Oral Contraceptive Pills

Oral contraceptive pills• Medications that prevent pregnancy• Contain hormones (estrogen and progesterone, or progesterone

alone)• Popular method• Relatively few contraindications• Effective

What they contain?Estrogens:• Ethinyl estradiol• Mestranol

Progesterones:• Norethynodrel• Norethindrone• Norethindrone acetate• Norgestimate• Desogestrel• Ethynodiol diacetate• Norgestrel• Levonorgestrel• Drospirenone

How they work?• By blocking ovulation (release of an egg from the ovaries)

• By altering mucus in the cervix, which makes it hard for sperm to travel further

• By changing the endometrium (lining of the uterus) so that it cannot support a fertilized egg

• By altering the fallopian tubes (the tubes through which eggs move from the ovaries to the uterus) so that they cannot effectively move eggs toward the uterus

• Several types of combination birth control pills exist, including monophasic pills, biphasic pills, triphasic pills, and 91-day-cycle pills.

Side Effects:• Breakthrough bleeding • Headache• Weight gain• Nausea • Breast tenderness• Headaches• Depression, anxiety, other mood changes

Contraindications• Pregnancy

• Personal history of thromboembolic disease

• Undiagnosed genital tract bleeding

• Cardiovascular disorders

• Migraine

• Active hepatobiliary disease

• Hypertension and diabetes

• 35yrs old who smoke

• BMI 35

• Allergy to any component of the product

• Unexplained abnormal bleeding

Caution:• Increased risk of venous thrombosis• May raise blood pressure• Cannot be used while breast feeding• Caution with liver enzyme inducers• Caution with broad spectrum antibiotics

Drug interactions:• Certain drugs can decrease the effectiveness of combination-type

birth control pills• Can result in pregnancy.• Antibiotics (cephalosporins, chloramphenicol, macrolides, penicillins,

tetracyclines, sulfas)• Seizure medications (e.g., barbiturates, carbamazepine, phenytoin,

topiramate)

• Effectiveness of some drugs ( Aspirin, oral anticoagulants, oral hypoglycemics) are decreased• Effectiveness of others ( Beta-blockers, corticosteroids, diazepam,

aminophylline) are increased• Should not be prescribed to lamotrigine users as it decreases

the serum drug concentration and therefore increases seizurefrequency

Pill-teach• Contraception is immediate if the woman starts the pill between days 1 and 5 of her cycle.• If her first pill is after day 5, other contraception is needed for 7 days.

• Take the pill the same time every day.

• One pill daily for 21 days followed by 7 pill-free days. Some formulations have 7 ‘dummy pills’, rather than the pill-free interval.

Special circumstances:• Post-partum (not breast-feeding): start day 21 after delivery.

• Post-termination: within 7 days of termination.

• Switching from implant or injectable progestagens: start at any time up to removal of implant or when injection is due.

Missed pill:• Missed pills may lead to failed contraception. • The risk of pregnancy is greatest at the beginning and the end of the pack

• If 1 pill is missed: Take the missed pill as soon as possibleContinue the rest of the pack as usual

• If 2 or more pills are missed:Take recent as soon as possibleNeed additional cover until 7 days

Non-contraceptive benefits:

• Polycystic ovaries• Regulation of menstrual cycle• Menorrhagia• DUB• Endometriosis• Decreased menstrual blood loss and pain

Progestin only pills:• Needs to be taken daily• Started on first day, and there are no pill-free days or different-colored pills

to track• May cause menstrual irregularity• May be used in hypertension• May be used while breastfeeding• Since progesterone is the only hormonal ingredient, estrogen-related side

effects are avoided• However, since these do not include estrogen, they have a higher failure rate

Other formulations:• Available in various other forms, such as injections (into a muscle),

topical (skin) patches, and slow-release systems (vaginal rings, skin implants, and contraceptive-infused intrauterine devices)

References:• Oxford Handbook of Obstetrics and Gynaecology, 3rd Edition• KD Tripathi - Essentials of Medical Pharmacology, 6th Edition• DC Dutta's Textbook of Gynecology, 6th Edition• Flip-charts related to family planning

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