ORALCONTRACEPTIVES

Birth control pills (oral contraceptives) are prescriptionmedications that prevent pregnancy.Birth control (contraceptive) medications containhormones (estrogen and progesterone or progesteronealone).Birth control pills may also be prescribed to reducemenstrual cramps or prevent anemia.Some women experience various levels of side effects ofbirth control pills.

Hormonal birth control medications prevent pregnancythrough the following ways:

By blocking ovulation(release of an egg from the ovaries),thus preventing pregnancyBy altering mucus in the cervix, which makes it hard forsperm to travel furtherBy changing the endometrium(lining of the uterus) sothat it cannot support a fertilized eggBy altering the fallopian tubes so that they cannoteffectively move eggs toward the uterus

Birth control(contraceptive) medications containhormones (estrogen and progesterone or progesteronealone).

The medications are available in various forms, such aspills, injections (into a muscle, topical (skin) patches,and slow-release systems (vaginal rings, skin implants,and contraceptive-infused intrauterine devices

Estrogens- Ethinyl estradiol-30 micro gramsMestranol-50 micro grams

Progesterones Norethindrone- 1mgNorethindrone acetateNorgestimateDesogestrel 150 micro gramsNorgestrel -0.5mgLevonorgestrel 150 micro grams

Combination contraceptives, that is, contraceptivemedications containing both estrogen and progesterone,are the most effective means for contraception with theexception of surgical sterilization.

Several types of combination birth control pills exist,including monophasic pills, biphasic pills, triphasic pills,and 91-day-cycle pills.

Monophasic pills have a constant dose of bothestrogen and progestin in each of the hormonallyactive pills throughout the entire cycle (21 days ofingesting active pills).

Several of the brands listed above may beavailable in several strengths of estrogen orprogesterone, from which doctors chooseaccording to a woman’s individual needs.

Biphasic pills typically contain 2 different progesteronedoses. The progesterone dose is increased about halfwaythrough the cycle.Ethinyl estradiol 35 micro gram+ Norethindrone 0.5mg(day1 to day 10)

Ethinyl estradiol 35 micro gram+ Norethindrone 1mg(day12 to day 21)

Triphasic pills gradually increase the dose ofprogesterone and provides higher dose of estrogenThree different increasing pill doses are contained ineach cycleEthinyl estradiol 35 micro gram+ Norgestrol 0.05mg(day1 to day 6)

Ethinyl estradiol 35 micro gram+ Norgestrol 0.075 mg(day 7 to day 11)

Ethinyl estradiol 35 micro gram+ Norgestrol 0.125 mg(day 12 to day 21)

Two tablets of progestin levonorgestrol containing 1500mgOr single 1500mcg tablet taken as soon as possible afterunprotected intercourse (up to 72 hours after)Preferably within 12 hours, no later than 72 hours

Ethinyl estradiol 50 micro gram+ levonorgestrol 250 microgram. Two such tablets are to be taken with in 72 hrs ofunprotected sexUlipristal (SPRM-Selective Progesterone ReceptorModulator)single dose 30mg effective with in 120hrs/5days

Non steroidal estrogen receptor antagonist-sermCentchroman- 30mg twice in a week for first 3month andonce in a week subsequently as long as the contraceptionis preferredReversible in 6 monthsIt is potent competitive antagonist at peripheral estrogenreceptors and supresses proliferative stage ofendometriumIt accelerates ovum transport, without affecting ovulationNo risk of teratogenesisC/I- hepatic dysfunction, polycystic ovarian disease,cervical hyperplasia, tuberculosis, renal disease

Depot medroxy progesterone acetate (Depot-Provera) -DMPAThe first injection is given within 5 days following the onset ofmenstruation. After that, an injection is needed every 11-13weeks.

Side effects: Since progesterone is the only hormonal ingredient,estrogen-related side effects are avoided.

A side effect unique to this method of birth control is that mostwomen eventually stop having their periods.Depo-Provera may last in the body for several months in womenwho have used it on a long-term basis and can actually delay thereturn to fertility after stopping the drug.Other side effects include weight gain and depression.

Norelgestromin /ethinyl estradiolThe topical patch may be applied to clean, on the shoulders,upper arms, buttocks or abdomen. The patch may be lesseffective in women weighing more than 198 pounds (90 kg).

Use: A new patch is applied on the same day of the week, eachweek for 3 weeks in a row.

The first patch is applied either on the first day of themenstrual period or on the Sunday following menses.On the fourth week, no patch is applied.This 4-week period is considered 1 cycle.Another 4-week cycle is started by applying a new patchfollowing the 7-day patch-free period.

Side effects are similar to other birth control agentscontaining both estrogen and progesterone.Effects include menstrual irregularities, weight gain,and mood changes.Other specific side effects include a skin reaction atthe site of application and problems with contactuse

Norethindrone Progesterone-only pills (POPs), also known asmini-pills. Less than 1% of users of oral contraceptives use themas their only method of birth control. Those who use theminclude women who are breast feeding and women who cannottake estrogen.Use: POPs are ingested once daily, every day.

POPs may be started on any day, and there are no pill-freedays or different-colored pills to track. Since progesterone isthe only hormonal ingredient, estrogen-related side effects areavoided. However, since POPs do not include estrogen, theyhave a higher failure rate.Users must take this pill at the same time daily for greatesteffectiveness.

Women with the following conditions should not use estrogen-containing birth control medications:

to any component of the productHistory of blood clotting disordersHistory of stroke or heart attackheart valve disease with complicationsSevere hypertensionPoorly controlled diabetesRecent major surgery with prolonged bed restBreast cancer, Liver cancer (or liver disease)Uterine cancer or other known or suspected estrogen-dependentcancersjaundice during pregnancy or jaundice with prior hormonalcontraceptive use

The effectiveness of oral contraceptives, ProgesteroneOnly Pill and post coital pill will be reduced byinteraction with drugs that are enzyme inducersDrugs that may cause this effect include: manyantibiotics (e.g., cephalosporins, chloramphenicol,macrolides, penicillins, tetracyclines, sulfas),aprepitant, bexarotene,

Broad spectrum antibiotics may reduce effectivenessof OCPs by altering the bacterial flora of the bowel

Nausea, breast tenderness, fluid retention, weight gain,acne, breakthrough bleeding, missed periods, headaches,depression, change in vision, other mood changes, andlower sexual desire.Additionally, the following more serious side effects may

occur: thromboembolism(blood clots)Breast cancer, cervical cancerBenign liver tumorsDiabetes

Smoking cigarettes while using this medication increasesyour chance of having heart problems.Do not smoke while using this medication.

The risk of heart problems increases with age (especiallyin women greater than 35 years of age) and withfrequent smoking (15 cigarettes per day or greater)If overdose is suspected, contact your local poisoncontrol center or emergency room immediately.Symptoms of overdose may include nausea andvomiting.May experience vaginal bleeding.

1. Menstrual Bleeding Disorders2. Dysmenorrhea3. Symptoms of Androgenisation (Seborrhea, Acne, Hirsutism,

Alopecia)4. Premenstrual Syndrome (PMS) and Premenstrual Disphoric

Disorder (PMDD )5. Ovarian Cysts6. Endometriosis/Adenomyosis7. Pelvic Inflammatory Disease (PID)8. Multiple Sclerosis9. Menstrual Migraine10. Endometrial Hyperplasia11. Benign Breast Disease12. Prevention of Ovarian Cancer13. Endometrial Cancer14. Colon Cancer