Oral contraceptives combined

The two synthetic steroidal estrogens which have attained the greatest degree of therapeutic use are ethinyl estradiol [57-63-6] (EE) (5) and its 3-methyl ether, mestranol [72-33-3]((5). In contrast to the naturally occurring estrone derivatives, these acetylenic analogues are orally active and are the main estrogenic components of combination oral contraceptives (see Contraceptives) and certain estrogen replacement products. 

Table 1. Low Dose Monophasic Estrogen—Progestogen Combination Oral Contraceptives Marketed in the United States...

A final area of research focuses on how the piU. can best be used by women. Physicians used to recommend pid-free hoHdays, but it is now known that there is no vaUd reason for this practice. Similarly, further research indicated that the U.S. EDA s restrictive guidelines for prescribing the piU. to women over the age of 35 are not justified, and those guidelines have been changed. EinaHy it is clear that cigarette smoking increases the risk of cardiovascular side effects, especially in women over 35 who utilize combination oral contraceptives. 

Estrogens and progestins (combination oral contraceptives) are used as oral contraceptives. There are three types of estrogen and progestin combination oral contraceptives monophasic, biphasic, and triphasic. The monophasic oral contraceptives provide a fixed dose of estrogen and progestin throughout the cycle The biphasic and triphasic oral contraceptives deliver hormones similar to the levels naturally produced by the body (Table 52-1). 

Side effects associated with the use of combined oral contraceptives may be minimized by appropriately adjusting either the total estrogen or progestin content. 

Historically, the 1950s represented an important time in the control of human fertility. It was during that decade that the first combined oral contraceptives were developed. Shortly after the discovery that the exogenous administration of hormones such as progesterone successfully blocked ovulation, the use of hormonal steroids quickly became the most popular method of contraception worldwide. Specifically, combined oral contraceptives represent the most commonly used reversible form of contraception today and it is estimated that nearly 100 million women worldwide take oral contraceptives.1 Further, in the United States, it is estimated that at some time during their lives, more than 80% of women born since 1945 have used oral... 

Combined oral contraceptives contain a combination of a synthetic estrogen and one of several steroids with progestational activity. Most oral contraceptives contain one of two types of estrogen ethinyl estradiol, which is pharmacologically... 

Although suppression of FSH and LH is the primary mechanism by which combined oral contraceptives prevent ovulation, there are other mechanisms by which these hormones work to prevent pregnancy. Other mechanisms include reduced penetration of the egg by sperm, reduced implantation of fertilized eggs, thickening of cervical mucus to prevent sperm penetration into the upper genital tract, and slowed tubal motility, which may delay transport of sperm.1 Thus, in... 

In addition to preventing pregnancy, there are several noncontraceptive benefits associated with the use of combined oral contraceptive pills. Many of the potential non-contraceptive benefits are highlighted below. 

Since the use of combined oral contraceptives may decrease the use of selected barrier contraceptive methods that do protect against STDs (e.g., latex condoms), one of the most common risks associated with the use of oral contraceptives is the risk of acquiring an STD.8... 

As with all medications, there are potential adverse effects with combined oral contraceptives (COCs). Many side effects can be minimized or avoided by adjusting the estrogen and/or progestin content of the oral contraceptive. It is also important to have proper patient selection for oral contraceptives because some women are at increased risk for potentially serious side effects. 

Two synthetic estrogens are used in hormonal contraceptives in the United States, ethinyl estradiol (EE) and mestranol. Mestranol must be converted to EE in the liver to be active. It is approximately 50% less potent than EE. Most combined oral contraceptives (OCs) contain estrogen at doses of 20 to 50 meg of EE daily. The contraceptive ring produces one-half the serum concentration of EE derived from a 30-mcg OC. 

Hannaford PC, Owen-Smith V (1998) Using epidemiological data to guide clinical practice review of studies on cardiovascular disease and use of combined oral contraceptives. Br Med J 316 984-987... 

Friedman AJ, Thomas PP (1995) Does low-dose combination oral contraceptive use affect uterine size or menstrual flow in premenopausal with leiomyomas Obstet Gynecol 85 631-635... 

Cilest contains ethinylestradiol and norgestimate whereas Yasmin contains ethinylestradiol in combination with drospirenone. Both are combined oral contraceptives available as tablets, which have to be taken once daily for 21 days. Both are contraindicated in patients with venous thromboembolic diseases. 

Combined oral contraceptives may cause migraine and are contraindicated in such patients. Progesteronenonly contraceptives are more suitable in this case. 

Phenergan contains the antihistamine promethazine. Valium contains the benzodiazepine diazepam. Both the antihistamine and the benzodiazepine tend to reduce the blink rate, leading to dry eyes. Cilest is a combined oral contraceptive, which, like other oral contraceptives, may cause reduced tolerance because of corneal and eyelid oedema. 

Q64 Advantages of the combined oral contraceptives over the progesto-gen-only contraceptives are that they are ... 

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