`Imalmostbacktothewaylwasbefore
`stillwasnthappyMydoctorchangedmetoMinuletandnow
`uptwobrasLzeTheygot
`WhenifirswentonMarvelonmybreastsjustbaJlooneL
`
`tendernessenlargement
`
`Breast
`
`upsetting
`
`tostayonitunlessyoufindtheabsence
`ofbleedingvery
`theymaydosoIfyouareotherwisehappywithyourpillit
`this
`
`triphasic
`
`pillor
`
`pillwillachieve
`
`thiswillworkNorisitcertainthatmore
`bleedsbychangingbrands
`
`thereisnoguarantee
`
`is
`
`of
`
`thediscomfort
`
`thereisthe
`
`infact
`
`thatyoudonothave
`inmissingwithdrawalbleeds
`
`Thereisnodanger
`
`59
`
`bleeds
`
`Missedwithdrawal
`
`beneeded
`changeofpillshouldwork
`effectbut
`
`andenlargement
`
`asbreasttenderness
`
`breast
`areoestrogenic
`
`likelytocause
`
`that
`
`sinceMarvelonitselfisquiteoestrogenic
`
`tosortoutthe
`
`changetoMarvelonmaybeenough
`
`isparticularly
`
`side-effects
`
`and
`Ovysmen/Brevirior
`
`breast
`youshouldbecare
`isonewhichhas
`pillwilloften
`fromBTB
`toMerdioribut
`bepossible
`betriedorifthat
`
`difference
`
`Ithasinadea
`
`lowfatyoghurts
`
`toadaptmydietbutyoucangethardcheesesnowwith
`
`onlyhalfthefatandofcourse
`ficult
`
`Itwasquitedif
`
`eatanawfullotofeheeseandyoghurL
`
`tarian
`
`thatbecauselmvege
`
`WhenthedoctormentioneditIrealI.ze4
`
`tenderness
`
`tocause
`
`tendency
`
`has
`
`onewhichitself
`
`tochoose
`
`ftilnot
`thesamedoseofhormonesallmonthalthough
`improveifyouchange
`
`that
`
`tomonophasicpill
`
`triphasic
`
`inthelastweekof
`
`tenderness
`
`Breast
`preferablynottoLoestrin20asyoumaywell
`simplytoreducethedoseofoestrogen
`isunavailableMicrogynon/Ovranene
`maynotbesufficientMinulet/Femodene
`problemHowever
`tenderness
`
`isalsoquitelikelythatyouwillhave
`
`It
`
`is
`
`bleedit
`
`veryunlikely
`Althoughmostwomenareanxiouswhentheydonotsee
`
`that
`
`bledforthelasttwoweeksofthe
`
`packerandthenwhenistoppeddidntbleedUIall
`Itwascompletelyridiculous
`
`wassickwithworry
`
`particularlybotherinc
`
`Then
`
`regularasclockwork
`
`Butlastmonthdi4nhaveoneatallwasin
`theystartedtogetlighterbutthatdidn
`Idalwayshadperiodsonatepill
`
`terriblestate
`
`Missedwithdrawalbleeds
`
`isnextin
`
`Guest
`
`isgivenbyMinulet/Femodene
`
`andMerdilon
`
`orderandthenMarvelon
`Bestcycle
`
`control
`
`Mercilon
`Minulet/Femoderte
`Cilest/Marvelon
`
`orderofoestrogendominancetheyare
`
`bleedingIndescending
`
`dominanceandcontrolof
`side
`
`realprogestogenic
`
`hutallvaryintheiroestrogen
`
`effects
`
`exhibits
`
`Amongthenewestpillsnone
`
`isbetter
`
`although
`
`progestogen-dominant
`
`as
`
`30megethinyloestradiol
`
`gestodene
`containing100mcg
`ethinyloestradioland10tablets
`gestodene
`
`40meg
`
`inadvisabletotrytoinducewithdrawal
`bleedingdespitebeingabletohaveyournormalpill-freeweekIt
`considerableadvantage
`
`tabletscontaining70meg
`
`30megethinyloestradiol
`
`gestodene
`
`tabletscontaining50mcg
`
`Tri-Minulet/Triadene
`
`triphasics
`
`Newer
`
`WhichPillwillSuitmellest
`
`58
`
`inallyhavewithdrawal
`testifyounor
`hirthesakeofcertainty
`theretoconicawayBlooddoesnotbuildupinsideNonetheless
`lininghasbuiltupinthewombthereisnothing
`that
`thisisduetopregnancyIndeedevenduringpreg
`
`brand
`pregnancy
`
`particular
`
`having
`
`bleedson
`
`itisworth
`
`isprobable
`
`It
`
`bleeds
`
`ispossibletohavewithdrawal
`
`insufficient
`
`because
`nancyit
`
`since
`nowitlidiawalbleedifyou
`
`bleedingyouwillprobably
`
`breakthrough
`
`further
`
`withdrawalbleedafteryournextpacket
`
`caseassuming
`
`cD
`
`CM
`cD
`
`cD
`-U
`
`have
`youdonothave
