Medicine 3: Combined Oral Contraceptives
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Medicine 3: Combined Oral Contraceptives
What is it?
Combination birth control pills, also known as the pill, are oral contraceptives that contain estrogen and a progestin.
Combination birth control pills come in different mixtures of active and inactive pills, including:
Conventional pack: One common type contains 21 active pills and seven inactive pills. Inactive pills do not contain hormones. Formulations containing 24 active pills and four inactive pills, known as a shortened pill-free interval, are also available. Some newer pills may contain only two inactive pills. You take a pill every day and start a new pack when you finish the old one. Packs usually contain 28 days of pills. Bleeding may occur every month during the time when you take the inactive pills that are at the end of each pack.
Extended-cycle pack: These packs typically contain 84 active pills and seven inactive pills. Bleeding generally occurs only four times a year during the seven days you take the inactive pills.
Continuous-dosing pack: A 365-day pill also is available. You take this pill every day at the same time. For some people, periods stop altogether. For others, periods become significantly lighter. You do not take any inactive pills.1
How does it work?
In women with primary dysmenorrhea, OCPs thin the endometrium, thereby reducing the amount of bleeding and inhibiting the metabolism of arachidonic acid to prostaglandin, effectively relieving cramping and pain.2
What is the efficacy?
Methods: This was a randomized, double-blind, placebo-controlled clinical trial of 76 healthy adolescents aged 19 years or younger reporting moderate or severe dysmenorrhea. Subjects were randomly allocated to receive either an OC (ethinyl estradiol [E2] 20 microg and levonorgestrel 100 microg) or a matching placebo for 3 months. The main outcome measure was the score on the Moos Menstrual Distress Questionnaire (pain subscale) for the third menstrual cycle on treatment. Secondary outcomes included pain intensity (rated 0 to 10), days of any pain, days of severe pain, hours of pain on the worst day, and use of pain medications.
Results: The mean Moos Menstrual Distress Questionnaire pain score was lower (less pain) in the OC group than the placebo group (3.1, standard deviation 3.2 compared with 5.8, standard deviation 4.5, P = .004, 95% confidence interval for the difference between means 0.88-4.53). By cycle 3, OC users rated their worst pain as less (mean pain rating 3.7 compared with 5.4, P = .02) and used fewer pain medications than placebo users (mean pain pills used 1.3 compared with 3.7, P = .05). By cycle 3, OC users reported fewer days of any pain, fewer days of severe pain, and fewer hours of pain on the worst pain day than placebo users; however, these differences did not reach statistical significance.
Conclusions: Among adolescents, a low-dose oral contraceptive relieved dysmenorrhea-associated pain more effectively than placebo.3
Side-effects:
Short-term effects: Breast tenderness, nausea, headaches, bloating, and unscheduled bleeding.
Long-term effects: Increased risk of venous and arterial thromboembolism (deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), mild increase in blood pressure, and possible increases in breast and cervical cancer risk.4
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