Hormonal Contraceptives

Pills, Rings, Patches and

Injectables

Oral Contraceptives

Pills can be taken to prevent pregnancy

Pills are safe and effective (>99%) when taken properly
(same time everyday)
Women must have a pap smear before.
Advised to use condoms for first month, when on antibiotics
& if pill is missed or taken late

Types of oral contraceptives

Constant-dose combination pill
Contains both estrogen and progestin
Dose of each is constant throughout cycle
Amount of estrogen in pills has decreased from
approx. 175 micrograms in 1960 to avg. of 25
micrograms today

Triphasic pill
Levels of hormones (estrogen & progestin) fluctuate
during cycle

Seasonale
Reduces the # of menstrual periods to 4 instead of
13 per year
Has lower dose of estrogen and progestin

Progestin-only pill
Low dose of progestin and no estrogen
For women who should not take estrogen

The Menstrual Cycle

MOA Of OCPs
Inhibition of
the midcycle
LH surge anovulation
Alterations in
cervical
mucus,
Impairment of
normal tubal
motility and
peristalsis.

Daily
progestin
exposure endometrial
decidualizatio
n and
eventual
atrophy

Suppression
of ovarian
folliculogene
sis (via
suppression
of pituitary
FSH
secretion).

Suppression of
ovarian steroid
production, due
to suppression
of gonadotropin
secretion

Benefits
Prevents pregnancy Decreased risk of
ovarian and
Eases menstrual
endometrial cancer
cramps & lightens
and ovarian cysts
flow
Reduced symptoms
Regulation of
of endometriosis,
irregular menses
acne, hirsutism
Decreased
incidence of benign
Side-effects
breast disease
Breast tenderness
Moodiness
Nausea
Weight change
Increase in
Spotting
headaches

Oral contraceptives Serious Side

Effects
Rare but serious side effects of OCs Be
aware when patients on OCs make any of
these complaints.

Contraindications

Vaginal Ring
Vaginal ring (Nuvaring)
2 ring inserted into the vagina
during period
Worn for 3 weeks, removed for 1
week, then replaced with new ring
Cost per year: $580
Pros: no daily pill; spontaneity
Cons: no STD protection, not
effective for women over 198 lbs.
Ring uses progesterone formulation
that may increase risk of VTC

The Patch
Transdermal patch (Ortho Evra)
Patch is placed on buttock, abdomen, outer upper arm,
or upper torso
Replaced weekly for 3 weeks, then a patch-free week
Cost per year: $420
Pros: no daily pill; spontaneity
Cons: no STD protection, skin irritation
Patch dispenses higher dose of hormones than COCs,
with possible higher risk of venous thromboemobolic
conditions

Injectables
Depo-Provera (prog.); Noristerat (prog.),
Lunelle (prog.+est.)
The progestin completely disrupts the
menstrual cycle. About 1/3 women using
this contraceptive have no menstrual
bleeding during the 3 months after the first
injection.
Another 1/3 have irregular bleeding and
spotting for more than 11 days each month.
After this contraceptive is used for a while,
irregular bleeding occurs less often.
After 2 years, about 70% of the women have
no bleeding at all. When the injections are
stopped, a regular menstrual cycle resumes
in about half the women within 6 months
and in about three fourths within 1 year.
Fertility may not return for up to 18 months
after injections are stopped.

Injectables contd
Injections: DepoProvera every 12 weeks; Noristerat
every 8 weeks; Lunelle monthly
Pros: no daily pill; spontaneity
Cons: no STD protection, weight gain, bleeding, mood
change, frequent clinic visits
Medroxyprogesteroneacetate does not increase the risk
of developing any cancer, including breast cancer.
It reduces the risk of developing uterine (endometrial)
cancer, pelvic inflammatory disease, and iron deficiency
anemia. Interactions with other drugs are uncommon.
Unlike combination oral contraceptives, progestin
injections do not increase the risk of high blood pressure
or blood clots.

Cost Comparison