Side Effects of Oral Contraceptive Pills (OCPs)

Services of Family Planning Units

• Pregnancy spacing (reversible or permanent) • Management of infertility • Management of recurrent fetal loss and genetic counseling

Classification of Contraceptives

• Hormonal contraceptives + Combined (Estrogen and Progesterone): OCP, monthly injectable, vaginal ring, skin patch + Progesterone only: POP, injectable (DMPA), implants, hormone releasing IUCD • Non-hormonal contraceptives + Physiological + Barrier + Chemical + IUCD + Surgical

Short Acting vs. Long Acting Contraceptives

• Short acting: physiological, barrier, chemical, OCPs • Long acting: implants, injectables, IUCD, surgical

Irreversible vs. Reversible Contraceptives

• Irreversible: surgical • Reversible: all others

Measuring Effectiveness (Pearl Index)

• Method used to determine pregnancy (failure) rate among 100 women using a contraceptive method for 12 months • Perfect use rate: represents the theoretical efficacy • Typical use rate: represents the actual users' experience

Effectiveness of Contraceptives

• Most effective: IUCD, contraceptive implants, sterilization • Effective: injectables, OCP, transdermal patches, vaginal ring • Least effective: diaphragm, cervical caps, condoms, spermicides, withdrawal, and periodic abstinence

Ideal Contraceptive

• Available • Affordable • Easily administered • Does not interfere with coitus • Has other non-contraceptive benefits • Has the least adverse effects • Effectiveness is immediate • Reversible as soon as discontinued

Eligibility for Contraceptive Use

• Conditions with no restriction for use (Category 1) • Conditions where advantages outweigh risks (Category 2) • Conditions where risks usually outweigh advantages (Category 3) • Conditions with unacceptable health risk (Category 4)

Counseling before Using Contraception

• Method: cost, duration, failure rate, reversibility • Technique: way of usage, missing, discontinuation, removal • Patient: advantages, disadvantages, contraindications, side effects

Natural Family Planning Methods

• Calendar method • Basal Body Temperature (BBT) method • Cervical Mucus (Billing) method • Urinary LH kits (Persona)

Lactational Amenorrhea Method

• Idea: stimulation of nipples sends nerve impulses to hypothalamus, inhibiting ovulation • Advantages: available from first day, no cost, healthy for infant • Disadvantages: not reliable, effective mainly in the first 6 months (50%)

Coitus Interruptus

• Idea: withdrawal of penis and ejaculation outside the vagina • Advantages: simple, readily available, no cost • Disadvantages: may cause pregnancy, less sexual satisfaction, may lead to pelvic congestion### Benefits of Hormonal Contraception

• Decrease incidence of fibroids, endometrial carcinoma
• Improve functional ovarian cyst and endometriosis
• Decrease benign breast lesions
• Decrease the risk for ectopic pregnancy
• Decrease the risk of PID (thick cervical mucus)

Disadvantages of Hormonal Contraception

• Incorrect use is common, increasing failure rate
• Require daily use
• Re-supply is required
• No protection against STI, including HIV
• May pose health risks for a small number of women

Types of Hormonal Contraception

Combined Oral Contraceptives (COCs)

• Choice of pills: low dose estrogen pills, monophasic pills, and pills containing new progesterone generation
• Starting pills: day 2-4 of the menstrual cycle, continued daily for 21 days, followed by a 7-day pill-free period
• Missing pills: take one as soon as possible, then continue with the next pill at the usual time

Progestin-Only Pills (POPs)

• Preparation: Microlut, Micronor, Exluton, and Cerazette
• Mode of action: mainly by rendering cervical mucus thick, and to a lesser extent, altering tubal motility and suppressing ovulation
• Use: one tablet daily from the first day of the cycle, continuously
• Indications: lactating patients, no estrogen side effects, suitable for cardiac, hepatic, over 40, and smokers

Injectables

• Forms: Depo-Provera, Depo-subQ Provera, and Norethisterone enanthate
• Mode of action: mainly by thickening cervical mucus, and to a lesser extent, suppressed ovulation
• Advantages: available, non-costly, require no action at the time of intercourse, no effect on lactation, highly effective, and offers non-contraceptive health benefits
• Disadvantages: menstrual irregularities, weight gain, delayed return to fertility, and decreased bone density

Subdermal Implants

• Method: Implanon, a single cylinder containing etonogestrel, left for 3 years
• Action: mainly by thickening cervical mucus, and to a lesser extent, suppressing ovulation
• Advantages: long-acting, rapidly reversible, and no estrogen side effects
• Disadvantages: headache, breast tenderness, weight gain, difficult insertion and removal, and menstrual irregularities

Vaginal Contraceptive Rings

• Combined vaginal ring: EE + Etonogestrel, inserted for 3 weeks and removed for 1 week
• Advantages: immediately reversible, simple introduction and removal, and fewer side effects

Combined Hormone Patches

• Evra patch: inserted for 3 weeks and removed for 1 week
• Failure rate: 1.2/HWY

Hormone-Releasing IUCD (LNG-IUS)

• Types: male and female
• Indications: permanent contraception, completed family, old couple, contraindication for pregnancy, and scarred uterus
• Complications: complications of anesthesia or surgery, pregnancy, and post-ligation syndrome

Male Contraception

• Permanent: vasectomy
• Temporary: physiological, mechanical, chemical, and hormonal

Postpartum Contraception

• Immediately: breastfeeding, barriers, and sterilization
• Lactating women at 6 weeks: progestagen-only methods, IUCD, and lactating women at 6 months: COC, combined monthly injectable, and VCR

Postcoital (Emergency) Contraception

• Hormones: given immediately or within 72 hours, inhibit ovulation, and cause early luteolysis
• Mechanical: IUCD inserted immediately or up to 120 hours, most effective method

Special Groups

• Diabetics: avoid estrogen-containing components, IUCD may be inserted with precaution
• Rheumatic heart disease: avoid estrogen-containing components, IUCD may be inserted with precaution
• Newly married: hormonal contraception (COC) is best
• Smokers: avoid estrogen-containing components, IUCD is better
• Elderly: IUCD is better, progesterone-containing contraceptives are more suitable, and permanent sterilization is considered

This quiz covers the potential side effects of taking oral contraceptive pills, including breast changes, acne, skin pigmentation, and more. Understand the possible effects of OCPs on the female body.