Oral Contraceptive Pills

Oral Contraceptive Pills


TYPES:

  • On the basis of mechanism it is divded into  two groups:

OCP’s Suppressing Spermatogenesis:

  • Gossypol: 10–20 mg/day for 3 month then 20mg twice weekly 
  • Side effects:Weakness, hypokalaemia and permanent sterility

OCP’s Suppressing  Ovulation (Hormonal Contraceptive Agents) 

  • Monophasic combined oral pills
  • Triphasic combined pills
  • Minipills.

Monophasic  Combined Oral Pills:

DOSE:

  • Mala-D:0.5 mg  d-norgestrel+ethinyloestradiol 20–30 mcg
  • Mala-N :1 mg norethisterone+ethinyloestradiol 20–30 mcg

MOA:

  • Suppresses pituitary hormones, FSH and LH peak.Thus prevent ovulation
  • Progestogen 
  • Atrophic changes in the endometrium and prevents nidation.
  • Make Thick & tenacious cervical mucus rendering it impermiable to sperm
  • Increases the tubal motility, so the fertilized egg reaches the uterine cavity before the endometrium is receptive for implantation.

ADMINISTRATION:

  • From second day of the cycle for 21 days with new course 7 days after the cessation of the previous
  • In a nonlactating woman:
  • After 3 weeks of delivery or soon after an abortion, MTP or an ectopic pregnancy
  • Following  hydatid mole:
  • After serum β-hCG is negative

ADVANTAGES:

  • Controls fertility
  • Treats Menorrhagia & polymenorrhoea.
  • Relieve dysmenorrhoea and premenstrual tension
  • Prevents anaemia
  • Lowers chances of
  • Fibrocystic disease
  • Ovarian cyst
  • Ovarian ,uterine & anorectal malignancy
  • PID
  • Ectopic pregnancy
  • Useful in acne, PCOD and endometriosis
  • Prevent RA

SIDE EFFECTS & CONTRAINDICATIONS:

  • Intermenstrual spotting
  • Decrease Menstrual bleeding
  • Amenorrhoea
  • Monilial vaginitis
  • Carcinoma of endocervix
  • Breast cancer in a nulliparous woman
  • Increase the risk of breast cancer
  • Pituitary adenoma
  • Libido
  • Suppress Lactation
  • High risk of thromboembolism in puerperium.
  • Nausea and vomiting
  • Adenomas
  • Avoided in Chronic liver disease and jaundice 
  • Contraindicated or cautiously given to a diabetic woman.
  • Oestrogen increases HDL and LDL 
  • Headache, migraine, depression, irritability, increased weight and lethargy
  • Pulmonary embolism and cerebral thrombosis
  • In Sickle cell anaemia cause thrombosis and crisis.
  • Relatively contraindicated in contact lens wearer

GENERATIONS:

GENERATION COMPOSITION
First Ethinyl oestradiol+Norethindrone
Second Ethinyl oestradiol+Norgestrel, LNG
Third Ethinyl oestradiol+Desogestrel, gestodene norgestimate
Fourth Ethinyl oestradiol+Drospirenone

 Triphasic Combined Pills:

EE2 and LNG Preprations:

  • First 6 days :30 mcg EE2 + 50 mcg LNG
  • Next 5 days: 40 mcg EE2 + 75 mcg LNG
  • Last 10 days 30 mcg EE2 + 125 mcg LNG

ADVANTAGES:

  • No risk of MI
  • Safe in Diabetes

New ORAL PILLS

  • Seasonal: EE2 +levonorgestrel( 1 tab at 7 day interval Three-monthly course)
  • OC tab : 10 mcg EE2
  • Once-a-month pill contains 3 mg quinestrol +12 mg megestrol acetate,
  • EE2 1 drospirenone (Yasmin, Tarana, Janya) 21 tablets
  • Janya contains 24 tablets  20 mcg EE2.
  • EE2 1 cyproterone acetate (Dianette) 35 mcg EE2.
  • Quadriphasic pill containing E2 1 dienogest (Daily)
  • 35 mcg EE2 and 0.4 mg norethidrone(Chewable)
  • Lybrel-continuous daily for 1 year :20 mcg EE2 1 +90 mcg LNG in a tablet
  • Drospirenone(beauty pill) :antimineral, corticocoid and with antiandrogenic activity
  • It inhibits ovulation, cures acne and hirsutism
  • It reduces fluid and sodium retention, and has no adverse effect on bone mineral density.
  • Prevents obesity
  • 3 mg

