Combination Oral Contraceptive

The combined oral contraceptive pill is usually just called "the pill". It contains artificial
versions of female hormones oestrogen and progesterone, which women produce naturally in
their ovaries. A woman can get pregnant if a man's sperm reaches one of her eggs (ova).
Contraception tries to stop this happening usually by keeping the egg and sperm apart or by
stopping the release of an egg (ovulation).

Oral contraceptives (birth-control pills) are used to prevent pregnancy. Estrogen and
progestin are two female sex hormones. Combinations of estrogen and progestin work by
preventing ovulation (the release of eggs from the ovaries). They also change the lining of the
uterus (womb) to prevent pregnancy from developing and change the mucus at the cervix
(opening of the uterus) to prevent sperm (male reproductive cells) from entering. The pill
prevents the ovaries from releasing an egg each month (ovulation). It also:
 thickens the mucus in the neck of the womb, so it is harder for sperm to penetrate the
womb and reach an egg
 thins the lining of the womb, so there is less chance of a fertilised egg implanting into the
womb and being able to grow

Oral contraceptives are a very effective method of birth control, but they do not prevent
the spread of human immunodeficiency virus (HIV, the virus that causes acquired
immunodeficiency syndrome [AIDS]) and other sexually transmitted diseases.

HOW TO TAKE THE PILL

Oral contraceptives come in packets of 21 tablets to take by mouth once a day, every day
or almost every day of a regular cycle. To avoid nausea, take oral contraceptives with food or
milk. Take your oral contraceptive at the same time every day. Follow the directions on your
prescription label carefully, and ask your doctor or pharmacist to explain any part you do not
understand. Take your oral contraceptive exactly as directed. Do not take more or less of it, take
it more often, or take it for a longer time than prescribed by your doctor.

This pill is normally 92% effective. This means 8 in 100 people will get pregnant each
year. It can be 99% effective if it’s taken correctly and continuously. If you have a 21-tablet
packet, take 1 tablet daily for 21 days and then none for 7 days. Then start a new packet. Take
the 21 hormone pills and then the seven non-hormone pills. You will get your period while you
are taking the seven non-hormone pills. It may be lighter and less crampy than your regular
period. You will not be protected from pregnancy if you forget more than one pill in a week.

Oral contraceptives will work only as long as they are taken regularly. Continue to take
oral contraceptives every day even if you are spotting or bleeding, have an upset stomach, or do
not think that you are likely to become pregnant. Do not stop taking oral contraceptives without
talking to your doctor.
Starting the combined pill
Most women can start the pill at any time in their menstrual cycle. There is special
guidance if you have just had a baby, abortion or miscarriage.
 You may need to use additional contraception during your first days on the pill – this
depends on when in your menstrual cycle you start taking it.

Starting on the first day of your period

If you start the combined pill on the first day of your period (day one of your menstrual
cycle) you will be protected from pregnancy straight away. You will not need additional
contraception.

Starting on the fifth day of your cycle or before

If you start the pill on the fifth day of your period or before, you will still be protected
from pregnancy straight away, unless you have a short menstrual cycle (your period is every 23
days or less). If you have a short menstrual cycle, you will need additional contraception, such as
condoms, until you have taken the pill for seven days.

Starting after the fifth day of your cycle

You will not be protected from pregnancy straight away and will need additional
contraception until you have taken the pill for seven days.

If you start the pill after the fifth day of your cycle, make sure you have not put yourself
at risk of pregnancy since your last period. If you're worried you're pregnant when you start the
pill, take a pregnancy test three weeks after the last time you had unprotected sex.

SIDE EFFECTS
If you have just started taking the pill, you might find that you:
 feel sick (especially if the pill is taken on an empty stomach),
 have sore breasts
 bleeding or spotting between menstrual periods or changes in menstrual flow
 stomach cramps or bloating
 diarrhea or constipation
 acne

These usually get better with time, but if you’re worried about any changes, we
recommend that you keep taking the pill and call your physician for advice. If you vomit within
two hours of taking the combined pill, it may not have been fully absorbed into your
bloodstream. Take another pill straight away and the next pill at your usual time. If you continue
to be sick, keep using another form of contraception until you've taken the pill again for seven
days without vomiting.
Very severe diarrhoea (six to eight watery stools in 24 hours) may also mean that the pill
doesn't work properly. Keep taking your pill as normal, but use additional contraception, such as
condoms, while you have diarrhoea and for two days after recovering.
MISSING A PILL
If you're on the combined contraceptive pill and you miss a pill, what you need to do depends on:
 how many pills you have missed (you have missed a pill when it's more than 24 hours
since you should have taken it)
 when you missed your pill (where you are in the pack)
  the type of combined pill you're taking

What if I have missed 1 pill?

