SEMINAR PRESENTATION
DANGER AND USES OF ORAL CONTRACEPTIVE
BY
OYEBODE-OMOLE AYOMIDE
2122/MLT/356
SUBMITTED TO THE DEPARTMENT OF MEDICAL LABORATORY
TECHNICIAN, MILLENNIUM COLLEGE OF HEALTH TECHNOLOGY AKURE,
ONDO STATE
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OUTLINES
• INTRODUCTION
• ORAL CONTRACEPTIVES
• INDICATIONS
• MECHANISM OF ACTION
• COMBINED ORAL CONTRACEPTIVE (COC)
• ADVERSE EFFECTS
• CONCLUSION
• RECOMMENDATION
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INTRODUCTION
• Currently, there are several entities that want to include oral
contraceptive counseling and medications within a preventive care
platform.
• Firstly, oral contraceptives (OCPs) have their own significant risks,
namely, an increase in cardiovascular events (such as an increase in
venous thromboembolism,
• Pulmonary embolism, myocardial infarction, and stroke) especially in
older women and smokers (Vecchia et al., 2019).
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• Secondly, OCPs increase the risk of the world's most frequently
occurring cancer, breast cancer.
• Thirdly, OCP use leads to an increase in human papillomavirus (HPV)
infection and an increase in cervical cancer, which is the second most
common cancer worldwide (Vecchia et al., 2019).
• Therefore, OCPs fail the most important test of preventive medicine:
they increase the risk of disease instead of decreasing it.
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ORAL CONTRACEPTIVES
• According to United Nations estimates, oral contraceptives are
currently used by nearly 62 million women (United Nations, 1989).
• Two types of oral contraceptives (OCs) are available:
Combination OCs, consisting of the hormones estrogen and
progestin,
Progestin-only pill (often called the minipill). (Trussell and Kost, 1987).
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INDICATIONS
• The birth control pill is the most commonly prescribed form of
contraception in the US.
• Approximately 25% of women aged 15-44 who currently use
contraception reported using the pill as their method of choice (Curtis
et al., 2016).
• Most women take OCP’s to prevent pregnancy, but 14% use them for
non-contraceptive reasons.
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• It can be used to address other health conditions, particularly
menstrual-related disorders such as menstrual pain, irregular
menstruation, fibroids (Maguire et al., 2011).
• The FDA has formally approved combined pills for acne for specific
brands (Arowojolu et al., 2019).
• Some formulations even have indications for the treatment of acne
and hirsutism (Shulman et al., 2011; ACOG, 2010).
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MECHANISM OF ACTION
• Progesterone is primarily responsible for preventing pregnancy.
• The main mechanism of action is the prevention of ovulation; they
inhibit follicular development and prevent ovulation.
• The progestogen negative feedback and lack of estrogen positive
feedback on LH secretion stop the mid-cycle LH surge.
• With no follicle developed and no LH surge to release the follicle,
ovulation is prevented
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• Estrogen has some effect with inhibiting follicular development
because of its negative feedback on the anterior pituitary with slowed
FSH secretion;
• it’s just not as prominent as the progesterone’s effect.
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COMBINED ORAL CONTRACEPTIVE
(COC)
• The combination is prescribed based on desirable effects and risk of
adverse events with progestin component and dose of estrogen and
progestin component. (Maguire et al., 2011).
• Estrogen component: Estradiol, Ethinylestradiol, or Estetrol
• First-generation progestin: Norethindrone acetate, Ethynodiol
diacetate, Lynestrenol, Norethynodrel
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• Second generation progestin: Levonorgestrel,dl-Norgestrel
• Third generation progestin: Norgestimate, Gestodene, Desogestrel
• Unclassified progestin: Drospirenone, Cyproterone acetate
• Progesterone only Pill (POP) (Nylander et al., 2014).
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ADVERSE EFFECTS
• Most side effects of OCP's are mild and disappear with continued use or
switching to another pill formulation.
• The most common adverse effect of combined oral contraceptive pills is
breakthrough bleeding. (Tayob et al., 2015).
• Women will also complain of nausea, headaches, abdominal cramping,
breast tenderness, and increased vaginal discharge or decreased libido.
(Nylander et al., 2014).
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ADVERSE EFFECTS
• Nausea can be avoided by taking the medication at night before sleep.
• The majority of the other consequences will resolve with time or
switching OCP to a different preparation.
• Oral contraceptive pills can cause hypertension in 4-5% of healthy
women and exacerbate hypertension in about 9-16% of women with
pre-existing hypertension. (Nylander et al., 2014).
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CONCLUSION
• Preventive medicine is the backbone of any medical system. Patients
must have confidence that the measures physicians are
recommending are going to be beneficial for their health.
• Oral contraceptives increase rates of cardiovascular morbidity and
mortality, as well as increasing the rates of breast and cervical
cancers.
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RECOMMENDATION
• Patients need complete informed consent on all of the possible risks of
OCPs.
• Complete personal and family histories need to be ascertained by health-
care providers to ensure that adverse events do not occur.
• Patients do incur health risks when choosing oral contraceptives.
• They should not be misled or confused into believing that what they are
taking is “good for them”
• Has similar beneficial effects to other evidence-based preventive measures.
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THANKS FOR LISTENING
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• ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010 Jan;115(1):206-218. [PubMed]
• Arowojolu AO, Gallo MF, Lopez LM, Grimes DA, Garner SE. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst
Rev. 2019 Jul 08;(3):CD004425. [PubMed]
• se, 2016. MMWR Recomm Rep. 2016 Jul 29;65(4):1-66. [PubMed]
• Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, Simmons KB, Pagano HP, Jamieson DJ, Whiteman MK. U.S. Medical
Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016 Jul 29;65(3):1-103. [PubMed]
• Estetrol/drospirenone (Nextstellis) - a new combination oral contraceptive. Med Lett Drugs Ther. 2021 Jun 28;63(1627):101-102. [PubMed]
• Kapp N, Curtis KM. Combined oral contraceptive use among breastfeeding women: a systematic review. Contraception. 2010 Jul;82(1):10-6. [
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Gynaecol. 2015 Aug;102(8):601-7. [PubMed]
• Maguire K, Westhoff C. The state of hormonal contraception today: established and emerging noncontraceptive health benefits. Am J Obstet
Gynecol. 2011 Oct;205(4 Suppl):S4-8. [PubMed]
• McCarthy KJ, Gollub EL, Ralph L, van de Wijgert J, Jones HE. Hormonal Contraceptives and the Acquisition of Sexually Transmitted Infections:
An Updated Systematic Review. Sex Transm Dis. 2019 May;46(5):290-296. [PubMed]
• Simmons KB, Haddad LB, Nanda K, Curtis KM. Drug interactions between non-rifamycin antibiotics and hormonal contraception: a systematic
review. Am J Obstet Gynecol. 2018 Jan;218(1):88-97.e14. [PubMed]
• Tayob Y, Adams J, Jacobs HS, Guillebaud J. Ultrasound demonstration of increased frequency of functional ovarian cysts in women using
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