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Oral contraceptive pill – what for who?
Mark Wilshere
2011
Content
• Introduction – the importance of the matter
• Types of oral contraception
• Oral contraception comparison
• Oestrogen/Progestogen/Androgen activity
• Tackling the side effect
• Summary
Introduction
• Pill is commonly used, especially in younger women
• Benefits include reliable contraception, easy to use, less bleeding, controls cycle, less painful periods
• Perceived negative effects include, nausea, headache, mood change, weight gain, irregular bleeding
Introduction
• Side-effects are an issue as compliance can subsequently be affected. Up to 20% of younger women may not take because the do not like it.
• 50% pregnancies in UK unintended
• 91% abortions funded by NHS
• 42% abortion rate in teenagers in 2001
Choice
• Very important
• Numerous to chose from
• Ethinylestradiol (standard)
• Progestin (variable) – oestrogen potency small if any
Combined
• 21 day standard strength COCP -
30-35mcg
• 21 & 7 day ED (Every Day) standard strength COCP – 30-35mcg for 21 days and 7 days of inactive pills
• 21 day low strength COCP – 20mcg
Ethinylestradiol 20mcg 21d monophasic
Progestogen content
Brand Price (3 cycle pack)
Desogestrel 150mcg
Gedarel 20/150
Mercilon
£5.98
£7.97
Gestodene 75mcg
Femodette
Millinette 20/75
Sunya 20/75
£8.85
£6.37
£6.62
Norethisterone acetate 1000mcg
Loestrin 20 £2.75
Ethinylestradiol 30mcg 21d monophasic
Progestogen content Brand Price (3 cycle pack)
Desogestrel 150mcg Gadarel 30/150
Marvelon
£4.93
£6.45
Drospirenone 3000mcg Yasmin £14.70
Gestodene 75mcg Femodene
Katya 30/75
Millinette 30/75
£6.73
£5.03
£4.85
Levonorgestrel 150mcg Levest
Microgynon 30
Ovranette
Rigevidon
£2.55
£2.82
£2.20
£1.89
Norethisterone acetate 1500mcg
Loestrin 30 £3.95
Ethinylestradiol 35mcg 21d monophasic
Progestogen content Brand Price (3 cycle pack)
Norgestimate 250mcg
Cilest £2.87
Norethisterone 500mcg
Brevinor
Ovysmen
£1.99
£1.49
Norethisterone 1000mcg
Norinyl-1 £2.19
Ethinylestradiol 50mcg 21d monophasic
• Norethisterone 1000mcg
• Norinyl-1
• £2.19
Ethinylestradiol 30mcg 28d monophasic
Progestogen content
Brand Price (3 cycle pack)
Gestodene 75mcg
Femodene ED(21 active, 7 inactive)
£6.73
Levonorgestrel 150mcg
Microgynon ED(21 active, 7 inactive)
£2.54
Ethinylestradiol Variable 21d phasic
Brand Ethinylestradiol dose/Progestogen (mcg)
Tablets Price
Triadene
(gestodene)
30 / 50
40 / 70
30 / 100
6
5
10
£8.99
Logynon
OR
TriRegol
(levonorgestrel)
30 / 50
40 / 75
30 / 125
6
5
10
£3.96
£2.87
BiNovum
(norethisterone)
35 / 500
35 / 1000
7
14
£1.96
Synphase
(norethisterone)
35 / 500
35 / 1000
35 / 500
7
9
5
£3.60
TriNovum
(norethisterone)
35 / 500
35 / 750
35 / 1000
7
7
7
£2.72
Ethinylestradiol Variable 28d ED phasic
Brand Ethinylestradiol dose/Progestogen (mcg)
Tablets Price
Logynon ED
(levonorgestrel)
30 / 50
40 / 75
30 / 125
6 active
5 active
10 active
7 inactive
£3.82
Qlaira
(estradiol / dianogest)
3mg / 0
2mg / 2mg
2mg / 3mg
1mg / 0
2 active
5 active
17 active
2 active
2 inactive
£25.18
Progestogen only
Brand Progestogen Price per 3 pack
Cerazette Desogestrel 75mcg £8.68
Femulen Etynodiol diacetate 500mcg
£3.31
Micronor Norethisterone 350mcg
£1.66
Noriday Norethisterone 350mcg
£2.10
Norgeston Levonorgestrel 30mcg £2.76*(35 pack = £0.92 x3)
Oestrogen activity
• Higher number of micrograms of ethinyl estradiol lead to more potent estrogenic effects. A higher amount of estrogenic activity helps to decrease androgen-related side effects. However, progestins tend to counter some of the estrogenic effects of ethinyl estradiol.
Progestational Activity
• Each progestin has a different potency
• Hence the differences in doses
• Is possible to compare potency of progestins and their androgenic activity
• High androgenic activity associated with acne, hair growth etc
Progestin Progestational Activity Androgenic Activity
Norethindrone 1mg (control)
1.0 1.0
Norethrindrone acetate 1mg
1.2 1.6
Norgestimate 1mg 1.3 1.9
Norelgestromin 1mg 1.3 1.9
Ethynodiol diacetate 1mg
1.4 0.6
Drospirenone 1mg 1.5 0.0
Dinorgestrel 1mg 2.6 4.2
Levonorgestrel 1mg 5.3 8.3
Desogestrel 1mg 9 3.4
What pill?
• Need to consider;
– Oestrogen dose– Progestin potency– Androgen potency
Side effect / problem Solution Suggestions
Acne ↑o ↓a Loestrin 30, Brevinor, Ovysmenn, gadarel, marvelon, cilest, Yasmin (price)
Break through bleed ↑o ↑p ↓a Gadarel 30/150, Marvelon,
Gestodene/levoner containing
Yasmin (price)
Weight gain ↓o ↓p Lower O dose
Breast soreness ↓o ↓p Lower O dose
Severe cramps ↑p Higher P potency
Headaches ↓o ↓p Lower O dose, mercilon
Depression, moody, irritable ↓p ?norethisterone based
a/oligo-menorrhoea ↑o ↓p
Endometriosis ↓o ↑p ↑a Levon, deso based
Progestogenic side effects
• Acne, hirtuism, vaginal dryness, wt gain, loss of libido, breast tenderness
• Try a pill with;– Less of same progestogen– Oestrogen dominant pill– Try different progestogen
Oestrogenic side effects
• Nausea, headache, dizziness, breast enlargement, cyclical wt gain, loss of libido
• Try a pill with;– Lower oestrogen content– Try progestogen dominant pill– Try progestogen only pill
Summary
• Numerous types of oral contraception available• Vary in oestrogen content and progesterone /
androgen activity• Tailor to individual needs• Trial and error may be needed and explained• May be variance between individuals• It takes about 2 cycles to see if suitable• Studies lacking in comparison