Portia

Use Portia birth control pills to avoid pregnancy

If you experience nausea, breast tenderness or headaches when taking standard birth control pills, Portia may be a good option to try as it contains only a low dose of estrogen.

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Information

Reviewed by Dr Yasmin Aghajan, MD

Information last reviewed 07/07/19

About

What is Portia?

Portia is a type of low-estrogen birth control pill. The pack contains both active pills and placebo pills, so it is ideal if you find it hard to remember when you need to take your pills again after your period. The lower levels of estrogen in Portia, make it a good alternative birth control pill for people who experience strong estrogen side effects, such as nausea, headaches and breast tenderness. 

How does Portia work?

Portia is a combined contraceptive pill, meaning that it contains synthetic versions of two female sex hormones: estrogen and progesterone.  The progesterone in Portia helps to prevent ovulation, and also thickens the mucus around the vagina and cervix. This helps to reduce the chances of an egg being fertilized by sperm.  The estrogen in Portia alters the endometrium (the lining of the uterus) so that a fertilized egg would be unable to implant itself and, therefore, is unable to progress to pregnancy, so the fertilized egg will naturally leave the body on its own.  

How effective is Portia?

Portia is 99% effective in preventing pregnancy. Actual success rates, which take into account women who occasionally miss a pill, are about 97%. Remember, Portia will not protect you from contracting STIs (sexually transmitted infections) and nor will any other form of hormonal contraceptive. The only form of contraception to offer protection from STIs is condoms.

Ingredients

Active ingredients

Portia contains both pink active pills and white placebo pills. The white placebo pills do not contain any active ingredients and are designed just to help you remember when you need to start the next pack. The active ingredients in the pink Portia pills are 30mcg ethinyl estradiol (EE) and 0.15mg norethindrone. This is quite a low dose of ethinyl estradiol - the synthetic estrogen - which should help to reduce estrogen-related side effects. 

Inactive ingredients

The inactive ingredients in the pink Portia pills are: Anhydrous lactose, hypromellose, magnesium stearate, and microcrystalline cellulose, FD&C blue no. 1 aluminum lake, FD&C red no. 40 aluminum lake, hypromellose, polyethylene glycol, polysorbate 80, and titanium dioxide.

The inactive ingredients in the white placebo pills are: Anhydrous lactose, hypromellose, magnesium stearate, and microcrystalline cellulose.

Dosage

Portia dosage

The usual dosage of Portia is 1 x pink, active tablets (containing 30 mcg ethinyl estradiol and 0.15 mg Norethindrone) per day for the first 21 days, and one white inert tablet per day for the following 7 days.

How to start Portia

Always read the package instructions carefully before starting Portia, and never start taking it without first consulting a doctor. Portia comes in 28-day blister packs, labeled with the days of the week and containing 21 pin active pills and 7 white inert pills. You will need to wait until the first Sunday after your period starts to begin taking Portia: take the first pink active pill in the pack, which will be labeled as a Sunday, even if you are still bleeding. You will need to use an additional method of contraception, such as condoms, for the first 7 days after starting Portia.

How to take Portia

Take 1 pill each day, at the same time each day, following the days of the week marked on the pack. To help you remember, try and make this a part of your daily routine: for example, take your pill each morning when you brush your teeth. When you reach the end of the 21 active pills, continue with the inactive pills the next day. During the 7 days when you are taking the inactive pills, you will experience a withdrawal bleed, which simulates a natural period. This does not necessarily mean that your period will last for 7 days. When you reach the end of the calendar pack, you should start the next one on the next day, so always make sure you have a new pack ready.

What should I do if I miss a pill?

Missing a dose of Portia can make it less effective in preventing pregnancy. If you miss 1 pill, take it as soon as you remember and take the next one at the usual time. This may mean you take 2 pills in one day and you will not need to use a back-up method of birth control. If you miss 2 days in a row, take 2 pills as soon as you remember and 2 pills the next day, then continue as normal. You are advised to use an additional method of birth control for the next 7 days, as the effectiveness of Portia may have been weakened. If you are unsure what to do about missed pills, contact your doctor or health worker for advice.

Side Effects

Portia side effects

Common side effects of Portia include:

  • Nausea

  • Breast tenderness

  • Headaches

  • Irregular periods

  • Spotting

 

If you experience any of the following side effects of Portia you should seek immediate medical advice:

  • Symptoms of an allergic reaction - breathing difficulties, hives, swelling of mouth, face, lips, tongue or throat.

  • Symptoms of liver problems - dark urine, fatigue, loss of appetite, upset stomach, stomach pain, jaundice (yellow skin & eyes), light-coloured stools

  • Symptoms of gallbladder problems - pain in upper right abdomen, right shoulder or between shoulder blades; dark urine, change in stools, jaundice (yellow skin & eyes), fever, chills.

