Oral contraceptives

1. • Presented by
Syeda Khadija Tazeen
•Pharm.D II year
•Shadan College of Pharm.D

2. INTRODUCTION:
CONTRACEPTION CLASSIFICATION OF
CONTRACEPTIVE METHODS
 The deliberate use of artificial
methods or other techniques
to prevent pregnancy as a
consequence of sexual
intercourse.
Permanent Methods:
 Male sterilization
 Female sterilization
Spacing Methods:
 Natural methods
 Barrier methods
 Intra Uterine devices
 Hormonal Contraceptives
 Emergency Contraceptives
 Post Conception methods.

3. Definition:
 Oral contraceptives are the prescribed medications
taken by oral route that helps in preventing pregnancy.
 They are also known as “ BIRTH CONTROL PILLS”.
 A birth control pill is taken by mouth. Most oral
contraceptives include both estrogen and
progesterone or progesterone only pills.
 When given in certain amounts and at certain times in
the menstrual cycle, these hormones prevent the ovary
from releasing an egg for fertilization.
 Birth control pills may also be prescribed to reduce
menstrual cramps or prevent anemia

4. How Birth control medications work?
 Hormonal birth control medications prevent
pregnancy through the following ways:
 By inhibiting ovulation, thus preventing fertilisation;
 By altering mucus in the cervix, which makes it hard
for the sperm to travel further;
 By changing the endometrium lining of the uterus so
that it cannot support a fertilized egg;
 By altering the fallopian tubes (the tubes through
which ovum moves from the ovaries to uterus) so that
they cannot effectively move egg towards the uterus.

5. TYPES OF ORAL CONTRACEPTIVES
ORAL CONTRACEPTION
COMBINED ORAL
CONTRACEPTIVES
(COC)
PROGESTERONE
ONLY PILLS (POP)
EMERGENCY
HORMONAL
CONTRACEPTION
(EHC)

6. COMBINED PILLS
(The combinations of estrogen with progestin)
Formulations may include:
• MONOPHASIC:
Monophasic pills contains a constant and fixed
amount of estrogen and progestin in each of the active
pills through out the entire cycle (21 days of ingesting
pills).
Several brands of pills are available where doctors
choose according to the women’s individual needs.
 Ethinylestradiol and norethindrone are examples of this
type of pill.

7.  BIPHASIC:
Biphasic pills contains a fixed amount of estrogen, while the
amount of progestin increases in the second half of the
cycle.
Examples: Ethinylestradiol and desogestrel (Azurette,
Kariva, Mircette, Viorele)
 TRIPHASIC:
The amount of estrogen may be fixed or variable, while the
amount of progestin increases in 3 equal phases.
Those levels change every seven days during the first three
weeks of pills. This was the first type of birth control pill.
Examples include Kariva and Mircette Ortho-Novum 10/11.

8. MODE OF ACTION

9. COMMON ADVERSE EFFECTS
 Weight gain, headache, abdominal cramps, elevated
blood pressure.
 Mild nausea, flushing, dizziness, depresson or
irritability, bloating.
 Skin changes (i.e. acne/ increased pigmentation) etc

10. POTENTIAL ADVERSE EFFECTS
 CARDIOVASCULAR:
 Thromboembolism
 Thrombophlebitis
 Hypertension
 Increased incidence of
Myocardial Infarction.
 These effects are more
common in the woman
who smoke and also
above 35 years of age;
although it may effect in
the woman of any age.
 CARCINOGENECITY:
 Decreased incidence of
endometrial and ovarian
cancer
 The production of benign
tumor in the liver that ay
and hemorrhage is also
rare.

