An overview for COCP

1. COCP
Dr.Kavinda Hewawitharana

2. Contraceptive effect
• Progesterone is primarily responsible for preventing pregnancy
• main mechanism of action is the prevention of ovulation
• inhibit follicular development and prevent ovulation
• Estrogen has some effect with inhibiting follicular development
• its negative feedback on the anterior pituitary with slowed FSH
secretion
• not as prominent as the progesterone’s effect

3. Non-contraceptive benifits
• Reduce risk of colonic CA
• ‘’ ‘’ ovarian CA
• ‘’ ‘’ endometrial CA
• Reduce benign breast disease
• Reduce benign ovarian cysts
• Reduce benign uterine mass
• ‘’ HMB
• ‘’ Dysmenorrhoea
• ‘’ PMS
• ‘’ Hirsutism

4. Preparations
• usual estrogen component is combined with a different generation of
progestin components with varying degrees of androgenic and
progestogenic potential
• prescribed based on desirable effects and risk of adverse events with
progestin component and dose of estrogen and progestin
component.
• Currently drugs have setup to minimum dose of estrogen with its
maximal effect to avoid side effects

5. • Estrogen component: Estradiol, Ethinylestradiol, or Estetrol
• First-generation progestin: Norethindrone acetate, Ethynodiol diacetate,
Lynestrenol, Norethynodrel
• Second generation progestin: Levonorgestrel,dl-Norgestrel
• Third generation progestin: Norgestimate, Gestodene, Desogestrel
• Fourth generation progestin: Drospirenone, Cyproterone acetate

6. Phasic preparations-Monophasic
• Monophasic birth control pills have the same amount of estrogen and
progestin in each active pill
• less likely to cause side effects that could result from fluctuating
hormones
• This is the most common type

7. Phasic preparations-Biphasic preparations
• Biphasic birth control pills change the level of hormones one time
during the pill pack
• deliver the same amount of estrogen each day, but the level of
progestin is increased about halfway through the pill cycle.
• During the first half of the cycle, the progestin/estrogen ratio is
usually lower.
• During the second half of the cycle, the progestin/estrogen ratio
tends to be higher

8. Phasic preparations-Triphasic preparations
• contain three different doses of hormones
• hormone combination changes approximately every seven days
throughout the pill pack.
• the amount of estrogen may change as well as the amount of
progestin
• no evidence-based advantage over monophasic pills in relation to
their adverse effect profile or cycle control

9. Phasic preparations-Quadriphasic OCP
• contains oestradiol valerate and desogestrel
• is formulated with an oestrogen step-down and progestogen step-up
sequence

10. Why we need phasic pills?
• Lower the total hormone dosage you may receive in each pill pack.
• They are also designed to more naturally mimic your body's
menstrual cycle
• But should not messed up with pills-each dose changed tablet has
different colour and should follow those in a row , otherwise not
effective

11. Why day 21 or 24 preparations?
• Some COCP has active 21 pills while others have 24
• Why 24?not 21
• reduce the chance of contraceptive failure
• ‘’ ‘’ breakthrough ovulation
• delay or avoid a withdrawal bleeding
• This is most easily achieved with monophasic regimens in which each active pill
contains the same amount of oestrogen and progestogen and the inactive pills
are skipped
• But now there are commercial preparations/formulations for this task with better
progesterone forms

12. Drospirenone
• 4th genereation progestogen
• Anti-mineralocorticoid activity(3 mg drospirenone has comparable
anti-mineralocorticoid activity as 25 mg dose of spironolactone)
• Anti-androgenic
• no negative metabolic effects on women with PCOS, and some
studies reported favorable metabolic effects

13. Cyproterone ; how about this?
• has high antiandrogenic activity
• controversy remains regarding whether CPA has a transiently negative
effect on carbohydrate metabolism and lipid profiles
• Unlike drospirenone – no anti-mineralocorticoid effect as former

14. Comparison of CYP and DPN
• Cyproterone acetate and drospirenone containing OCs have similar
effects regarding carbohydrate/lipid metabolism and oxidative stress
parameters.
• Cyproterone acetate containing OCs seem to be more effective to
treat clinical hirsutism in patients with PCOS after 12 months of
treatment
• Both drugs have adrenal influence which is more prominent with
drospirenone containing OCs.

15. Which one we select?
• 21 or 24
• Cyp or Dpn
• Monophasic or polyphasic
• Open for discussion………………