Oral contraceptive pill

Start on the first day of menstrual bleeding. (The "dayone starter" regimen prevents ovulation in the
first cycle, eliminating the need to use an alternative backup method for contraception during the first
cycle.)
Start on the first Sunday after menstrual bleeding begins. (This "Sunday starter" regimen prevents
periods on weekends, but an alternative backup method is necessary for the first 7 days of pill use.)

A woman on the pill will have a withdrawal bleed sometime during the placebo week, and is still
protected from pregnancy during this week.

Mechanism of action
The dominant component is progestin, which inhibits ovulation by
suppressing the cyclical release of luteinizing hormone (LH) from the
anterior pituitary gland.
Progestins also create a thick cervical mucus that slows sperm transport
and inhibits capacitation (the activation of enzymes that permit the sperm
to penetrate the ovum).
Estrogen in COCs contributes to ovulation inhibition by suppressing the
release of follicle stimulating hormone (FSH) and LH. Estrogen also
accelerates ovum transport, which decreases fertilization time. Finally,
estrogen alters secretions within the uterus to produce areas of edema
and dense cellularity, making implantation less likely.

Some women take COCs strictly to reduce menstrual bleeding

irregularities or cyclical menstrual symptoms.
COCs can affect menstrual cycle control in several ways.
These medications can decrease menstrual cramps and pain, including
pain experienced during ovulation (mittelschmerz).
They may also decrease menstrual flow (number of bleeding days and
amount of blood loss) by 60% or more.[5]
Additionally, COCs can help women avoid menstrual periods if the women
take "active" pills for a longer period of time or skip the placebo week (i.e.,
7 days of inactive pills).
Combined oral contraceptive, COC
Components
Contain synthetic estrogen and progestin
USethinyl estradiol and mestranol (a prodrug the must convert to EE by
the liver)
Contraindication

Breast cancer
venous thromboembolism
migraine with aura
Dosing
adverse effects
estrogenic effects (such as altered bleeding patterns, mood changes,
breast enlargement/tenderness, and nausea)
androgenic effects (such as acne, hirsutism, and lipid changes)
COCs reported to double the risk for venous thromboembolism compared
to nonusers, but overall risk is still low
current use of oral contraceptives may be associated with increased risk
for ischemic stroke but not hemorrhagic stroke or myocardial infarction

A Abdominal pain (severe)

C Chest pain (severe), cough, shortness of breath, or sharp pain upon breathing in
H Headache (severe), dizziness, weakness, or numbness (especially if onesided)
E Eye problems (vision loss or blurring), speech problems
S Severe leg pain (calf or thigh)

oral contraceptives and cancer

o

combined oral contraceptives may be associated with decreased

mortality from cancer and various other causes

COCs may reduce risk for some cancers, including

about 40% overall reduced risk for ovarian cancer

about 50% overall reduced risk for endometrial cancer

Adverse effect
The most common effects are bleeding irregularities, nausea, weight gain, mood swings,
breast tenderness, and headache.

Progesterone only pills, POP

considered contraceptive of choice for

o

women who prefer oral contraceptive but have contraindications to

combined oralcontraceptives

nonbreastfeeding women immediately postpartum (not associated

with increased risk of thrombosis)

breastfeeding women > 6 weeks postpartum (unlikely to influence

breast milk)

o
o

o
o

dosing regimens
o

no pill-free interval indicated in women taking POPs

for traditional POPs, take 1 pill at same time every day (within 3
hour window) to ensure maximum contraceptive efficacy (FSRH
Grade C)

for desogestrel-only pill, take 1 pill daily within 12 hour window

(does not need to be taken at the same time every day)

adverse effects
altered bleeding patterns considered most common adverse effect associated with
POPs
may be associated with mood changes but no direct evidence suggests increased
risk for depression (FSRH Grade C)
drug interactions
liver enzyme-inducing drugs contraindicated in women using POPs due to increased
metabolism of progestogen and potential for reduced contraceptive efficacy
certain anticonvulsants contraindicated in women using POPs due to potential for
reduced seizure control