Contraception is the method of controlling unwanted pregnancies. It is a method of birth control. It is now-a-days considered very vital due to population explosion.
Some common methods of contraception includes condoms, diaphragm, etc. Different contraceptive devices work in different ways.
Hereby in this post I’m going to talk about hormonal contraceptives which will also be continued in the next post:
HORMONAL CONTRACEPTION:
Hormonal contraceptives began with synthetic progesterone which were progesterone derivatives but due to their androgenic adverse effects pure forms of progesterone were synthesized.
Due to use of only progesterone as contraceptive methods it lead to break through bleeding (because of thinning of endometrium), progesterone and estrogen both were combined together.
Mechanism of action of estrogen and progesterone in contraception:
1. Progesterone inhibits pituitary gland which decreases LH which leads to inhibition of ovulation. This is the main action of contraceptives. Progesterone has other actions also:
• Cervical mucus thickening
• Altered tubal transport
• Thinning of endometrium
2. Estrogen also inhibits pituitary gland which decreases FSH production leading to decreased follicular growth. Estrogen was Incorporated in order to prevent break through bleeding.
Hormonal contraceptives are of 2 types:
1. Combined contraceptives
• Combined oral contraceptive pills
• Rings
• Patches
2. Progesterone only contraceptives
• Pills (Minipills)
• Injectables
• Implants
• IUDs- MIRENA
First of all talking about combined oral contraceptive (COC) pills:
It contains:
• Estrogen – Etinyl Estradiol (EE)
• Progesterone
– 1st gen: Norethindrone
– 2nd gen: Levonorgestral & norgestral
– 3rd gen: Norgestimate, Gestodene, Desogestral
– 4th gen: Drosperidone
4th gen is spironolactone derivative. It has anti androgenic effect and also causes weight loss. Therefore, it is very good for females with PCOS.
1st, 2nd and 3rd gen are testosterone derivatives which causes androgenic side effects. It also causes weight gain due to water retention.
Beneficial effects of COC pills is seen in these cases:
• Abnormal uterine bleeding
• Acne and hirsutism
• PCOS
• Dysmenorrhea
• Endometriosis
• Hormone replacement therapy
• Functional ovarian cysts
• Midcycle pain
• Decreases risk of benign breast diseases
• Decreases risk of ectopic pregnancy
• Decreases risk of PID (pelvic inflammatory diseases)
Contraindications of using COC pills:
• Uncontrolled diabetes mellitus (diabetic vasculopathy)
• Uncontrolled hypertension
• History of smoking
• Migraine with aura
• Breast cancer
• Coronary artery diseases
• Complicated valvular heart diseases
• Age more than 35 + smoking
• Acute liver dysfunction
• History of deep venous thrombosis
Some adverse effects of the pill:
• Headache
• Nausea
• Weight gain
• Breast tenderness
Initial evaluation done on prescribing COC pills:
We need to first check for following
• Pregnant or breast feeding woman
-Breastfeeding + postpartum who are less than 6 months OCPs are contraindicated.
-Non breastfeeding+ postpartum woman who are less than 6 weeks OCPs are contraindicated.
• Look for if any contraindicated conditions exists in woman
• General physical examination
• Measure BP
• Per speculum and per vaginal examination
• USG and lab tests (if needed)
COCs contains 2 types of pills
1. Hormonal pills (white) – 21 pills
2. Iron sulphate pills (red) – 7 pills (pill free interval)
These pills can be started anytime from day 1 to day 5 of the cycle (in this case effectiveness of the pill is seen from the very same month i.e., no need of any additional method of contraception).
If pill is started after day 5 of cycle pills are given along with some additional method of contraception like use of condoms.
Woman is advised to take one pill same time everyday so that it becomes habit and she doesn’t miss any pill. And after she finishes the pack she should start the next pack the very next day.
If woman misses 1 pill she should take the 1 missed pill as soon as she remembers.
If she misses 2 pills consecutively she should take the latest missed pill as soon as she remembers and use some back up method for next 7 days.
Remaining part of Hormonal contraception will be covered in my next post.
Contributor – Medico Eshika Keshari
