Oral Contraceptives

Outline

Definition

Purpose

Types of oral contraceptives

Mechanism of action

Advantages and disadvantages of each type

Summary

Definition

Is a hormonal method of contraception use primarily to prevent

pregnancy.

Types of ocp

Progesterone only

Combined ( Progesterone and oestrogen(estradiol))

Progesterone Only
Progesterone is referred to by one of several names:
Progesteroneis the name for the natural hormone.
Progestogenis a synthetic form.
Progestinis the term for any hormone, natural or synthetic, that causes
progesterone effects.

Two formulations are available: one contains

0.35 mg of norethindrone, the other contains
0.075 mg of norgestrel

Progestins can be divided into the following:

Second generation (levonorgestrel, norethisterone_)

Third generation(desogestrel, gestodene, norgestimate, drospirenone).

Combined

The most common types are estradiol and progestin

Most of the currently available COC formulations contain 20 to

35 mcg of ethinyl estradiol plus one other type of progestins.

Desogestrelis the progestrin used in Mircette.

Drospirenoneis used in Yasmin and Yaz
Levonorgestrelis used in Seasonale and
Seasonique,
Norethindroneis used in Loestrin and Loestrin 24
Fe (which adds iron supplements to the placebo
pills).
Norgestrelis used in many other brands.

Mechanism of Action

Primarily:Exerts negative feedback on the hypothalamicpituitary

axis disruption of follicular growth (reduced secretion of FSH
and LH) =suppresses ovulation

Progesterone causes thickening of the cervix which prevents

sperm from penetrating

Estrogen causes thin, watery mucus cervix which inbibits sperm

penetration

Regime
There is 28 and 21 days regime:

Progestin only pills come in a 28 day pack and all pills are active

For combination pills there is the 21 and 28 day pills where:

1 pill a day for 21 days, and then wait 7 days before starting a new 21-day
pack.

28-day packs contains 21 hormone pills and 7 placebo pills that do not contain
hormones. Pills are taken for 21 days and then the inactive pills for seven days.

OCP can be taken using different doses of hormones.

Monophasic (same amount of oestrogen and progestin)

Biphasic(Contains two different doses of progesterone changed

half way through cycle.

Triphasic Three doses of progestin hormones changed every 7

days during first three weeks
of taking the pills. Estrogen fixed
or varied

Advantages of Combined

95% effective when taken consistently

Inexpensive

Reversible within three month of stop taking

Reduce menorrhagia (heavy menstrual bleeding)

Lowers t the risk of anemia.

Reduce dysmenorrhea

May help reduce symptoms of premenstrual syndrome.

Improve acne

Improve symptoms of endometriosis.

Reduce risk of endometrial and ovarian cancer with long term use

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Disadvantages of
combined
Combination birth control pills contain estrogen,
which can increase the risk for stroke, heart
attack, and blood clots in some women.
Must be take same time each day
Offers no protection against STIs.

Advantages of Progestin only

Can safely be used by women who cant use estrogen

Safe to use while breast feeding

Effective if taken properly

Disdvantages

Irregular periods

Must be taken everyday at the same time

No Sti protection

Side Effects

The primary side effect of progestin-only oral contraceptives is

irregular menstrual bleedingspotting or breakthrough bleeding,
amenorrhea, or shortened cycles.

Emergency
Contraception
Plan B One-Step is a single tablet
that contains 1.5 mg of
levonorgestrel.
Next Choice is taken as two doses,
which each contain 0.75 mg of
levonorgestrel. Both pills can be
taken at the same time or as two
separate doses 12 hours apart.
*Works best if taken with 24hrs of
having sex

Contraindications

Absolute

Cardiovascular disease-ishchaemic heart disease,severe high blood

pressure

Liver disease

Estrogen related neoplasm eg. Breast cancer

Arterial or venous thrombosis

Relative

Migraines
Risk factor for cardiovascular disease
Irregular vaginal bleeding

Summary

OCP are effective if taken properly

There are options for women who cant take estrogen including
breast feeding mothers

Many different progestin types are available

Some reduce the risk of ovarian and uterine cancers

They however donot protect against STIs

Not all women are suitable to use them.