Oral Contraceptive Pills (OCP)

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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