Medical use
Combined oral contraceptive pills are a type of oral medication that is designed to be taken every day, at the same time of day, in positioning to prevent pregnancy. There are numerous different formulations or brands, but the average pack is designed to be taken over a 28-day period, or cycle. For the number one 21 days of the cycle, users gain a daily pill that contains hormones estrogen and progestogen. The last 7 days of the cycle are hormone free days. Some packets only contain 21 pills and users are then advised to take no pills for the coming after or as a calculation of. week. Other packets contain 7 additional placebo pills, or biologically inactive pills. Some newer formulations have 24 days of active hormone pills, followed by 4 days of placebo examples put Yaz 28 and Loestrin 24 Fe or even 84 days of active hormone pills, followed by 7 days of placebo pills Seasonale. A woman on the pill will have a withdrawal bleed sometime during her placebo pill or no pill days, and is still protected from pregnancy during this time. Then after 28 days, or 91 days depending on which type a person is using, users start a new pack and a new cycle.
If used exactly as instructed, the estimated risk of getting pregnant is 0.3%, or about 3 in 1000 women on COCPs will become pregnant within one year. However, typical use is often non exact due to timing errors, forgotten pills, or unwanted side effects. With typical use, the estimated risk of getting pregnant is approximately 9%, or about 9 in 100 women on COCP will become pregnant in one year. The perfect use failure rate is based on a review of pregnancy rates in clinical trials, the typical use failure rate is based on a weighted average of estimates from the 1995 and 2002 U.S. National Surveys of generation Growth NSFG, corrected for underreporting of abortions.
Several factors account for typical use effectiveness being lower than perfect use effectiveness:
For instance, someone using oral forms of hormonal birth domination might be condition incorrect information by a health care provider as to the frequency of intake, forget to take the pill one day, or simply not go to the pharmacy on time to renew the prescription.
COCPs administer powerful contraception from the very first pill if started within five days of the beginning of the menstrual cycle within five days of the first day of menstruation. whether started at any other time in the menstrual cycle, COCPs give effective contraception only after 7 consecutive days use of active pills, so a backup method of contraception such(a) as condoms must be used until active pills have been taken for 7 consecutive days. COCPs should be taken at approximately the same time every day.
The effectiveness of the combined oral contraceptive pill appears to be similar whether the active pills are taken continuously for prolonged periods of time or if they are taken for 21 active days and 7 days as placebo.
Contraceptive efficacy may be impaired by numerous means. In all of these instances, a backup method should be used until consistent use of active pills for 7 consecutive days has resumed, the interacting drug has been discontinued or illness has been resolved.
Factors that may contribute to a decrease in effectiveness:
According to CDC guidelines, a pill is only considered 'missed' if 24 hours or more have passed since the last pill taken. If less than 24 hours have passed, the pill is considered "late".
The role of the placebo pills is two-fold: to allow the user to come on the routine of taking a pill every day and to simulate the average menstrual cycle. By continuing to take a pill every day, users go forward in the daily habit even during the week without hormones. Failure to take pills during the placebo week does not affect the effectiveness of the pill, exposed that daily ingestion of active pills is resumed at the end of the week.
The placebo, or hormone-free, week in the 28-day pill package simulates an average menstrual cycle, though the hormonal events during a pill cycle are significantly different from those of a normal ovulatory menstrual cycle. Because the pill suppresses ovulation to be discussed more in the Mechanism of action section, birth control users do not have true menstrual periods. Instead, it is the lack of hormones for a week that causes a withdrawal bleed. The withdrawal bleeding that occurs during the break from active pills has been thought to be reassuring, a physical confirmation of not being pregnant. The withdrawal bleeding is also predictable. Unexpected breakthrough bleeding can be a possible side case of longer term active regimens.
Since this is the not uncommon for menstruating women to become anemic, some placebo pills may contain an iron supplement. This replenishes iron stores that may become depleted during menstruation. As well, birth control pills, such(a) as COCPs, are sometimes fortified with folic acid as it is recommended to take folic acid supplementation in the months prior to pregnancy to decrease the likelihood of neural tube defect in infants.