11.  METABOLIC:
 Abnormal Glucose
tolerance is sometimes
associated with oral
contraceptives.
 Weight gain is common in
women who are taking
nortestosterone derivatives.
 SERUM LIPIDS:
 The combination Pills causes
changes in serum lipoprotein
profile: Estrogen cause an
increase in HDL and
decreases LDL levels in the
blood.
 Note: Potent progestin
causes a greatest increase in
LDL:HDL ratio;
 Therefore, Estrogen-
dominant pills are the best
for the individuals with
elevated serum cholesterol
Progestin may decrease some of
the beneficial effects of estrogen

12. BENEFICIAL EFFECTS
 The Combined pills markedly decreases menstrual
symptoms such as irregular menstrual cycle,
intermenstrual bleeding, etc
 Iron deficiency anemia and premenstrual tension is also
reduced (uterine fibroids, & functional cysts of the
ovaries.

13. PROGESTERONE ONLY PILLS
 Progesterone-only pills (POPs) contains one active
ingredient i.e.- progesterone.
 These pills have to be taken continuously without any
interruption right from the beginning of the course.
 It also acts an alternative when estrogen pills are
contraindicated.
 They are also known as ‘Mini-pills’; since progesterone is
the active hormonal ingredient , estrogen-related side
effects are avoided.
*But Failure rates are higher in POPs as they do not include estrogen*
 Example include Cerazette,Cerelle,Micronor,Norgeston

14. MODE OF ACTION
 The mode of action is
primarily on the cervical
mucous, which is made
inhospitable to sperm.
Progesterone
only pills
Hinders
implantation by
effecting on
endometrium
Further it effects
secretion and
motility of
fallopian tubes

15. POTENTIAL BENEFICIAL AND
UNWANTED EFFECTS
 Progesterone only contraceptives are given to the
women whose blood pressure increases
unacceptably during the treatment with estrogen.
 They offer a suitable alternative to the combined pill
for some women in which estrogen is contraindicated.
 However, the contraceptive effect of these pills is less
reliable than that of the combination pills, missing a
dose may result in conception.
 Disturbances of menstruation is common.

16. EMERGENCY HORMONAL
CONTRACEPTIVES (EHC)
 Emergency contraception can prevent pregnancy after
unprotected intercourse or if the contraception which
had used been gets failed – for example, if you have
missed a pill.
 There are 2 types of emergency contraception:
 the emergency contraceptive pill – Levonelle or ellaOne
 the intrauterine devices (IUD or coil)

17. HOW THE EMERGENCY PILL WORKS?
 Levonelle
 Levonelle contains levonorgestrel, a synthetic version of
the natural hormone progesterone produced by the ovaries.
 Taking it's thought to stop or delay the release of an egg
(ovulation).
 Levonelle has to be taken within 72 hours (3 days) of
intercourse to prevent pregnancy.
 ellaOne
 ellaOne contains ulipristal acetate, which stops
progesterone working normally. This also works by stopping
or delaying the release of an egg.
 ellaOne has to be taken within 120 hours (5 days) of
intercourse to prevent pregnancy.

18.  They aren't intended to be used as a regular form of
contraception. But it can used as emergency
contraception more than once in a menstrual cycle if
needed.
 Taking the emergency contraceptive pills Levonelle or
ellaOne can give you a headache or stomach pain and
make you feel or be sick.
 The emergency contraceptive pill can make the next
menstrual cycle earlier, later or more painful than
usual.

19. INTRA-UTERINE DEVICES
 The IUD can be fitted up to 5 days after unprotected
intercourse, or up to 5 days after the earliest time of
ovulation; for it to be more effective.
 The IUD is more effective than the contraceptive pill at
preventing conception.
 If IUD is used as emergency contraception, it can be left
in and used as regular contraceptive method;
 But it can the next menstrual cycle longer or more
painful.
 There are no serious side effects of using emergency
contraception.

20.  Most women can use the emergency contraceptive pill.
This includes women who can't use hormonal
contraception, such as the combined
pill and contraceptive patch.
 But you may not be able to take the emergency
contraceptive pill if you're allergic to anything in it,
have severe asthma or already taking any medicines .