  • Symptoms of high blood pressure - severe headache, dizziness, fainting, visual changes

  • Symptoms of high blood sugar - confusion, fatigue, excessive thirst, increased appetite, frequent urination, hot flushes/flashes, fast breathing, fruit-smell to breath.

  • Symptoms of a blood clot - chest pain, coughing up blood, shortness of breath, swelling, warmth, numbness, change of skin color, pain in a leg or arm, difficulty speaking or problems swallowing.

  • Symptoms of a stroke - Weakness on one side, speech problems, confusion, loss of coordination, change in balance, drooping on one side of the face, or blurred eyesight.

  • Symptoms affecting mood - mood changes, low mood, depression, difficulty falling asleep, fatigue.

  • Symptoms affecting the eyes - Loss of eyesight, bulging eyes, changes in vision, increased discomfort when using contact lenses.

  • Symptoms affecting the breasts - Lump in the breast, breast soreness/tenderness, nipple discharge

  • Symptoms affecting the genitourinary system - Difficulty urinating, changes in amount of urine, vaginal itching, vaginal discharge, spotting, heavy vaginal bleeding

  • Other physical symptoms - Weakness, upset stomach, vomiting, swelling, abdominal pain.

This list of side effects is not exhaustive. You should always read the patient information leaflet before taking any medication.

Contraindications

Do NOT take Portia if:

  • You are or suspect you may be pregnant, or are trying to get pregnant
  • You have previously had a stroke or a heart attack
  • You have blood clots in the legs (thrombophlebitis), lungs (pulmonary embolism) or eyes
  • You previously had blood clots in the deep veins of your legs
  • You experienced chest pain (angina pectoris)
  • You have or suspect you may have breast cancer, cancer of the lining of the uterus, or cervical cancer
  • You experience unexplained vaginal bleeding
  • You have had jaundice (yellowing of the skin or whites of the eyes) during pregnancy or during the use of other contraceptive pills
  • You have a benign or cancerous liver tumor

Before taking Portia, inform your doctor and be careful if:

  • You smoke. It is advisable to refrain from smoking while taking the pill.
  • You have breast nodules, fibrocystic disease of the breast, and abnormal breast x-ray or mammogram
  • You have diabetes
  • You have elevated cholesterol or triglycerides
  • You have high blood pressure
  • You experience migraines, other headaches, or epilepsy
  • You suffer from depression
  • You have heart, gallbladder or kidney problems
  • You have/had irregular menstrual periods

Drug interactions

Before you take Portia, tell your doctor about any other medications you are taking (non-prescription) or medications you have been prescribed. Among the drugs that are known to interfere with the effectiveness of Portia are:

  • Drugs for epilepsy, such as barbiturates (e.g. phenobarbital), phenytoin, primidone, topiramate, and phenylbutazone
  • Some drugs for HIV, including ritonavir and modafinil
  • Certain antibiotics, such as ampicillin and other penicillins, and tetracyclines
  • St John’s Wort, an herbal remedy used to treat depression
  • Lamotrigine, an anticonvulsant used for epilepsy. Portia may interact with Lamotrigine and increase the risk of seizures.
  • Bosentan
  • Carbamazepine
  • Felbamate
  • Griseofulvin
  • Oxcarbazepine
  • Topiramate

Do NOT take Portia if you are taking any Hepatitis C drug combination containing ombitasvir/paritaprevir/ritonavir with or without dasabuvir.

Treatment Options

Alternatives to Portia

Portia is a low-estrogen form of hormonal contraceptive, and is therefore suited to women who are particularly sensitive to estrogens and suffer from estrogen-related side effects. However, there are many different types of hormonal contraceptives, and women often try a few different ones before finding one that is a good fit for them. The progestogen-only pill, also known as the mini pill, is also a good option for women who are sensitive to estrogen or who take other medications which may interact with the combined pill. The progestogen-only pill is continuous, meaning it does not allow a break for a monthly bleed, and in some cases can also be used by women who are breastfeeding. 

You may wish to try a form of hormonal contraception that does not require you to remember daily administration and is not taken orally. These include the implant (Implanon, Nexplanon), the shot (Depo-Provera), and the intrauterine device (IUD, Mirena, ParaGard, Skyla, Liletta, Kyleena). In particular, the IUD may be appropriate for women with other health conditions, such as diabetes or hypertension, as it works locally to the reproductive system. Speak to your doctor or health worker for information and advice about these types of contraception.

Alternatively, some women choose to avoid hormonal contraceptives altogether and rely on barrier methods of contraception. These include the cervical cap (FemCap) and Male and Female Condoms. Male condoms are the only form of contraception to offer protection from STIs.  

Q&A

Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.

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