SIDE EFFECTS:

  • Potassium retention

CONTRAINDICATION:

  • Thromboembolism.
  • Renal and liver disease

Minipill/Prgestogen- Only Pill(POP):

  • Norethisterone 350 mcg+ norgestrel 75 mcg or LNG 30 mcg

Advantage:

  • Suits lactating women
  • Women over 35 years
  • Those with focal migraine
  • Those intolerant to oestrogen
  • Diabetic, hypertensive woman, sickle cell anaemia

Drawbacks:

  • Pregnancy rate of 2–3 per 100 woman years
  • Irregular bleeding (20%)
  • Amenorrhoea,
  • Depression, headache, migraine and weight gain,
  • Ectopic pregnancy,
  • Functional ovarian cysts

Desogestrel,

  • New generation of synthetic progestogen
  • Cerazette containing 75 mcg desogestrel
  • Mode of Action:
  • Cerazette suppresses ovulation
  • Forms a thick plug of mucus in the cervical canal and acts as a barrier to sperms
  • Increases tubal peristalsis
  • No androgenic effect
  • Stringent time compliance not necessary
  • No ectopic pregnancy, no effect on carbohydrate or lipid metabolism.
  • Safe in lactating women
  • High incidence of thromboembolism,weight gain,irregular menstrual bleeding, bleeding & breast cancer

Contraindications:

  • Previous ectopic pregnancy
  • Ovarian cyst, breast and genital cancers,
  • Abnormal vaginal bleeding
  • Active liver and arterial disease
  • Porphyria
  • Liver tumour
  • Valproate, spironolactone and meprobamate.
  •  Because of osteopenia, it is contraindicated in adolescents and young women.

Non contraceptive benefits of OCPs:

  • Cycle stabilization
  • Cure of menstrual disorder- useful in menorrhagia & polymenorrhea
  • Prevents anemia.
  • Reduces the incidence of ectopic pregnancy.
  • Protection against cancer – Ovarian ,Endometrial
  • Benign tumour – Benign breast disease, Ovarian functional cyst, Fibromyoma uterus
  • Protects – PID, Anemia, Endometriosis, PCOD, Acne, hirsutism, Rheumatoid arthritis, Osteoporosis 

DRUGS CAUSING OCP FAILURE 

  • Phenobarbitone
  • Carbamazepine
  • Phenytoin(All anti-epileptics except valproate)
  • Rifampicin
  • Ampicillin
  • Tetracyclines
  • Primadone
  • Griseofulvin
Exam Question
 
  • The first step in the management of hirsutism due to stein leventhal syndrome is OCP
  • In a 45 years old lady with polymenorrhoea for 6 months duration best line of management is OCP for 6 months
  • OCP and progesterone use over long periods may contribute in Risk factors for development of Ca cervix
  • Reversible methods of contraception are OCP
  • OCP is a reversible method of contraception
  • Non contraceptive use of OCPs are Ca endometrium, Rheumatoid arthritis & Endometriosis
  • OCP gives protection against  Endometrial & Ovary cancers
  • OCPs cause Hepatic adenoma, Cancer Cervix & Hepatic vein thrombosis
  • OCP’s are contraindicated in Smoking 35 years,Intermittent vaginal bleeding,H/0 thromboembolism, Coronary occlusion & Cerebro vascular ds
  • Complication of OCP are Hyperlipidemia, Hypertension & Depression
  • OCP has LEAST pregnancy failure rate
  • Estrogen in the OCP causes  Breast & Endometrial  carcinoma and Thromoembolism
  • OCP fail when used with  Ethoxsuccimide,Phenobarbital,Griseofulvin, Carbamazepine,Primidone, Phenytoin & Rifampin
  • Use of OCP is associated with increased risk of asymptomatic chlamydial infection
  • combined OCP decreases the risk of ectopic pregnancy,PID, Ovarian cysts & acute salpingitis & also improves dysmenorrhea from endometriosis
  • Combined OCP  is the ideal contraceptive for a newly married couple who wants to plan their family after 6 months
  • Thromboembolism is due to Estrogen in OCP
  • Most common cause of stroke in young women in India among OCP users is Cortical vein thrombosis
  • OCP provides protection against Fibroadenoma breast, Carcinoma ovary & Uterine malignancy
Don’t Forget to Solve all the previous Year Question asked on Oral Contraceptive Pills

Leave a Reply

%d bloggers like this:
Malcare WordPress Security