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