Characteristics Regular light menses. 2-4 days flow: mild or no cramps Regular moderate menses.

4-6 days flow: moderate cramps Regular heavy menses. 6 plus days flow: severe cramps Irregular and infrequent menses, hypermenorrhea whon occurs: associated acne, oily skin, hirsutism Irregular menses, hypomenorrhea when occurs: no adreogen effects

Type of OC Indicated Low endometrial activity Intermediate endometrial activity High endometrial activity Probably polycystic ovarian syndrome. High progestional and low androgenic activity desireable. If galactorrhea present, possible pituitary adenoma. Skull x-ray or prolactin needed. If no galactorrhea, low estrogen and low progestational activity combination OCs or multiphasic OCs may be used Combination OCs contraindicated Sub 35 mcg estrogen, intermediate/high progestin, combination OC Lower estrogen and low progestin dose High estrogen and intermediate to high progestin Low progestin does and progestational activity. Monitor blood pressure.

Suggested OC for Initial Cylces (see table 2) Groups 3,6,8 Groups 2, 4, 5, 7, 9, 10, 11 Group 13 Groups 2, 6, 7, 8, 10 Groups 1, 5, 8 , barrier and spermicidal methods

Smokers- ages 35+ Nonsmokers- 35+ Weight less than 110 lbs Weight more than 160 lbs Progesterone hypersensitivity: history of toxemia, stong family history of hypertension, excessive weight gain, tiredness or varicone veins during pregnancy, depression, excessive premenstrual edema Estrogen hypersensitivity: excessive nausea, edema or hypotsn in pregnancy,hypertrophy of cervix or uterus, uterine fibrios, large or fibrocstic breasts; heavy menses, migraine Conditions predisposing to cardiovascular disease type ii hyperlipidemia (high cholesterol) diabetes mellitus, obesity, smoking more than 15 cigarettes per day, hypertension, varicose veins, thrombophlebitis during pregnancy, family of cardiovascular disease before age 50 Surgery planned within 1-4 weeks

Group 1, barrier and spermicidal methods 20-25 mcg EE Ocs from groups 2, 3, 5, 7, 8 Groups 5, 7, 8 or any triphasic Group 11, 12, 13 Groups 1, 8, 10 (antimineralocorticoid activity) or any triphasic Group 1 or any 20 mcg EE OC Group 1, barrier and spermicidal methods

Low estrogenic activity

Combination pills not recommended.

Combination pills should be stopped

Group 1, barrier and spermicidal methods

Group 1 2 3

Index name: Generic name Micronor, Nor-QD: Camila, Errin, Jolivette, Nora-be Ovrette: Lybrel Mircette: Kariva, Desogen, Ortho-cept: Apri, reclipsen Loestrin 1/20: Junel 1/20, Microgestin 1/20 Loestrin 1/24: Loestrin 1.5/30; Junel 1/50, Microgestin 1.5/30 Estrostep: Seasonale, Seasonique LoOvral: Cryselle, Low-Ogesstrel NordetteL Levlen, Levora, Portia Ortho Tri-Cyclen Lo: Ortho Tri-Cyclen: Triness, Tri-previfem, tri-sprintec Orthocyclen: monessa, privifem, sprintec Traphasil: Enpressse, tri-levlen, trivora Ovcon 25: Balziva Demulen 1/35:kelnor, zovia 1/35 Cyclwaa: Velivet Ortho-vovum7/7/7: Nortel 7/7/7 Orthonovum 10/11: Necon 10/11, Nelova 10/11 Alesse: avianna, lessina, levlite, lybrel, lutera, sronyx Brevicon, modican: necon . 5/35, nortral .5/35Tri-norinyl: arnelle Norinyl, ortho-novum 1/35; necon 1/35, nortrel 1/35 Yasmin yaz Demulen 1/50: zovia 1/50 Norinyl, ortho-novum 1/50M: necon 1/50M, Nelova 1/50 M Norlestrin 1/50, ovcon 1/50 Ovral: ogestrel

Activity Endometrial: Low Progestational: Low Androgenic: low Endometrial:Intermediate Progestational: high Androgenic: low Endometrial: Low Progestational: intermediate Androgenic: Intermediate Endometrial:intermediate Progestational: intermediate Androgenic: intermediate Endometrial: intermediate Progestational: low Androgenic: low Endometrial: low Progestational: high Androgenic: low Endometrial:intermediate Progestational:intermediate Androgenic:low Endometrial:low Progestational:low Androgenic:low Endometrial:intermediate Progestational:intermediate Androgenic:intermediate Endometrial:intermediate Progestational:highe Androgenic:none Endometrial: intermediate Progestational: high Androgenic: low Endometrial: intermediate Progestational: intermediate Androgenic: intermediate Endometrial: high Progestational: high Androgenic: high

4 5

6 7

8 9 10 11 12 13

Taken from: Managing Contraceptive Pill Patents, Thirteenth edition, by Richard P. Dickey, MD, PhD