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Oral contraceptives
- 2. Introduction… • Hormonal Preparations… • Fertility can be suppressed as far as desired • Fertility returns on discontinuity
- 3. Types Of OCP • There are four types of oral contraceptive pills…. Combined Pills Phased Pills Progestin only Pills Emergency(postcoital) Pills
- 4. Combined Pills… • Widely used • Contains Oestrogen and progestin in a fixed dose… • Commonly used Progestins – Norethindrone, Levonorgestrel,Norgestrel • Commonly used Oestrogen – Ethinyl estradiol • Third genration progestins – Desogestrel,Gestodene,Norgestimate are LIPID friendly, Increase HDL and reduce atherogenioc risk.
- 5. Phased Pills… • Monophasic agents – Fixed amt of oestrogen and progestin in each pill • Biphasic – Oestrogen is kept constant but progestin varies according to the phase of the menstrual cycle • Triphasic – Oestrogen is increased in Mid- Cycle, Progestin increases in three sucessive phases of the cycle
- 6. • Oestrogen content – 20-50 mcg • Progestin content – 0.15-1 mg • If oestrogen is < 35 mcg Low dose pills. PREPARATIONS: • Monophasic – Ethinyl Estradiol (50) [EE] + (Ovcon 50) Norethindrone(1.0) [NE] • Biphasic – Days 1 to 10 – EE(35) + NE(0.5) (NECON) Days 11 to 21 – EE(35) + NE(1.0)
- 7. • Triphasic : Days 1 to 7 – EE(35) + NE(0.5) Days 7 to 21 – EE(40) + NE(0.75) Days 15 to 21 – EE(35) + NE(1.0) (ORTHONOVUM) Schedule: One Tab daily from the 1 st day of bleeding till 21 days followed by 7 days gap
- 8. Progestin Pill • Contains very low dose of Progestin only (norethindrone or norgestrol ) • May cause Menstrual irregularities and ectopic pregnancy • Schedule: One Tab daily without gap.. • Norethindrone (0.35 mg) MICRONOR • Norgestrel (0.075 mg) NORGEST
- 9. Postcoital Pills… • Levonorgestrel,Ulipristal and Mifepristone • Schedule: Levonorgestrel 0.75 mg, 2 doses, 12 hrs apart within 72 hrs of unprotected intercourse • Ulipristal 30 mg, single dose, within 120 hrs of intercourse • Mifepristone 600 mg, single dose, within 72 hrs of intercourse
- 10. Mechanism Of Action • Combined pills- Estrogen Inhibits FSH, Progestin Inhibits LH LH surge abolished,Hence no ovulation • Progestin Pills- Attenuate LH surge, Ovulation May occur • Postcoital pills- Direct action on genital tract
- 11. Other Mechanisms • Thick cevical mucus secretion • Endometrium- Hyperproliferative,Hypersecretory or atrophic • Uterine and tubal contractions • Postcoital pills can dislodge a just implanted blastocyst
- 12. Indications… • Aviods unwanted pegnancy • Dysmenorrhoea and pre menstrual tension. • Prevents Anaemia by reducing blood loss • Pelvic inflammatory disease • Prevents ovarian and endometrial carcinoma • Beningn Breast tumours and ovarian cysts
- 13. Contraindications… • Thromboembolic, coronary and cerebrovascular disease • HT, hyperlipidaemia • Hepatoma,jaundice • Porphyria • Diabetes • Smoking
- 14. Adverse effects… • Nausea , vomitting • Head ache • Weight gain (Androgenic action of older Progestins) • Cholasma • Thromboembolic, coronary and cerebrovascular disease • Genital carcinoma • Gall stones