1 The Content of this Presentation is only intended for registered healthcare professionals. The medical information in this Presentation is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purpose. Pfizer (including its parent, subsidiary and affiliate entities) makes no representation or warranties of any kind, expressed or implied; as to the content used in the Presentation and/or the accuracy, completeness of its content. Overview of Oral Contraceptives
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1
The Content of this Presentation is only intended for registered healthcare professionals.
The medical information in this Presentation is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purpose. Pfizer (including its parent, subsidiary
and affiliate entities) makes no representation or warranties of any kind, expressed or implied; as to the content used in the Presentation and/or the accuracy, completeness of its content.
Overview of Oral Contraceptives
2
DISCLAIMER
• The Content in this presentation is only intended for healthcare professionals in India . The
medical information in this presentation is provided as an information resource only, and is not
to be used or relied on for any diagnostic or treatment purpose. “
• “The views and opinions mentioned in the presentation is strictly that of the author and the
individuals expressing the same and Pfizer may not necessarily endorse the same. Pfizer
(including its parent, subsidiary and affiliate entities) makes no representation or warranties of
any kind, expressed or implied; as to the content used in the presentation and/or the accuracy,
completeness of its content.”
• Pfizer Limited, The Capital- A Wing, 1802, 18th Floor, Plot No. C-70, G Block, Bandra - Kurla Complex,
Bandra (East), Mumbai 400 051, India
• For the use only of Registered Medical Practitioners or a Hospital or a Laboratory
PP-NXM-IND-0252 9th Apr 2019
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Table of Contents
• Choice of contraception
• Types of Oral Contraceptives
• Combined oral contraceptives: Myths and Facts
• Progestin-only pills
• When and how to use oral contraceptives
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Choice of Contraception
NICHD. What are the different types of contraception? Available from:
Hormonal
Combined oralcontraceptives
Progestin-only pills
Contraceptivepatch
Vaginal rings
Barrier
Condoms
Diaphragms and cervical caps
Contraceptivesponges and spermicides
Intrauterine
Copperintrauterine
device
Hormonal intrauterine
device
Sterilization
Implant
Tubal ligation
Vasectomy
https://www.nichd.nih.gov/health/topics/contraception/conditioninfo/Pages/types.aspx. Accessed on 6 April 2019
1. U.S. Selected Practice Recommendations for Contraceptive Use, 2013. Available from: https://www.cdc.gov/mmwr/pdf/rr/rr62e0614.pdf. Accessed on 6 April 2019. 2. Borgelt LM and Martell CW. Estradiolvalerate/dienogest: a novel combined oral contraceptive. Clin Ther. 2012;34:37-55.
What are the Benefits/Risks of Combined OralContraceptives?
Benefits
• Improved cycle control and relief
from menstrual symptoms
• Reduced acne and hirsutism
• Improved bone health
• Prevention of ovarian / endometrial
and colorectal cancers
Risks
• Blockage of blood vessel by a
blood clot (venous
thromboembolism)
• Heart attack (myocardial infarction)
• Reduced blood supply to brain
(stroke)
Dragoman MV. The combined oral contraceptive pill - recent developments, risks and benefits. Best Pract Res Clin Obstet Gynaecol. 2014;28:825-34.
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Different Types of Combined Oral ContraceptivesRegimens
Combined oralcontraceptives
Traditionalregimen
28-day (21/7) regimen: 21 active
(contains hormones) and 7 inactive (placebo) pills
24/4 or 26/2 regimen:
28-day regimen with<7 hormone-free
days
Extendedregimen
More than 28 days of active hormones use
followed by hormone-free or -decreased interval
Continuousregimen
Regimen taken in an uninterrupted
manner with no hormone-free
interval
Benson LS and Micks EA. Why Stop Now? Extended and Continuous Regimens of Combined Hormonal Contraceptive Methods.Obstet Gynecol Clin North Am. 2015;42:669-81.
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Extended and Continuous Combined Oral Contraceptives
Benson LS and Micks EA. Why Stop Now? Extended and Continuous Regimens of Combined Hormonal Contraceptive Methods.Obstet Gynecol Clin North Am. 2015;42:669-81.
