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Oral contraceptive pill – what for who?

Oral contraceptive pill – what for who?. Mark Wilshere 2011. Content. Introduction – the importance of the matter Types of oral contraception Oral contraception comparison Oestrogen/Progestogen/Androgen activity Tackling the side effect Summary. Introduction.

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Oral contraceptive pill – what for who?

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  1. Oral contraceptive pill – what for who? Mark Wilshere 2011

  2. Content • Introduction – the importance of the matter • Types of oral contraception • Oral contraception comparison • Oestrogen/Progestogen/Androgen activity • Tackling the side effect • Summary

  3. Introduction • Pill is commonly used, especially in younger women • Benefits include reliable contraception, easy to use, less bleeding, controls cycle, less painful periods • Perceived negative effects include, nausea, headache, mood change, weight gain, irregular bleeding

  4. Introduction • Side-effects are an issue as compliance can subsequently be affected. Up to 20% of younger women may not take because the do not like it. • 50% pregnancies in UK unintended • 91% abortions funded by NHS • 42% abortion rate in teenagers in 2001

  5. Choice • Very important • Numerous to chose from • Ethinylestradiol (standard) • Progestin (variable) – oestrogen potency small if any

  6. Combined • 21 day standard strength COCP - 30-35mcg • 21 & 7 day ED (Every Day) standard strength COCP – 30-35mcg for 21 days and 7 days of inactive pills • 21 day low strength COCP – 20mcg

  7. Ethinylestradiol 20mcg 21d monophasic

  8. Ethinylestradiol 30mcg 21d monophasic

  9. Ethinylestradiol 35mcg 21d monophasic

  10. Ethinylestradiol 50mcg 21d monophasic • Norethisterone 1000mcg • Norinyl-1 • £2.19

  11. Ethinylestradiol 30mcg 28d monophasic

  12. Ethinylestradiol Variable 21d phasic

  13. Ethinylestradiol Variable 28d ED phasic

  14. Progestogen only

  15. Oestrogen activity • Higher number of micrograms of ethinyl estradiol lead to more potent estrogenic effects. A higher amount of estrogenic activity helps to decrease androgen-related side effects. However, progestins tend to counter some of the estrogenic effects of ethinyl estradiol.

  16. Progestational Activity • Each progestin has a different potency • Hence the differences in doses • Is possible to compare potency of progestins and their androgenic activity • High androgenic activity associated with acne, hair growth etc

  17. What pill? • Need to consider; • Oestrogen dose • Progestin potency • Androgen potency

  18. Progestogenic side effects • Acne, hirtuism, vaginal dryness, wt gain, loss of libido, breast tenderness • Try a pill with; • Less of same progestogen • Oestrogen dominant pill • Try different progestogen

  19. Oestrogenic side effects • Nausea, headache, dizziness, breast enlargement, cyclical wt gain, loss of libido • Try a pill with; • Lower oestrogen content • Try progestogen dominant pill • Try progestogen only pill

  20. Summary • Numerous types of oral contraception available • Vary in oestrogen content and progesterone / androgen activity • Tailor to individual needs • Trial and error may be needed and explained • May be variance between individuals • It takes about 2 cycles to see if suitable • Studies lacking in comparison

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