Oral contraceptives

Introduction Preventing unwanted pregnancy is the important goal of contraceptive use There are several methods of contraception Oral contraceptives are highly effective provided they are used appropriately Their effectiveness approaches that of surgical sterilization

Composition OCs contains, combination of synthetic estrogen and synthetic progestin or progestin alone The low dose combination OCs contains, approximately one third to one fourth the estrogen and one tenths the progestin dose

Composition . . . The progestin only (mini pills) contains even lower doses of progestin . Third generation OCs contain, newer progestins e.g. desogestrel, grospirenone, gestodene and norgestimate which have no estrogenic effect

Mechanism: Estrogens suppresses FSH, prevents development of dominant follicle stabilizes endometrial lining potentiate the action of progestin Progestin suppresses LH surge, block ovulation thicken cervical mucous causes endometrial atrophy

Classification Combined pill Progesterone only pill Post coital pill Once in a month pill Male pill

contain 30-35 mcg of a synthetic estrogen and 0.-1mg of progesterone Combined pills contain 30-35 mcg of a synthetic estrogen and 0.-1mg of progesterone One pill daily given orally, for 21 days beginning of the fifth day of menstrual cycle Not recommended for breast feeding women because they affect quality and quantity of milk

Combined pills . . . Very rarely can cause stroke blood clots in deep veins of the legs, or heart attack women with high blood pressure and women who are age 35 or old and smokes more than 20 cigarettes per day Eg: Mala –N, Mala-D

Progesterone-only pill contains very small amounts of only one kind of hormone, a progestin 0.35mg These are known as progestin-only pills (POPs), POCs and mini pills recommended for breast-feeding women Progestin-only oral contraceptives do not disrupt existing pregnancy

Emergency pills After unprotected coitus, emergency oral contraception can prevent pregnancy Also called post coital or ‘morning after’ contraception Mainly stops ovulation (release of egg from ovary) It does not disrupt existing pregnancy

Emergency pills . . . Up to 72 hours after unprotected coitus, the woman should take 4 low-dose or 2 "standard-dose" combined oral contraceptives, and then take another equal dose 12 hours later It contains either a high dose of estrogen or double dose of standard combined pills EC kit contains 4 tablets (2 tablets/dose), each tablet contains 50mcg of ethinyl estradiol and 0.25mg of levonorgestrel or two tablets each containing 0.75mg levonorgestrel

Once in a month pill contains a long acting estrogen in combination with short acting progesterone Male pill contains gossypol, derivative of cottonseed oil acts by decreasing sperm production and sperm count

ADRs Myocardial infraction thromboembolic complications breast cancer hyperglycemia hypertension jaundice weight gain nausea and vomiting

Drug interactions Decreased effects of contraceptives: Ampicillin Anticonvulsants Griseofulvin NNRTIs PIs Rifampicin Phenytoin Pioglitazone Sulfonamides Tetracyclines Theophylline Decreased effects of, Paracetamol Oral anticoagulants Tolbutamide Methyldopa

Conclusion -OCs are the effective means of contraception -Selection of proper OCs is important -Effects of concomitant drugs on OCs must be analyzed

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