Levonorgestrel has the highest binding affinity, followed by desogestrel and its metabolite. CHCs act to inhibit ovulation: Ovulation is inhibited by the oestrogen and progestogen components which act on the hypothalamo-pituitary axis to reduce production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Trussell J, Rodriguez G, Ellertson C: Updated estimates of the effectiveness of the Yuzpe regimen of emergency contraception. If bleeding persists for longer than three months, is bothersome, and cannot be attributed to a cause other than the OC, switching to a pill with a higher dosage of estrogen (rarely higher than 35 µg) or a different progestin (gonane) is appropriate in an effort to stabilize the endometrium. Nevertheless, patients should be warned to report severe abdominal pain and reminded to use condoms. Food and Drug Administration: Oral contraceptives and the risk of blood clots. The recommendations in this report are intended to assist health care providers when they counsel women, men, and couples about contraceptive method choice.Recommendations about the use of hormonal contraceptive methods (including depot medroxyprogesterone acetate) and intrauterine devices among women at high risk for HIV were updated in April 2020 in the The 2016 U.S.

If hypertension develops, the WHO criteria outlined in Table 1 provide guidance about the risk of continuing to prescribe an OC. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. Instruct these patients to call your office if they have a severe headache or acute visual disturbances while taking an OC. Zabin LS, Stark HA, Emerson MR: Reasons for delay in contraceptive clinic utilization. Be sure to tell patients not to use petroleum-based lubricants such as Vaseline with latex condoms; instead, they should choose a water-based product such as K-Y Jelly or Surgilube. No matter the selection, make every effort to have the patient continue the same pill for a three-month trial because most benign, but annoying, side effects disappear within that time.At least three commonly used timetables exist for starting the first pack of OCs: Sunday after the first day of menses, the first day of menses, or the day of the clinic visit. Rosenberg MJ, Waugh MS: Oral contraceptive discontinuation: A prospective evaluation of frequency and reasons. Spending a few moments explaining the packaging reduces confusion. In general, the risk of pregnancy increases most significantly after three or more pills are missed, although little data exist on pills that contain 20 µg of ethinyl estradiol. The higher the bioavailability, the lower the dose of progestin required. Weave into this conversation the benefits and drawbacks of existing contraceptive choices, including abstinence, barrier methods, and hormonal methods (oral contraceptives, Depo- Provera, Norplant, Lunelle). 20 and 30 micrograms). 20. 26. the combined oral contraceptive pill, transdermal patch and combined vaginal ring) currently available in the UK. One type has 26 days of hormone pills and two days of placebo. OCs are classified in two ways. Rosenberg MJ, Meyers A, Roy V: Efficacy, cycle control, and side effects of low- and lower-dose oral contraceptives: A randomized trial of 20-microgram and 35-microgram estrogen preparations. Other causes of nausea also must be considered because not all concomitant symptoms are necessarily caused by the OC.Rarely, low-dose OCs can mildly elevate blood pressure (BP). If change in contraceptive method is not acceptable or possible, take combined oral contraceptive to provide at least 50 micrograms of ethinylestradiol daily (e.g. No matter what birth control method a teen chooses, the contraceptive visit offers physicians many teachable moments to provide counseling about sexual activity, its consequences, and how to practice safe sex. In two randomized studies comparing OCs containing 20 µg and 35 µg ethinyl estradiol, the rate of breakthrough bleeding was higher in the first cycle for one of the 20-µg pills but similar across all formulations at the end of six months.Because breakthrough bleeding is a major reason why women stop taking OCs, patients should be counseled about this side effect during the initial clinic visit. Rosenberg M: Weight change with oral contraceptive use and during the menstrual cycle. Establishing that the patient does not want to become pregnant opens the subject of birth control methods. 22. Understanding the pathophysiology involved in suppressing ovulation and the pharmacology of OCs is helpful in choosing the appropriate pill.