`whatliningtherewashasalreadybeenshedInthat
`sufferedfrombreakthrough
`
`bleedingduringthelastpacket
`
`Mylan v. Warner Chilcott IPR2015-00682
`WC Ex. 2020, Pg. 8
`
`

`
`increasein
`
`an
`
`clearly
`
`and
`can
`
`pill
`
`progestogen
`
`goadideatoturnto
`
`andagainitis
`
`dominantpill
`andmigraines
`
`ofsimpleheadaches
`
`worsening
`
`Waterretentioncanoftencause
`
`Headaches/migraines
`
`pifis
`
`pills
`
`by
`
`tooneofthenewest
`lesslikelywiththenewprogestogeristhe
`on
`
`thiswouldbeunusual
`
`fromthisHowever
`
`problemmaythusdisappear
`low-dosepillsandiseven
`weightmayresult
`
`ifyoutrychanging
`
`anincreaseinappetite
`
`cause
`
`narrow
`retentionwhichoccursthenThewristsswelland
`itismorecommoninpregnancyarid
`tunnelsyndromeisanoccasionalmanifestationofthis
`dominantpill
`ruleistoreducethe
`
`ofthenerve
`
`thecarpaltunnelThesquashing
`nervewhichhastopassthrough
`
`although
`
`usemoreprogestogen
`
`thesolutionas
`
`and/or
`byoestrogen
`
`improveif
`
`should
`
`nerveThecondition
`
`inthefingersin
`
`twofingerssincetheyaretheones
`andnumbness
`
`inthethumbandfirst
`tingling
`
`gradual
`
`isreduced
`
`thedoseofoestrogen
`suppliedbythisparticular
`particular
`
`bringsabout
`space
`called
`thisputspressureon
`isduetothewater
`particular
`
`inthewrist
`
`side-effect
`
`Thecarpal
`doseofoestrogen
`
`Sincethisiscaused
`
`itbuildingupeverymonthMytummygetslargerand
`
`canfeel
`
`feelmorelethargicItgetsbetterintheweekImoffthepilL
`
`61
`
`retention
`
`Bloating/water
`
`retention
`
`Bloating/water
`
`take
`
`betriedProgestogens
`lower-dose
`retentioncausedaswehaveseenbyoestro
`Inthefirstplace
`pillsitisalmostunknown
`inthepastweightgainwascommon
`
`foritsoccurrence
`
`todaywiththenewerlow-dose
`
`pillsused
`
`Withthehigh-dose
`
`putonweightMy
`
`mothersoIdsheputonhaifastonewhensheused
`ThethingImmostworriedabout
`
`iswill
`
`thepilL
`
`Weightgain
`
`inwhichcase
`
`can
`gen
`itmaybeduetowater
`Therearetwopossiblereasons
`but
`
`successfully
`
`for
`
`bloodsample
`
`is
`
`it
`
`ifyouare
`
`thisis
`tobeheldresponsibleformaking
`bromocripunewhich
`treatmentandmonitoringwillbeneededthetreatment
`pituitarytumour
`
`called
`
`ofmedicine
`
`thatyoudohave
`
`sometimes
`
`asthiscan
`
`detectthetumourIfitemerges
`youtohave
`
`skullX-ray
`
`levelandwillperhapsarrange
`
`yourprolactin
`
`inordertocheck
`
`specialist
`
`countatitssixe
`thiskindoftumourneverspreadstootherpartsofthebody
`ofprolactin
`sinceanextremelyraretumourofthepituitaryglandcan
`youshouldnot
`
`doctorwhowilltake
`
`inthebrainsolelyon
`
`tooshouldthereforeconsult
`itcancauseseriousproblems
`Although
`
`increaseinthepioduction
`
`large
`
`of
`
`bethecause
`
`also
`
`ignorethisconditionorassumethat
`
`inthebreasts
`bythepillintheproductionoftheliar
`fromthenipplesthismaybedueto
`
`whichstimulatesmilkproduction
`
`increaseinduced
`harmless
`Ifyougetmilkydischarge
`
`fromthenipples
`
`Milkydischarge
`
`seeChapter
`
`progestogen
`
`oraninjectable
`
`ter
`
`harmless
`
`However
`nionepolactin
`
`of
`harmlessconditionitmaygetbetteronitsown
`
`pillmayhelpusuallytomoreprogesto
`
`change
`
`genictype
`
`Sometimes
`
`Ifitisshowntobe
`
`treatment
`
`c-n
`
`cD
`
`cD
`
`tocarryontakingthepillevenwhileouareunder
`thespecialist
`
`bepermitted
`
`tumoursworsebutwiththemodernlow-dose
`
`endocrinologist
`nolongersoYoumayindeed
`such
`shrinksthetumourThepillused
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`
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