Benefits of extended and continuous combined oral contraceptives are
• High user acceptability
• Improved control of medical
conditions
• Likely improved efficacy
due to consistent ovulation
suppression
• Decreased frequency of
scheduled bleeding
• Decrease in estrogen-
withdrawal symptoms
• Unscheduled bleeding
lessens over time
COMBINED ORAL CONTRACEPTIVES:MYTHS AND FACTS
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Myths and Facts: Birth Defects
1. Myths and facts about... Contraceptive Pill. Available from: http://www.ippf.org/blogs/myths-and-facts-about-contraceptive-pill. Accessed on 6 April 2019. 2. Charlton BM, et al. Maternal use of oral contraceptives and risk of birth defects in Denmark: prospective, nationwide cohort study. BMJ. 2016;352:h6712.
• Combined oral contraceptives cause birth defects in babies1
MYTH
• Oral contraceptive use beforeor during pregnancy does notincrease the risk of birthdefects2
• Studies revealed a smallincrease in the risk of breastcancer, which, however,disappeared 5–10 years afterdiscontinuation of the COCs 2
MYTH FACT
COCs: Combined oral contraceptives1. Myths and facts about... Contraceptive Pill. Available from: http://www.ippf.org/blogs/myths-and-facts-about-contraceptive-pill. Accessed on 6 April 2019. 2. Küçük M, et al. Misconceptions about the side effects of combined oral contraceptive pills. Gynecol Endocrinol. 2012;28:282-5. 3. Bhupathiraju SN, et al. Exogenous Hormone Use: Oral Contraceptives, Postmenopausal Hormone
• Use of COCs increases the risk for cancers1
• Use of COCs reduces the riskfor endometrial,2 ovarian, andcolon cancers3
Therapy, and Health Outcomes in the Nurses’ Health Study. Am J Public Health. 2016;106:1631-7.
• Combined oral contraceptive use may cause minor and less frequentside effects such as headache,bloating and fluid retention, mood changes, and irregular bleeding2
• There are several reported healthbenefits of COCs as well such asreduction in menstrual blood loss,acne, hirsutism, and premenstrualsyndrome2
FACT
COCs: Combined oral contraceptives1. Myths and facts about... Contraceptive Pill. Available from: http://www.ippf.org/blogs/myths-and-facts-about-contraceptive-pill.Accessed on 6 April 2019. 2. Stewart M and Black K. Choosing a combined oral contraceptive pill. Aust Prescr. 2015;38:6-11.
1. Myths and facts about... Contraceptive Pill. Available from: http://www.ippf.org/blogs/myths-and-facts-about-contraceptive-pill. Accessed on 6 April 2019. 2. Küçük M, et al. Misconceptions about the side effects of combined oral contraceptive pills. Gynecol Endocrinol. 2012;28:282-5. 3. Benson LS and Micks EA. Why Stop Now? Extended and Continuous Regimens of Combined Hormonal
• Combined oral contraceptiveuse may cause infertility or adelay in conceiving1
MYTH
• No correlation has been foundbetween the use of oral contraceptives and infertility2
• Return to fertility is observedwith the use of oralcontraceptives if you decide tobecome pregnant3
FACT
Contraceptive Methods. Obstet Gynecol Clin N Am. 2015;42:669-81.
.COCs: Combined oral contraceptive1. Myths and facts about... Contraceptive Pill. Available from: http://www.ippf.org/blogs/myths-and-facts-about-contraceptive-pill. Accessed on 6 April 2019.2. Pastor Z, et al. The influence of combined oral contraceptives on female sexual desire: a systematic
• Combined oral contraceptivesreduce interest in sex (loss oflibido) and sexual pleasure1
MYTH
• Combined oral contraceptiveuse does not cause change insexual activity. Majority ofCOCs users reported no change in libido2
FACT
review. Eur J Contracept Reprod Health Care. 2013;18:27-43.
COCs: Combined oral contraceptives1. Myths and facts about... Contraceptive Pill. Available from: http://www.ippf.org/blogs/myths-and-facts-about-contraceptive-pill.Accessed on 6 April 2019. 2. Küçük M, et al. Misconceptions about the side effects of combined oral contraceptive pills. Gynecol
• Combined oral contraceptive use may cause weight changes1
MYTH
• Overweight issues may berelated to negative self-esteem and anxiety. There isno evidence of weight gain bylow-dose COCs2
Special Considerations: Combined Oral Contraceptives
COCs: Combined oral contraceptives; VTE: Venous thromboembolism1. U.S. Selected Practice Recommendations for Contraceptive Use, 2013. Available from: http://www.cdc.gov/mmwr/pdf/rr/rr62e0614.pdf. Accessed on 6 April 2019. 2. WHO Press. Medical eligibility criteriafor contraceptive use. 5th ed. 2015. Available from: http://apps.who.int/iris/bitstream/10665/181468/1/9789241549158_eng.pdf?ua=1. Accessed on 6 April 2019
• Reversible and can be used by women of all ages2
• Effective for women with contraindications to use of estrogen1
• Progestin pills can be used as emergency contraception1
• – Levonorgestrel is the most popular form for emergency contraception1
• Can be started at any time provided the woman is not pregnant2
http://www.cdc.gov/mmwr/pdf/rr/rr62e0614.pdf. Accessed on 6 April 2019.
