combined oral contraceptive -bernard

7/31/2019 Combined Oral Contraceptive -Bernard

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Name : Bernard Ho

Group : 13

Course : 6th year 1stsemester


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Introduction

1. The oral contraceptive pill (combined OC) was

first introduced in 1960.

2. Since then it has undergone many modifications andhas been used by millions of women

worldwide.


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Types of OCP :1. Monophasic (each tablet contains a fixed

amount of estrogen and progestin);

2. Biphasic (each tablet contains a fixed amountof estrogen, while the amount of progestin

increases in the second half of the cycle)3. Triphasic (the amount of estrogen may be fixed

or variable, while the amount of progestinincreases in 3 equal phases).

* Biphasic and triphasic formulations were initiallydeveloped with the intent of lowering the total steroidcontent of combined OCs.


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OCP

They are to be taken 21 days with a 7 days break or

placebo


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Efficacy

1. The combined OC is a highly effective method of

reversible contraception.

2. With perfect use, the combined OC is 99.9%effective in preventing pregnancy.

3. However, typical user failure rates range from 3

- 8%.

4. Poor patient compliance is a major factor inlimiting effectiveness.


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Mechanism of action

1.Its main mechanism of action is tosuppress gonadotropin secretion,thereby inhibiting ovulation.

2.Development ofendometrial atrophy, making theendometrium unreceptive to implantation;

3.Production ofviscous cervical mucus thatimpedes sperm transport;

4.Possible effect on secretion and peristalsis withinthe fallopian tube, which interferes with ovumand sperm transport.


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Indication:

1. In the absence of contraindications,

use of the combined OC may be considered for

any woman seeking a reliable, reversible,

coitally-independent method of contraception.

2. It is particularly suited for women who wish to

take advantage of its noncontraceptive benefits.

3. The use of condoms is still recommended in

combined OC users for protection against STD

and HIV


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Absolute Contraindication

1. < 6 weeks postpartum if breastfeeding

2. Smoker over the age of 35 ( 15 cigarettes per day)

3. Hypertension (systolic 160mm Hg or diastolic 100mm Hg)

4. Current or past history of venous thromboembolism (VTE)5. Ischemic heart disease

6. History of cerebrovascular accident

7. Complicated valvular heart disease

8. Migraine headache with focal neurological symptoms

9. Breast cancer (current)

10. Diabetes with retinopathy/nephropathy/neuropathy

11. Severe cirrhosis

12. Liver tumour (adenoma or hepatoma)


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Relative contraindication

1. Smoker over the age of 35 (< 15 cigarettes per day)

2. Adequately controlled hypertension

3. Hypertension (systolic 140159mm Hg,

diastolic 9099mm Hg)

4. Migraine headache over the age of 35

5. Currently symptomatic gallbladder disease

6. Mild cirrhosis

7. History of combined OC-related cholestasis

8. Users of medications that may interfere with

combined OC metabolism


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Non contraceptive benefits

1. Cycle regulation2. Decreased menstrual flow3. Increased bone mineral density4. Decreased dysmenorrhea

5. Decreased peri-menopausal symptoms6. Decreased acne7. Decreased hirsutism8. Decreased endometrial cancer9. Decreased ovarian cancer10. Decreased risk of fibroids

11. Possibly fewer ovarian cysts12. Possibly fewer cases of benign breast disease13. Possibly less colorectal carcinoma14. Decreased incidence of salpingitis15. Decreased incidence or severity of moliminal symptoms


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Side effects :

The most common reason patients discontinuecombined OC use is:

1. Abnormal menstrual bleeding, followed

by:2. Nausea,

3. Weight gain,

4. Mood changes,

5. Breast tenderness,

6. Headache.


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Risk :

1) Thromboembolism

2) Myocardial infarction and stroke (if estrogen

>50microgram)3) Gall bladder disease

4) Breast cancer


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How to start taking the OCP ?

Non pregnant :

1) Can be started any time within your menstrual cycle(usually on 1stday of period)

Pregnant :

1) Non Breastfeed : start on day 21(3rd week) after birth

2) Breastfeed : start after 6th month of delivery

Misscariage or abortion:1) Start up to 7 days after the event

2) If start after 7 days , use additional non oralcontraceptive


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What to do if missed pills ?


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combined oral contraceptive -bernard

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