ORAL CONTRACEPTIVES

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By: sarita1226rita (42 month(s) ago)

assalamoalikom nice work sir, i can see that those new formulations of oral contraceptives are not considered to be one of the risk factors for breast cancer as it was believed... may Allah be with you

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In the Name of God Most Gracious Most Merciful : 

In the Name of God Most Gracious Most Merciful

ORAL CONTRACEPTIVES : 

ORAL CONTRACEPTIVES By- Mohammad Sadiq Final yr. M.B.B.S. M.M.C.R.I.

TYPES : 

TYPES COMBINED PILLS POP / MINIPILLS Monophasic Pills Multiphasic Pills Sequential Pills Only P NO E

COMBINED PILLS : 

COMBINED PILLS Oestrogen + Progestogens Oestrogen: Ethinyl estradiol (EE) or Mestranol Progestogens: Megestrol acetate & MPA ( C 21) Norethisterone group – Norethsterone, norethisterone acetate, ethynodiol diacetate & lynestrenol Norgestrel group – Norgestrel Newer progestogens – Desogestrel, Gestodene & norgestimate C 19

MULTIPHASIC PILLS : 

MULTIPHASIC PILLS Biphasic & Triphasic BIPHASIC – 0.035mg EE + low dose P – 10 days 0.035mg EE + high dose P - 11 days TRIPHASIC – Triquilar: l-norgestrel 0.05mg (6days), 0.075mg (5days), 0.125mg (10days) + constant 0.03mg EE

CHOICE OF PILL : 

CHOICE OF PILL ADMINISTRATION - 21 day pack - 28 day pack MISSED PILL? - 21 day pack - 28 day pack

MECHANISM OF ACTION : 

MECHANISM OF ACTION Inhibition of ovulation Alteration of endometrium Changes in cervical mucous EFFICACY Almost 100% if used properly Failure rate 0.1% Failures mostly due to missed pills

BENEFITS & ADVANTAGES : 

BENEFITS & ADVANTAGES Prevention of Pregnancy Cycle stabilisation Cure of menstrual disorders Protection against cancer Protection against benign diseases Protection against disease – Ectopic, PID, Anaemia & Malnutrition, Endometriosis, Acne & Hirsuitism, Menstrual abnormalities, RA, Osteoporosis Simplicity No affection of future fertility

SIDE EFFECTS & RISKS : 

SIDE EFFECTS & RISKS MINOR: Nausea, Vomiting, loss of appetite BTB Menorrhagia/ irregular bleeds Oligo/amenorrhoea Breast changes Vaginal discharge Headache/migraine Chloasma Weight gain Acne/oily skin Psychosocial troubles & Others

SIDE EFFECTS & RISKS : 

SIDE EFFECTS & RISKS MAJOR: CVS disease- MI, stroke, VTE, HT, Coagulation, ? LDL Carcinogenicity – Breast, Cervix, Liver, DM Cholestasis & jaundice Decrease milk volume within 6 wks ? Teratogenesis & pregnancy outcome Nutritional disorders- ? folate, C, B12, B5, B2, Zn

DISADVANTAGES : 

DISADVANTAGES Relative expensiveness Possible increase in promiscuity & STDs Interference with biochemical & biopsy findings

POP / MINIPILL : 

POP / MINIPILL COMPOSITIONS: Norethindrone 0.350 mg Levonorgestrel 0.075 mg Norgestrel 0.030 mg Ethynodiol diacetate 0.500 mg Progestogen amount is about 50% of COCs.

MECHANISM OF ACTION : 

MECHANISM OF ACTION Thickening mucus plug – Impermeable Inhibiting ovulation (60%) Involuting the endometrium – making it hostile to implantation

ADMINISTRATION : 

ADMINISTRATION BF mothers – 6 wks following delivery. NO back up method. Others – 1st day + back up for 7 days Taken daily at the same time. Coitus at night – take in the noon. > 3hrs late – use back up for 48hrs

INDICATIONS : 

INDICATIONS Lactating mothers & women >40. Oestrogen C/I: DM, Vascular disaese, CVS disease, SLE, Thrombosis

ADVANTAGES : 

ADVANTAGES Prevention of pregnancy No increase of VTE No effect on milk volume Can be used in cases where E form health risks.

DISADVANTAGES : 

DISADVANTAGES Irregular menstrual bleeding Acne, mastalgia, headache Amenorrhoea Regular intake at same time (even delay of 3hrs – inc risk of failure)

OCP USED IN MEDICAL PROBS : 

OCP USED IN MEDICAL PROBS GDM PIH after BP comes to Normal Obesity Hepatic disease when LFT- normal Sickle cell disease BBD Hyperlipidemia Smoking <35yrs age Pituitary microadenoma IMN (LFT Normal) UC Parasitic diseases Thalassemia

WARNING FEATURES : 

WARNING FEATURES Chest pain / Dyspnoea Severe throbbing headaches Eye problems Swelling/severe pain in one leg Missed periods (2 consecutive) Excessive white discharge Postcoital/persistent irregular vaginal bleeding after 3 months of pill use Yellowing of skin or eyes.

THANK YOU : 

THANK YOU