If you have missed 1 pill anywhere in the pack or started a new pack 1 day late, you're
still protected against pregnancy.

You should:
 take the last pill you missed now, even if this means taking 2 pills in 1 day
 carry on taking the rest of the pack as normal
 take your 7-day pill-free break as normal, or if you're on an everyday (ED) pill, take your
dummy (inactive) pills
 You do not need to use extra contraception.

What if I have missed 2 or more pills?

If you have missed 2 or more pills anywhere in the pack or started a new pack 2 or more
days late (48 hours or more), your protection against pregnancy may be affected.

You should:
 take the last pill you missed now, even if this means taking 2 pills in 1 day
 leave any earlier missed pills
 carry on taking the rest of the pack as normal
 use extra contraception, such as condoms, for the next 7 days

When you come to the end of your pill pack, after missing 2 or more pills:
 If there are 7 or more pills left in the pack after the last missed pill – finish the pack, take
your 7-day pill-free break as normal, or take your inactive pills before you start your next
pack
 if there are less than 7 pills left in the pack after the missed pill – finish the pack and start
a new pack the next day; this means missing out the pill-free break or not taking your
inactive pills
 You may also need emergency contraception if you have missed 2 or more pills in the
first week of a pack and had unprotected sex in the previous 7 days.

Who can use the combined pill

If there are no medical reasons why you cannot take the pill, and you don't smoke, you
can take the pill until your menopause. However, the pill is not suitable for all women. To find
out whether the pill is right for you, talk to your GP, practice nurse or pharmacist.
You should not take the pill if you:
 are pregnant
 smoke and are 35 or older
 stopped smoking less than a year ago and are 35 or older
 are very overweight
 take certain medicines (ask your GP or a health professional at a contraception clinic
about this)
You should also not take the pill if you have (or have had):
 thrombosis (a blood clot) in a vein, for example in your leg or lungs
 stroke or any other disease that narrows the arteries
 anyone in your close family having a blood clot under the age of 45
 a heart abnormality or heart disease, including high blood pressure
 severe migraines, especially with aura (warning symptoms)
 breast cancer
 disease of the gallbladder or liver
 diabetes with complications or diabetes for the past 20 years

After having a baby

If you have just had a baby and are not breastfeeding, you can most likely start the pill on
day 21 after the birth but you will need to check with your doctor. You will be protected against
pregnancy straight away.

If you start the pill later than 21 days after giving birth, you will need additional
contraception (such as condoms) for the next seven days. If you are breastfeeding, you're not
advised to take the combined pill until six weeks after the birth.

After a miscarriage or abortion

If you have had a miscarriage or abortion, you can start the pill up to five days after this
and you will be protected from pregnancy straight away. If you start the pill more than five days
after the miscarriage or abortion, you'll need to use additional contraception until you have taken
the pill for seven days.

Advantages and disadvantages

Some advantages of the pill include:
 it does not interrupt sex
 it usually makes your bleeds regular, lighter and less painful
 it reduces your risk of cancer of the ovaries, womb and colon
 it can reduce symptoms of PMS (premenstrual syndrome)
 it can sometimes reduce acne
 it may protect against pelvic inflammatory disease
 it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease

Some disadvantages of the pill include:

 it can cause temporary side effects at first, such as headaches, nausea, breast tenderness
and mood swings – if these do not go after a few months, it may help to change to a
different pill
 it can increase your blood pressure
 it does not protect you against sexually transmitted infections
 breakthrough bleeding and spotting is common in the first few months of using the pill
 it has been linked to an increased risk of some serious health conditions, such as
thrombosis (blood clots) and breast cancer

Risks of taking the combined pill

 There are some risks associated with using the combined contraceptive pill. However,
these risks are small and, for most women, the benefits of the pill outweigh the risks.

