Oral contraceptive pill what for who?Mark Wilshere2011

ContentIntroduction the importance of the matterTypes of oral contraceptionOral contraception comparisonOestrogen/Progestogen/Androgen activityTackling the side effectSummary

IntroductionPill is commonly used, especially in younger womenBenefits include reliable contraception, easy to use, less bleeding, controls cycle, less painful periodsPerceived negative effects include, nausea, headache, mood change, weight gain, irregular bleeding

IntroductionSide-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 unintended91% abortions funded by NHS42% abortion rate in teenagers in 2001

ChoiceVery importantNumerous to chose fromEthinylestradiol (standard)Progestin (variable) oestrogen potency small if any

Combined21 day standard strength COCP -30-35mcg21 & 7 day ED (Every Day) standard strength COCP 30-35mcg for 21 days and 7 days of inactive pills21 day low strength COCP 20mcg

Ethinylestradiol 20mcg 21d monophasic

Ethinylestradiol 30mcg 21d monophasic

Ethinylestradiol 35mcg 21d monophasic

Ethinylestradiol 50mcg 21d monophasicNorethisterone 1000mcg

Norinyl-1

2.19

Ethinylestradiol 30mcg 28d monophasic

Ethinylestradiol Variable 21d phasic

Ethinylestradiol Variable 28d ED phasic

Progestogen only

Oestrogen activityHigher 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.

Progestational ActivityEach progestin has a different potencyHence the differences in dosesIs possible to compare potency of progestins and their androgenic activityHigh androgenic activity associated with acne, hair growth etc

ProgestinProgestational ActivityAndrogenic ActivityNorethindrone 1mg (control)1.01.0Norethrindrone acetate 1mg1.21.6Norgestimate 1mg1.31.9Norelgestromin 1mg1.31.9Ethynodiol diacetate 1mg1.40.6Drospirenone 1mg1.50.0Dinorgestrel 1mg2.64.2Levonorgestrel 1mg5.38.3Desogestrel 1mg93.4

What pill?Need to consider;

Oestrogen doseProgestin potencyAndrogen potency

Side effect / problemSolutionSuggestionsAcneo aLoestrin 30, Brevinor, Ovysmenn, gadarel, marvelon, cilest, Yasmin (price)Break through bleedo p aGadarel 30/150, Marvelon, Gestodene/levoner containingYasmin (price)Weight gaino pLower O doseBreast sorenesso pLower O doseSevere crampspHigher P potencyHeadacheso pLower O dose, mercilonDepression, moody, irritablep?norethisterone baseda/oligo-menorrhoeao p

Endometriosiso p aLevon, deso based

Progestogenic side effectsAcne, hirtuism, vaginal dryness, wt gain, loss of libido, breast tenderness

Try a pill with;Less of same progestogenOestrogen dominant pillTry different progestogen

Oestrogenic side effectsNausea, headache, dizziness, breast enlargement, cyclical wt gain, loss of libido

Try a pill with;Lower oestrogen contentTry progestogen dominant pillTry progestogen only pill

SummaryNumerous types of oral contraception availableVary in oestrogen content and progesterone / androgen activityTailor to individual needsTrial and error may be needed and explainedMay be variance between individualsIt takes about 2 cycles to see if suitableStudies lacking in comparison