Combined Pill: Efficacy, Contraindications, and Side Effects

Combined Pill Introduction

a.k.a oral contraceptive pill, birth control pill, or 'pill.' 99% effective if used correctly. Ineffective for those;

• ≥35 years of age and smokers
• those with some medical conditions; -heart diseases /abnormality (including hypertension) -diabetes with complications or 20 yr period of having diabetes. -stroke or any other disease that narrows arteries e.g arteriosclerosis & atherosclerosis -breast cancer -gall bladder disease/ liver disease

❖ whose medications have an interaction with contraceptives; -drugs used to reduce bile acid- cholestyramine -enzyme inducing drugs cause fast processing of contraceptive hormones; Drugs used to treat epilepsy, HIV, antibiotics in tuberculosis & meningitis Already pregnant /Still breastfeeding <6 months < 21 days after giving birth Close family with person that got blood clot <45 yrs Overweight

How it works

Combined pill contains artificial versions of female hormones; oestrogen and progesterone, which are produced naturally in the ovaries. It prevents sperm and ovum from being in contact with one another through delaying ovulation due to oestrogen

Other ways the combined pill works

• Thickening the mucus in the neck of the womb-harder for sperm to penetrate.
• Thins the lining of the womb (prevents egg implantation)

Advantages & Disadvantages

Advantages of the Combined Pill

• Does not interrupt person's sex life.
• Involves more privacy.
• Easy usage in family planning.
• usually makes your bleeds regular, lighter and less painful.
• reduces your risk of cancer of the ovaries, womb and colon
• reduces symptoms of PMS (premenstrual syndrome)
• sometimes reduce acne
• it may protect against pelvic inflammatory disease
• it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease.

Disadvantages of the Combined Pill

• Other methods of contraception are better at preventing contraceptives i.e IntraUterine Device's, progesterone injection etc.
• Start involves side effects; headaches, nausea, breast tenderness and mood swings.
• Involves risk (low) of serious side effects; blood clots, cervical cancer & depression.

" Long use found associated with infertility in women2 since fertility takes long to return3. ▪ - BP as a result of oestrogen . Does not protect you against Sexually Transmitted Infections (STI's) e.g E.coli infection (urethritis)4

Three main types of combined pill

Mono-phasic 21 day pill

• Most common.
• Each pill has the same amount of hormone.
• One pill taken for 21 days with 7day break period. Eg. Microgynon Marvelon Yasmin

Phasic 21 day pill

• Each pill contains different amount of hormones.
• 3 or 2 different coloured sections in pack.
• One pill taken for 21 days with 7day break period.
• need to be taken in the right order. Eg Logynon

Everyday (ED) pill

• Pack has 21 active and 7 inactive (dummy) pills.
• Type of pills look different. One pill taken for 21 days with no break period (continuous everyday)
• Everyday pills need to be taken in the right order. Eg Microgynon ED

Dosage Guidelines

21 day pills

• Take your 1st pill from the packet marked with the correct day of the week, or the 1st pill of the 1st colour (phasic pills)
• Take pill each time until pack is finished.
• Don't take pill for 7 days (expected to/ might bleed).
• On 8th day take your pill on the same day you took the 1 st pill whether bleeding is there or not.

Everyday pills

• Take the 1st (active) pill from the section of the packet marked "start".
• Continue to take pill everyday (prefer same time) until 28 pack is finished.
• During the 7 days of taking the inactive pills, you will get a bleed.
• Start your next pack of pills after you have finished the 1st pack, whether you are still bleeding or not.

Progesterone only pill (POP)

Is 99% effective Can be used for those that cannot use combined pill, patch or ring. Can be used if you cannot use contraception that contains oestrogen. (allergic) People that can use it;

• you're over 35 and you smoke.

. Ineffective for;

• Patients taking antibiotics.
• Patients with severe diarrhoea.
• Patients that are vomiting.
• People with history of breast cancer or any cancer

Mechanism of action

• prevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg.
• Also stops ovulation

2 different types of progestogen-only pill

• 3-hour progestogen-only pill (traditional progestogen-only pill) - must be taken within 3 hours of the same time each day
• 12-hour progestogen-only pill (desogestrel progestogen-only pill) - must be taken within 12 hours of the same time each day

DOSES

There are 28 pills in a pack of progestogen-only pills. Take 1 pill every day within either 3 or 12 hours of the same time each day.X

Side effects

Acne Breast tenderness and Breast enlargement An increased / decreased sex drive Mood changes Headache and migraine Nausea or Vomiting Cysts on ovaries

References

1. https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/
2. Sedlander, E., Bingenheimer, J. B., Lahiri, S., Thiongo, M., Gichangi, P., Munar, W., & Rimal, R. N. (2021). Does the Belief That Contraceptive Use Causes Infertility Actually Affect Use? Findings from a Social Network Study in Kenya. [viewed: 19/01/24] Studies in family planning, 52(3), 343- 359. [online] https://doi.org/10.1111/sifp.12157
3. https://www.nhs.uk/conditions/contraception/which-method-suits-me/
4. Dan, M., Gottesman, T., Schwartz, O., Tsivian, A., Gophna, U., & Rokney, A. (2012). Sexually transmitted Escherichia coli urethritis and orchiepididymitis. Sexually transmitted diseases, 39(1), 16-17. [online] [viewed: 19/01/24] https://doi.org/10.1097/OLQ.0b013e31823156a0