Blood clots
The risk of getting a blood clot is very small, but your doctor will check if you have
certain risk factors that before prescribing the pill. The oestrogen in the pill may cause your
blood to clot more readily. If a blood clot develops, it could cause:
 deep vein thrombosis (clot in your leg)
 pulmonary embolus (clot in your lung)
 stroke
 heart attack

The pill can be taken with caution if you have one of the risk factors below. It is unlikely
you would be advised to take it if you have two or more risk factors. These include:
 being 35 years old or over
 being a smoker or having quit smoking in the past year
 being very overweight (in women with a BMI of 35 or over, the risks of using the pill
usually outweigh the benefits)
 having migraines (you should not take the pill if you have severe or regular migraine
attacks, especially if you get aura or a warning sign before an attack)
 having high blood pressure
 having had a blood clot or stroke in the past
 having a close relative who had a blood clot when they were younger than 45
 being immobile for a long time – for example, in a wheelchair or with a leg in plaster

Hormonal Injection
The contraceptive injection is a shot that contains hormones, either a progestin alone, or a
progestin and an estrogen together, that stop your body from releasing eggs and thickens the
mucus at the cervix. You need one shot either once every month or once every three months
from a healthcare provider. However once injected, it is not reversible, i.e. in case of side effects
it cannot be stopped.

HOW TO take the hormonal injections

 Firstly, you’re going to need to talk to your healthcare provider - As with most
contraceptives, they aren’t the ideal choice for everyone so getting advice from a
professional is something we always recommend.
 If you decide the contraceptive injection is a method you’re interested in your healthcare
provider will do it for you. Then, depending on the type of shot you get, you’ll just need
 to go back every month or three months for another top up and you’ll be highly protected
in between.

Indications
 This drug is indicated in amenorrhea and abnormal uterine bleeding due to hormonal
imbalance in the absence of organic pathology, such as submucous fibroids or uterine
cancer.

Side Effects:
 Irregular menstrual periods- longer or shorter menstrual periods, heavier or lighter
periods
 Loss of menstrual periods
 Headaches
 Weight gain
 Breast pain

ADVANTAGES:
 It lasts for 1 up to 3 months
 It permits sexual spontaneity and doesn’t interrupt sex
 It doesn`t require daily or weekly attention
 It can offer an alternative to those affected by the hormone estrogen

DISADVANTAGES:
 It requires keeping track of the number of month used
 It may take up to one year for your period and fertility to return after stopping injection
 Does not protect against HIV infection (AIDS) and other sexually transmitted infections
(STIs)

Estrogen Free Pill or Progestin Only Pills

Progestin is a form of progesterone, a hormone that plays a role in the menstrual cycle
and pregnancy. Progestin-only pills contain progestin. They are available by prescription only.
Progestin-only birth control pills, sometimes called “mini-pills,” have several effects in the body
that help prevent pregnancy:
 The mucus in the cervix thickens, making it difficult for sperm to enter the uterus and
fertilize an egg.
 They stop ovulation, but they do not do so consistently. About 40% of women who use
progestin-only pills will continue to ovulate.
 They thin the lining of the uterus.

The minipill norethindrone (Camila , Ortho Micronor, others) is an oral contraceptive that
contains the hormone progestin. Unlike combination birth control pills, the minipill — also
known as the progestin-only birth control pill — doesn't contain estrogen. The progestin dose in
a minipill is lower than the progestin dose in a combination oral contraceptive pill.

INDICATIONS:
Your health care provider may recommend the minipill if:
 You're breast-feeding. For years it was thought that the estrogen in combination birth
control pills inhibited breast milk production. Although recent research has found that
combination birth control pills don't affect lactation, many providers and patients still
have experience and confidence in the minipill for breast-feeding.
 You have certain health problems. If you have a history of blood clots in the legs or the
lungs, or if you have an increased risk of those conditions, your doctor might recommend
the minipill.
 You're concerned about taking estrogen. Some women choose the minipill because of
possible side effects of birth control pills containing estrogen.

The minipill is an easily reversible method of contraception. Your fertility is likely to

return to normal immediately after you stop taking the minipill. Your health care provider might
also recommend the minipill to help treat a type of skin inflammation (dermatitis) that seems to
be related to your menstrual cycle.

The minipill isn't appropriate for everyone, however. Your health care provider may
discourage use of the minipill if:
 You have or have had breast cancer
 You have liver disease
 You have unexplained uterine bleeding
 You're taking medications for tuberculosis, HIV/AIDS or to control seizures
 You'll have trouble taking the pill at the same time every day due to a changing work
schedule or other factors
How to take progestin-only pills
The progestin-only pill comes in packs of 28 pills. All the pills in the pack contain
progestin. Take one pill at the same time each day for 28 days. It is important to take the
progestin-only pill at the exact same time each day for maximum effectiveness. Do not skip pills
for any reason—even if you bleed between periods or feel sick.

What if I forget to take a pill?

