ORAL CONTRACEPTIVE

PILLS
OCPILLS
HISTORY OF OCP
Enovid (norethynodrel 10 mg and
mestranol 0.15 mg) was used in the first
contraceptive field trial in Puerto Rico in
1956 by Pincus and his colleagues.
COMBINED ORAL CONTRACEPTIVES
PILLS
IT IS MOST EFFECTIVE REVERSIBLE METHOD OF CONTRACEPTION
IT HAS TWO COMPONENTS 1.ESTROGEN—EHTINYLESTRADIOL
AND 2.PROGESTINS—LNG,NORETHISTERONE
MODE OF ACTION:-
1.of EE-
Inhibition of ovulation-both hormones suppress the FSH &
LH .that suppress surge on ovulation day .that leads to anovulation
2.of progestin-
Alteration of the character of the cervical mucus (thick)
Alteration of tubal motility (decreases)
Making endometrium unsuitable
HOW TO START A PILL
Ideally it has to be started on day 1
It has to be taken for 21 days +7 days (dummies) at fixed time of day
Next package should be started before 5th day after first bleeding day
for max protection Missed pill
If 1 pill is missed -take 2 pills on following day
If 2 pill at missed-1.in week 1,2:-take 2 pills /day for next 2days
2.in week 3:-start new package and must use alternative method for
protection In lactating women - with held for 6 months
 BENEFITS OF OCP
1.Conctraceptive benfit
2.
ADVERSE EFFECTS OF OCP
Nausea,vomiting,headache
Chloasma,acne,mastalgia
Menorrhagia,amenorrhea-spontaneous resumption occurs,if not it has to be investigated
Libido-decrease due to dryness of vagina
Leukorrhea
Depression
HTN -due to increase in raas mechanism .it is reversible.
There is increase in systolic but not diastolic
Vascular complication-venous thrombosis and arterial thrombosis that leads to increase in risk of cardiac
disease
Cholestatic jaundice
Increase in Cervix cancer,hepatic adenomas
Breakthrough bleeding -bleeding in PFI due to significant rise in natural hormones can be managed by giving
estradiol 2mg for 7days
Effect on carbohydrate-causes insulin resistance,hyperglycaemia
Effect on protein -increase free protein in plasma like SHBP
Effect on lipids -increase in LDL and decrease in HDL,increase in total cholesterol level in blood
 INDICATION
EFFECT ON REPRODUCTION FOR
WITHDRAWAL
Ovulation returns within 3 months of withdrawal of the drug in 90%
cases. The indications for withdrawal of the pill are—
Risk to fetus: When COC is taken during(1)early pregnancy
Severe migraine inadvertently
there is no greater risk of significant congenital anomaly
(2) Visual or speech disturbances
(3) Sudden chest pain
Lactation (OGN + PGN): Lactation is probably affected by a reduction
(4) Unexplained fainting attack
in the milk production and also by alteration of the quality of the milk or acute vertigo
(6) Excessive weight gain
(7) Severe depression
(8) Prior to surgery (it should be withheld for
at least 6 weeks to minimize postoperative
vascular complications)
INDICATIONS FOR WITHDRAWAL
The indications for withdrawal of the pill are—
(1) Severe migraine
(2) Visual or speech disturbances
(3) Sudden chest pain
(4) Unexplained fainting attack or acute vertigo
(6) Excessive weight gain
(7) Severe depression
(8) Prior to surgery (it should be withheld for at least 6 weeks to minimize
postoperative vascular complications)Indication for withdrawal
TRIPHASIC FORMULATION
the hormonal doses of each compound vary over the course of the cycle.
Minimum doses are provided for contraceptive effect in the early part of
the cycle and slightly higher doses later in the cycle to prevent
breakthrough bleeding.
Triquilar tablets (Shering-AG): First 6 tablets contain 0.05 mg
levonorgestrel and 30 mg of ethinyl estradiol; next 5 tablets contain 0.075
mg levonorgestrel and 40 mg ethinyl estradiol; the last 10 tablets contain
0.125 mg levonorgestrel and 30 mg ethinyl estradiol
PROGESTROGEN ONLY PILLS
It has only progestin component only :-levonorgestrel 75 g,
norethisterone 350 g, desogestrel 75 g, lynestrenol 500 g or norgestrel
30 g

How to start a pill??

It has to be taken daily from the first day of the cycle.At same time of
the day .No delay more than 3hr.started on day 1 of cycle
MOA:-

Alteration of the character

of the cervical mucus
(thick)
Alteration of tubal motility
(decreases)
Making endometrium
unsuitable
NEWER PILLS WITH ANTIANDROGENIC
PROPERTIES- DROSPIRENONE
It reduces fluid and sodium retemion, and has
no adverse effect
it has antimineraloorticoid and with
antiandrogenic activity
It inhibits ovulation, and has no effect on bone
mineral density
It also prevents obesity and maintains good lipid
profile. Because of this property and relieffrom
acne, it is also been called 'beauty pill'.
MINI PILL
Advantages
Less side effects than ocp , indicated in
lactating women’s , used in hypertensions
women,
Side effects
Ache , mastalgia , simple cyst of
ovary,Failure rate is about 0.5–2 %
women years of use.
CONTRAINDICAT
IONS
Pregnancy
A.

B. unexplained vaginal bleeding,

C. recent breast cancer
EMERGENCY PILL

Within 72hrs/120hrs

Within 5days
MORNING AFTER PILL
It contains 0.75 mg LNG. One tablet should be taken within 72 hours of
unprotected intercourse and another 12 hours later.
Alternately two tablets can be taken as a single dose. The tablet can be
offered up to 120 hours
IT is not teratogenic
Contraindications
In liver disease, in a woman with history of thrombophlebitis and migraine.
MIFEPRISTONE RU468
Mifepristone acts on progesterone receptors. It blocks the action of
progesterone on endometrium, it causes sloughing and shedding of decidua
and prevent implantation
Effective dose is 100mg single dose
Not teratogenic

ULIPRISTAL ACETATE
It is a progesterone hormone receptor modulator, it attaches to progesterone
receptor and delays ovulation and suppresses endometrium, prevents
implantation.
CENTCHROMAN/SAHELI
lt has been developed by Central Drug Research institute , Lucknow,
and has been released in lndia under the name of Saheli
It was introduced free of cost in India under family plan “CHHAYA”
IT IS NONSTEROIDAL contraceptive drug and it prevents
implantation through endometrial changes
How to start???
It is started on day1 and taken twice weekly for 12 weeks and once
weekly thereafter
Side effects :-
Headache, nausea, vomiting
Weight gain
Does not protect against HIV and STD
Some delay in return of fertility (up to 6 months)
It can be used as emergency contraceptive also -
Two tablets (60 mg) taken twice in 24 hours within 24 hours of
intercourse
THANK YOU

ADARSH
73