Oral Contraceptive Pills

Summary

Oral contraceptive pills, or OCPs for short, contain a combination of the hormones estrogen and progesterone. As contraceptives, these drugs are used to prevent pregnancy, however they carry a risk of causing blood clots. For this reason, OCPs are not recommended in patients with a prior history of blood clots, those who smoke, or patients who have hypertension.

Key Points

• Oral Contraceptive Pills (OCPs)
  • Key Drugs
    • Estrogen
      • Most common synthetic estrogen used is ethinyl estradiol (EE)
    • Progesterone
      • Many different types of progestin: norethindrone, ethynodiol diacetate, norgestrel, levonorgestrel, desogestrel, norgestimate, etc.
    • OCPs can include a combination of estrogen and progesterone, or some are progesterone-only
  • Mechanism
    • Estrogen
      • Inhibits ovulation by preventing formation of a dominant follicle
    • Progesterone
      • Suppresses the luteinizing hormone (LH) surge that is required for ovulation
      • Alters the uterine lining so it's not as favorable for implantation
      • Thickens cervical mucus
  • Clinical Use
    • Contraception
      • One pill taken daily
      • 21 days of active pills, followed by 7 days of inert pills during which the user may experience withdrawal bleeding. Some manufacturers will include iron supplementation in the inert pills to prevent iron-deficiency anemia.
      • Backup contraception should be used for the first 7 days after starting OCPs
    • Menstrual Irregularity
      • OCPs can be used to alter hormone balance to correct for irregular menses
  • Side Effects and Adverse Reactions
    • Increased risk for blood clots
      • Not recommended for people with a history of clots
        • Deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), or cardiovascular accident (CVA) stroke
      • Not recommended for those who smoke or have hypertension
        • At a higher risk for blood clots
        • Do not smoke while taking oral contraceptives
        • Report severe leg pain and swelling (DVT), loss of vision or headaches (stroke), or chest pain (PE or MI)
    • Contraindicated with history of estrogen-dependent tumors
      • E.g. certain types of breast cancer, endometrial cancer, ovarian cancer
    • Breast tenderness
      • Normal, expected side effect. No need to report.
    • Spotting between menses
      • Normal, expected side effect. No need to report.
    • Increased risk for cervical cancer
    • Does NOT protect against sexually transmitted infections (STIs)