If a pill is missed by more than 3 hours, you should take a pill as soon as possible and use
a backup method of contraception (such as condoms) for the next 2 days. If vomiting or severe
diarrhea occurs within 3 hours after taking a pill, the progestin may not be absorbed completely
by your body. Keep taking your pills, but use a backup method until 2 days after your vomiting
or diarrhea stops.

ADVANTAGES:
 They do not interfere with sex.
 They may reduce menstrual bleeding or stop your period altogether.
 They are not associated with an increased risk of high blood pressure or cardiovascular
disease and can be taken even if you have certain health conditions that prevent you from
taking combination pills, such as a history of deep vein thrombosis or uncontrolled high
blood pressure.
 They can be used immediately after childbirth, even if you are breastfeeding.
  Can be used during breast-feeding
 Offers a quick return to fertility if you hope to get pregnant
 Avoidance of risks associated with pregnancy, such as greater risk of blood clots, higher
rates of ectopic pregnancy, and increased nausea and breast tenderness (though some of
these risks occur with birth control pills, they are much less severe than with pregnancy)

DISADVANTAGES:
 No protection against sexually transmitted infections, including HIV
 Potentially less effective than combination birth control pills
 Must be taken at the same time every day (taking the minipill more than three hours later
than usual means backup birth control will be needed for at least two days)
 Side effects such as irregular menstrual bleeding, ovarian cysts, decreased libido,
headache, breast tenderness, acne, weight gain, depression and hirsutism
 Slightly increased risk that if pregnancy occurs it will be ectopic — the fertilized egg
implants outside the uterus.

RISKS:
Progestin-only pills may not be a good choice for women who have certain medical
conditions, such as some forms of lupus. Women who have breast cancer or who have a history
of breast cancer should not take progestin-only pills.

SIDE EFFECTS:
Bleeding may be unpredictable. You may have short cycles of bleeding, spotting, or
heavy bleeding or no bleeding at all. Other side effects include:
 Headaches
 Nausea
 Irregular menstrual bleeding
 Acne
 Breast tenderness
 Decreased sex drive (libido)
 Depression
 Ovarian cysts

References:
Bayer. (2018). Contraceptive Injection: Hormonal Method. Retrieved from Your Life: https://www.your-
life.com/en/contraception-methods/short-acting-contraception/contraceptive-injection/
Bedsider. (2017, February 22). Which birth control pill is right for me? Retrieved from Bedsider:
https://www.bedsider.org/features/89-which-birth-control-pill-is-right-for-me
Center for Young Women's Health. (2019, January 23). Estrogen/Progestin Hormonal Injections .
Retrieved from Center for Young Women's Health:
https://youngwomenshealth.org/2011/07/01/hormonal-injections/
Mayo Clinic. (2018, February 02). Choosing a birth control pill. Retrieved from Healthy Lifestyle: Birth
control: https://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/best-birth-control-
pill/art-20044807
Mayo Clinic. (2018, March 02). Minipill (progestin-only birth control pill). Retrieved from Mayo Clinic:
https://www.mayoclinic.org/tests-procedures/minipill/about/pac-20388306
Mayo Clinic. (2019, January 09). Combination birth control pills. Retrieved from Mayo Clinic:
https://www.mayoclinic.org/tests-procedures/combination-birth-control-pills/about/pac-20385282
New Zealand Family Planning. (2019). The Pill. Retrieved from New Zealand Family Planning:
https://www.familyplanning.org.nz/advice/contraception/combined-oral-contraceptive-pill
NHS. (2019, February 14). What should I do if I miss a pill (combined pill)? Your contraception guide.
Retrieved from NHS: https://www.nhs.uk/conditions/contraception/miss-combined-pill/
The American College of Obstetricians and Gynecologists. (2018, March). Progestin-Only Hormonal
Birth Control: Pill and Injection. Retrieved from Women's Health Care Physicians:
https://www.acog.org/Patients/FAQs/Progestin-Only-Hormonal-Birth-Control-Pill-and-Injection?
IsMobileSet=false
US National Library of Medicine. (2015, September 15). Estrogen and Progestin (Oral Contraceptives).
Retrieved from MedlinePlus: https://medlineplus.gov/druginfo/meds/a601050.html

ARTIFICAL METHODS
of Family Planning
 Submitted by:
PERALTA, Keanu
CATRAL, Kirsten
HERNANDO, Alex
MARZAN, Aiyra

September 25, 2019

BSN2 I

Submitted to:
Mr. Sheerween Cacanando