Counselling OCP's

Dr.Anant khot

Contraceptive Methods
Oral steroidal contraceptives

Injected steroidal contraceptives

Intrauterine devices
Transdermal and transvaginal steroidal

contraceptives
Physical, chemical, or barrier techniques
Sexual abstinence around the time of
ovulation
Breast feeding
Permanent sterilization

Hormonal contraceptives
Types of Hormonal Contraceptives:

Oral:

Combination Oral Contraceptives

ii. Progestin-Only Contraceptives
iii. Phased regimens
iv. Postcoital (emergency) contraception
Injectable
1) Long acting progestin alone
2) Long acting progestin+ long acting
i.

Phased regimens
Formulations may be :
1. Monophasic (each tablet contains a fixed
amount of estrogen and progestin);
2. Biphasic (each tablet contains a fixed amount
of estrogen, while the amount of progestin
increases in the second half of the cycle); or
3. Triphasic (the amount of estrogen may be fixed
or variable, while the amount of progestin
increases in 3 equal phases).

MECHANISM OF ACTION
The contraceptive actions of COCs are

multiple
Most important effect is to prevent ovulation
by suppression of hypothalamic gonadotropinreleasing factors, which in turn prevents
pituitary secretion of FSH & LH
Estrogen suppresses FSH release & stabilizes

the endometrium to prevent metrorrhagia

 Progestins inhibit ovulation by suppressing

LH, they thicken cervical mucus to retard

sperm passage, & they render the
endometrium unfavorable for implantation.
Transit of sperm, the egg, and fertilized

ovum are important to establish pregnancy,

and steroids are likely to affect transport in
the fallopian tube.

Table 5-6 Some Benefits of Combination Estrogen Plus Progestin Oral

Contraceptives

Increased bone density

Reduced menstrual blood loss and anemia
Decreased risk of ectopic pregnancy
Improved dysmenorrhea from endometriosis
Fewer premenstrual complaints
Decreased risk of endometrial and ovarian cancer
Reduction in various benign breast diseases
Inhibition of hirsutism progression
Improvement of acne
Prevention of atherogenesis
Decreased incidence and severity of acute salpingitis
Decreased activity of rheumatoid arthritis

1.
2.
3.

ABSOLUTE
CONTRAINDICATIONS

< 6 weeks postpartum if breastfeeding

Smoker over the age of 35 ( 15 cigarettes per day)
Hypertension (systolic 160mm Hg or diastolic 100mm
Hg)
4. Current or past history of venous thromboembolism (VTE)
5. Ischemic heart disease
6. History of cerebrovascular accident
7. Complicated valvular heart disease
8. Migraine headache with focal neurological symptoms
9. Breast cancer (current)
10. Diabetes with retinopathy/nephropathy/neuropathy
11. Severe cirrhosis
12. Liver tumor (adenoma or hepatoma)

Relative contraindications
1.

2.
3.
4.
5.
6.
7.
8.

Smoker over the age of 35 (< 15 cigarettes per

day)
Adequately controlled hypertension
Hypertension (systolic 140159mm Hg,
diastolic 9099mm Hg)
Migraine headache over the age of 35
Currently symptomatic gallbladder disease
Mild cirrhosis
History of combined OC-related Cholestasis
Users of medications that may interfere with
combined OC metabolism

Emergency contraception
LNG 0.5 mg+ EE 0.1mg-2 tabs taken

immediately and at 12 hrs

LNG 0.75 mg twice
Mifepristone-600mg single dose
Copper-Containing Intrauterine

Devices
Ulipristal aceate

Contraception during Lactation

Use of combination OCs generally is not

advised during lactation because they reduce

the amount and quality of breast milk
Combination OCs can be used after 6 weeks,
once milk production is established.
Progestin-only OCs, implants, and injectable

contraception do not affect milk quality or

quantity
FDA- progestin-only OCs can be started 2 to 3
days postpartum, DMPA or implants at 6 wks