5. Action
Suppress ovulation through negative
feedback to hypothalamic-pituitary axis.
Thickening of cervical mucus to prevent
sperm entry.
May also slow tubal motility, disrupt
transport of ova. (not proven)
6. Efficacy
COC is highly effective 99.9% in preventing
pregnancy.
However the user failure rate is 3-8%.
7. Types of COCs
1. Monophasic pills.
E.g. Microcept, Gynera, Cilest, Marvelon and Yasmin.
2. Biphasic pills.
Estrogen fixed dose throughout the cycle with doubled
dose of progestin in the 2nd. Half of the cycle.
3. Triphasic pills.
1st. 6days : 30 µg EE + 50 µg LNG
2nd. 5days: 40 µg EE + 75 µg LNG
3rd. 10days: 30 µg EE + 125 µg LNG
8. Types of COCs
1st. Generation: EE > 50 µg
2nd.Generation: EE<50 µg + any
progestin except( Gestodine, Desogestrel,
Norgestimate or Drospirenone)
3rd. Generation: EE<50 µg + Gestodine,
Desogestrel or Norgestimate.
4th. Generation: EE<50 µg +
Drospirenone.
9.
10. How and when to use it???
Start on the 1st 5 days of the cycle
regularly every day.
21 days 0n, 7 days off.
11. Missed pills
One pill.
No problem.
Take the missed pill immediately.
2 pills or more.
Take the pills
Backup methods should be used.
Emergency contraception if sexual intercourse
was occurred in preceding 7 days.
12. Advantages of COCs
1. Highly effective if used correctly.
2. Rapid return of fertility after stoppage.
3. Suitable for nulligravida and newly
married couples.
4. Completely controlled by the woman and
can be stopped at any time unlike other
methods (IUD & Implants).
5. No need to do any thing at the time of
intercourse.
13. Non contraceptive benefits of COCs
Regulation of the cycle with ↓
amount & duration.
So it helps in prevention & ttt of iron
def. anemia.
↓risk of epithelial ovarian tumors.
↓Inc. of functional ovarian cysts.
↓ risk of ectopic pregnancy.
14. Non contraceptive benefits of COCs
↓risk of developing PID.
↓risk of endometrial cancer.
↓spasmodic dysmenorrhea and PMS.
↓risk of benign breast lesions.
May protect from colorectal cancer.
May ↓ Inc. of fibroid.
Improvement of rhumatoid arthritis.
15. Non contraceptive uses of COCs
Ttt of Dysfunctional uterine bleeding.
Ttt of Endometriosis.
Ttt of PMS.
Ttt of spasmodic dysmenorrhea.
Postponing of menstruation for social or
religious causes.
Ttt of hirsutism: “ Yasmin” contains
antiandrogenic progestin Drosprirenone.
16. Disadvantages & Side effects
1- The need for daily use.
2- GIT:
Nausea and vomiting.
Increased incidence of gall bladder stones).
Women with active hepatitis will have a deterioration in
liver functions.
↑inc. of hepatocellular adenoma ( rare).
3-central nervous system:
Headache and migraine.
Mood changes: depression, irritabilty.
17. 4-Breast
Not suitable with breast feeding.
Mild breast tenderness may occur.
5-Genital tract.
Cervix:
Cervical erosion is a common finding.
Vagina:
Increased normal vaginal disharge.
Vaginal candidiasis.
18. 6-CVS:
Increased risk of venous thromboembolism.
Increased risk of MI & stroke in elderly patients
with hypertension and smokers.
7-Metabolic :
Increased body wt.
In diabetic patients: leads to hyperglycemia and
increased risk of vascular complications.
Dyslipidemia:↑cholesterol, ↑triglycrides, ↑LDL&
↓HDL.
19. Absolute contraindications
< 6 months postpartum if breastfeeding
Smoker over the age of 35 (≥ 15 cigarettes per day)
Hypertension (systolic ≥ 160mm Hg or diastolic ≥
100mm Hg)
Current or past history of venous thromboembolism
(VTE)
Ischemic heart disease
History of cerebrovascular accident
20. Absolute contraindications
Complicated valvular heart disease
Migraine headache with focal neurological symptoms
Breast cancer (current)
Diabetes with retinopathy/nephropathy/neuropathy
Severe cirrhosis
Liver tumour (adenoma or hepatoma)
21. Relative contraindications
Smoker over the age of 35 (< 15 cigarettes per
day)
Hypertension (systolic 140–159mm Hg,
diastolic 90–99mm Hg)
Currently symptomatic gallbladder disease
Mild cirrhosis
History of combined OC-related cholestasis
Users of medications that may interfere with
combined OC metabolism
22. MYTHS AND MISCONCEPTIONS
1. The combined OC causes cancer.
Fact:
The combined OC reduces the risks of ovarian and
endometrial cancer.
The risk of ovarian cancer is reduced by at least half
in women who use combined OCs.
23. MYTHS AND MISCONCEPTIONS
2. Women on the combined OC
should have periodic pill breaks.
Fact:
This is unnecessary.
Pill breaks place a woman at risk
for unintended pregnancy and
cycle irregularity.
24. MYTHS AND MISCONCEPTIONS
3. The combined OC affects future
fertility.
Fact:
Fertility is restored within
1 to 3 months after stopping
the combined pills.
25. MYTHS AND MISCONCEPTIONS
4. The combined OC causes
birth defects if a woman
becomes pregnant while taking it.
Fact:
There is no evidence that the
combined OC causes birth defects.
26. MYTHS AND MISCONCEPTIONS
5. The combined OC must be
stopped in all women
over 35 years old.
Fact:
Healthy, non-smoking women may
continue to use the combined OC
until menopause.
27. MYTHS AND MISCONCEPTIONS
6.The combined OC causes acne.
Fact:
Acne improves in women using the
combined OC due to a decrease in
circulating free androgen.
All combined OCs will result in an
improvement of acne
30. Efficacy
Must be taken at same time every day to be
effective.
Perfect use failure rate 0.5%
Typical use failure rate 5-10%
31. Mechanism of action
1-Main mechanism is alteration of Cx mucous.
↓↓ volume of mucous
↑↑ viscosity
2- Ovulation is suppressed in 60% of the
women.
3-Endometrial changes ↓↓ implantation.
32. How to use????
Start on the 1st 5 days of the cycle or after 6
weeks postpartum.
Daily tablet at the same time every day
without discontinuation.
Woman consider her self fertile for the first
week of use.
33. Missed pill
To be taken as soon as possible.
Next pill to be taken at the regular time.
If delayed > 3hrs use back up contraception for
48 hrs.
If 2 or more pills missed in a row 2 pills/day for
2 days back up contraception for 48 hrs.
Emergency contraception must be used if
intercourse occurred after a missed pill.
34. Advantages
Suitable when breast feeding.
Suitable when EE is contraindicated.
Immediate return of fertility.
Less likely to cause metabolic
disturbances.
35. Disadvantages
Must be taken daily at the same time
Less effective than COCs
More likely to cause menstrual irregularities
Headache, nausea, breast tenderness, mood
changes, depression and ↓libido.
Less effective in preventing ectopic
pregnancy.