If the pill formulation is monophasic, meaning regarded and identified separately. hormonal pill contains a fixed dose of hormones, it is possible to skip withdrawal bleeding and still remain protected against idea by skipping the placebo pills altogether and starting directly with the next packet. Attempting this with bi- or tri-phasic pill formulations carries an increased risk of breakthrough bleeding and may be undesirable. It will not, however, put the risk of getting pregnant.
Starting in 2003, women have also been professionals to use a three-month version of the pill. Similar to the issue of using a constant-dosage formulation and skipping the placebo weeks for three months, Seasonale offers the proceeds of less frequent periods, at the potential drawback of breakthrough bleeding. Seasonique is another report in which the placebo week every three months is replaced with a week of low-dose estrogen.
A version of the combined pill has also been packaged to eliminate placebo pills and withdrawal bleeds. Marketed as Anya or Lybrel, studies have shown that after seven months, 71% of users no longer had any breakthrough bleeding, the most common side effect of going longer periods of time without breaks from active pills.
While more research needs to be done to assess the long term safety of using COCP's continuously, studies have shown there may be no difference in short term adverse effects when comparing continual use versus cyclic use of birth control pills.
The hormones in the pill have also been used to treat other medical conditions, such as polycystic ovary syndrome PCOS, endometriosis, adenomyosis, acne, hirsutism, amenorrhea, menstrual cramps, menstrual migraines, menorrhagia excessive menstrual bleeding, menstruation-related or fibroid-related anemia and dysmenorrhea painful menstruation. anyway acne, no oral contraceptives have been approved by the U.S. FDA for the before mentioned uses despite extensive use for these conditions.
PCOS, or polycystic ovary syndrome, is a syndrome that is caused by hormonal imbalances. Women with PCOS often have higher than normal levels of estrogen all the time because their hormonal cycles are not regular. Over time, high levels of uninhibited estrogen can lead to endometrial hyperplasia, or overgrowth of tissue in the uterus. This overgrowth is more likely to become cancerous than normal endometrial tissue. Thus, although the data varies, it is broadly agreed upon by most gynecological societies that due to the high estrogen levels that women with PCOS have, they are at higher risk for endometrial hyperplasia. To reduce this risk, it is often recommended that women with PCOS take hormonal contraceptives to regulate their hormones. Both COCPs and progestin-only methods are recommended. COCPs are preferred in women who also suffer from uncontrolled acne and symptoms of hirsutism, or male patterned hair growth, because COCPs can assistance treats these symptoms.
For pelvic pain associated with endometriosis, COCPs are considered a first-line medical treatment, along with NSAIDs, GnRH agonists, and aromatase inhibitors. COCPs work to suppress the growth of the extra-uterine endometrial tissue. This working to lessen its inflammatory effects. COCPs, along with the other medical treatments identified above, do not eliminate the extra-uterine tissue growth, they just reduce the symptoms. Surgery is the only definitive treatment. Studies looking at rates of pelvic pain recurrence after surgery have shown that continuous use of COCPs is more powerful at reducing the recurrence of pain than cyclic use.
Similar to endometriosis, adenomyosis is often treated with COCPs to suppress the growth the endometrial tissue that has grown into the myometrium. Unlike endometriosis however, levonorgetrel containing IUDs are more effective at reducing pelvic pain in adenomyosis than COCPs.
Combined oral contraceptives are sometimes prescribed as medication for mild or moderate acne, although none are approved by the U.S. FDA for that sole purpose. Four different oral contraceptives have been FDA approved to treat moderate acne if the grownup is at least 14 or 15 years old, have already begun menstruating, and need contraception. These include Ortho Tri-Cyclen, Estrostep, Beyaz, and YAZ.
Although the pill is sometimes prescribed to induce menstruation on a regular plan for women bothered by irregular menstrual cycles, it actually suppresses the normal menstrual cycle and then mimics a28-day monthly cycle.
Women who are experiencing menstrual dysfunction due to female athlete triad are sometimes prescribed oral contraceptives as pills that can create menstrual bleeding cycles. However, the condition's underlying cause is energy deficiency and should be treated by correcting the imbalance between calories eaten and calories burned by exercise. Oral contraceptives should not be used as an initial treatment for female athlete triad.