Name : Bernard Ho Group : 13 Course : 6th year 1st semester

Introduction
1. The oral contraceptive pill (combined OC) was

first introduced in 1960. 2. Since then it has undergone many modifications and has been used by millions of women worldwide.

1. Monophasic (each tablet contains a fixed

Types of OCP :

amount of estrogen and progestin); 2. Biphasic (each tablet contains a fixed amount of 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 progestin increases in 3 equal phases).
* Biphasic and triphasic formulations were initially developed with the intent of lowering the total steroid content of combined OCs.

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

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 in limiting effectiveness.

Mechanism of action
1.Its main mechanism of action is to

suppress gonadotropin secretion, thereby inhibiting ovulation. 2.Development of endometrial atrophy, making the endometrium unreceptive to implantation; 3.Production of viscous cervical mucus that impedes sperm transport; 4.Possible effect on secretion and peristalsis within the fallopian tube, which interferes with ovum and sperm transport.

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

Absolute Contraindication
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

< 6 weeks postpartum if breastfeeding Smoker over the age of 35 ( 15 cigarettes per day) Hypertension (systolic 160mm Hg or diastolic 100mm Hg) Current or past history of venous thromboembolism (VTE) Ischemic heart disease History of cerebrovascular accident Complicated valvular heart disease Migraine headache with focal neurological symptoms Breast cancer (current) Diabetes with retinopathy/nephropathy/neuropathy Severe cirrhosis Liver tumour (adenoma or hepatoma)

Relative contraindication
1. 2. 3. 4.

5.
6. 7. 8.

Smoker over the age of 35 (< 15 cigarettes per day) Adequately controlled hypertension Hypertension (systolic 140159mm Hg, diastolic 9099mm Hg) Migraine headache over the age of 35 Currently symptomatic gallbladder disease Mild cirrhosis History of combined OC-related cholestasis Users of medications that may interfere with combined OC metabolism

Non contraceptive benefits

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Cycle regulation Decreased menstrual flow Increased bone mineral density Decreased dysmenorrhea Decreased peri-menopausal symptoms Decreased acne Decreased hirsutism Decreased endometrial cancer Decreased ovarian cancer Decreased risk of fibroids Possibly fewer ovarian cysts Possibly fewer cases of benign breast disease Possibly less colorectal carcinoma Decreased incidence of salpingitis Decreased incidence or severity of moliminal symptoms

Side effects :
1.
2. 3. 4. 5. 6.

The most common reason patients discontinue combined OC use is: Abnormal menstrual bleeding, followed by : Nausea, Weight gain, Mood changes, Breast tenderness, Headache.

Risk :
1) Thromboembolism

2) Myocardial infarction and stroke (if estrogen

>50microgram) 3) Gall bladder disease 4) Breast cancer

How to start taking the OCP ?

Non pregnant : 1) Can be started any time within your menstrual cycle (usually on 1st day 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 oral contraceptive

What to do if missed pills ?