1. Christin-Maitre S. History of oral contraceptive drugs and their use worldwide. Best Pract Res Clin Endocrinol Metab. 2013;27:3-12.2. U.S. Selected Practice Recommendations for Contraceptive Use, 2013. Available from:
Christin-Maitre S. History of oral contraceptive drugs and their use worldwide. Best Pract Res Clin Endocrinol Metab. 2013;27:3-12.
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What are the Benefits/Risks of Progestin-Only Pills?
Benefits
• Improvedsymptoms
• Can be
menstrual
used inbreastfeeding women
• Improvementmenstrual premenstrual and anemia
in heavyperiods,
syndrome,
Risks
• Breast cancer
• Cirrhosis of liver• Reduced blood supply to
brain (stroke)
Am J Obstet Gynecol. 2011;205:S14-7.
• Acute or recurrent vein thrombosis
• Liver tumors
deep
Burke AE. The state of hormonal contraception today: benefits and risks of hormonal contraceptives: progestin-only contraceptives.
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What are the Benefits/Risks of Progestin-Only Pills?
Risks
• Breast cancer
• Cirrhosis of liver
• Reduced blood supply to brain
(stroke)
• Acute or recurrent deep vein
thrombosis
• Liver tumors
Benefits
• Improved menstrual symptoms
• Can be used in breast-feeding
women
• Improvement in heavy menstrual
bleeding, pre-menstrual syndrome
and anemia
Am J Obstet Gynecol. 2011;205:S14-7.
Burke AE. The state of hormonal contraception today: benefits and risks of hormonal contraceptives: progestin-only contraceptives.
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What are the Side Effects of Progestin-Only Pills?
Primary Side effect
• Irregular bleeding1,2
• Amenorrhea2
• Shortened cycles2
Less Common side effects
• Headache2
• Breast tenderness2
• Dizziness2
OCs. Accessed on 6 April 2019.
1. Burke AE. The state of hormonal contraception today: benefits and risks of hormonal contraceptives: progestin-only contraceptives. Am J Obstet Gynecol. 2011;205:S14-7. 2. Choosing a Birth control Method: Progestin-Only Oral Contraceptives.Available from: http://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-Clinicians/choosing/Progestin-Only-
Burke AE. The state of hormonal contraception today: benefits and risks of hormonal contraceptives: progestin-only contraceptives.Am J Obstet Gynecol. 2011;205:S14-7.
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What to Do if a Dose of Progestin-Only Pills is Missed?
http://www.cdc.gov/mmwr/pdf/rr/rr62e0614.pdf. Accessed on 6 April 2019.
A dose is considered missed if it has been more than 3 hours since its scheduled time.
• One pill should be taken as soon as possible
• Continue taking pills daily (one each day, at the same timeeach day, even if two pills required on the same day)
• Back-up contraception should be used (e.g., condoms) oravoidance of sexual intercourse until pills have been takencorrectly on time for 2 consecutive days
• If the woman has had unprotected sexual intercourse,emergency contraception should be considered
U.S. Selected Practice Recommendations for Contraceptive Use, 2013. Available from:
Combined oral contraceptives may be avoided in the following cases:– After delivery
• If breastfeeding, no use before 6 weeks and avoid use up to 6 months• If not breastfeeding, no use before 42 days without doctor ’s advice
– Smokers over 35 years– Higher than normal BP (systolic 140–159 mm Hg; diastolic 90–99 mm Hg)– History of loss/reduced blood supply to heart (ischemic heart disease) or
brain (stroke)– Severe headache (migraine with auras)
– History of blood clots in arms or legs (DVT/PE); prolonged immobilizationafter surgery
– Breast cancer (current or in the past)– Long-term severe diabetes
• While some conditions may rule out oral contraceptives, medicaladvice is always best in assessing individual cases
BP: Blood pressure; DVT: Deep vein thrombosis; PE: Pulmonary embolismWHO Press. Medical eligibility criteria for contraceptive use. 5th ed. 2015. Available from: http://apps.who.int/iris/bitstream/10665/181468/1/9789241549158_eng.pdf?ua=1. Accessed on 6 April 2019.