Progestin pill

Progestin pill Birth control pill that contains only progestin, a synthetic progesterone (Chapter 14). 

In monophasic preparations a fixed estrogen/progestin combination is present in each contraceptive pill. 

CHCs, even those with less than 35 meg estrogen, can cause small increases in blood pressure (6 to 8 mm Hg) in both normotensive and hypertensive women. In women with hypertension, OCs have been associated with an increased risk of MI and stroke. Use of CHCs is acceptable in women younger than 35 years with well-controlled and monitored hypertension. Hypertensive women with end-organ disease or who smoke should not use CHCs. Progestin-only pills and depot medroxyprogesterone acetate (DMPA) are choices for women with hypertension. 

Monophasic OCs contain the same amounts of estrogen and progestin for 21 days, followed by 7 days of placebo. Biphasic and triphasic pills contain variable amounts of estrogen and progestin for 21 days and are followed by a 7-day placebo phase. 

In addition, progestin-only pills can be used as EC (Ovrette [20 tablets/dose]). Common side effects of EC are nausea, vomiting, and irregular bleeding. 

Progestin-only contraception One tablet every day at the same time. Administration is continuous, with no interruption between pill packs. Every time a pill is taken late, especially if a pill is missed, pregnancy is more likely. 

Missed dose - If the patient is more than 3 hours late or misses 1 or more tablets, she should take a missed pill as soon as remembered, then go back to taking progestin-only pills (POPs) at the regular time, but should use a backup method (such as a condom or spermicide) every time she has sexual intercourse for the next 48 hours. 

Switching from a combination oral contraceptive Insert the contraceptive vaginal ring anytime within 7 days after the last combined (estrogen plus progestin) oral contraceptive tablet and no later than the day that a new cycle of pills would have started. No backup method is needed. 

Any day of the month when switching from a progestin-only pill do not skip any days between the last pill and the first day of contraceptive vaginal ring use ... 

The major oestrogen preparations used medically are outlined in Table 1.12, and their chemical structure is illustrated in Figure 1.3. The widest clinical application of oestrogens relate to their use as oral contraceptives. Most such contraceptive pills contain an oestrogen in combination with a progestin (discussed later). 

A low dosage of progestin ( mini-pill ) is used, in the form of medroxyprogesterone acetate, which is active at a very low dose. The mini-pill does not inhibit ovulation, but rather interferes with the endometrium and the cervical mucus. The use of this pill prevents most of the side effects of oral contraception, specifically nausea, water retention, and in some cases thrombophlebitis. However, a lower success rate and other frequent side effects have reduced the widespread acceptance of this preparation. Nevertheless, the mini-pill has a role to play in certain specific situations. For example, in an uncommon form of epilepsy called catamenial epilepsy, female patients will experience seizures at particular times during their menstrual cycle, reflecting the fact that seizure focus is stimulated by estrogens but inhibited by progestins. In such women, the mini-pill may afford not only birth control but also improved seizure control. 

It is a combination of estrogen and progestin given together for remarkable efficacy, safety and ease in administration. It has total 21 pills, each pill is given orally for 21 consecutive days beginning on the 5th day of menstrual cycle (when the bleeding occurs... 

This is a combined pill but biphasic or triphasic in nature e.g. the estrogen level is kept constant but the progestin amount is low in early phase and increasing in subsequent phases of menstrual cycle. 

It is also known as progestin only pill (POP). It contains only progestins, which is given in small amount throughout the menstrual cycle (without interruption) but because of lower efficacy rate, it is not much popular. 

The effectiveness of progestin-only pills is reduced by hepatic enz5me-inducing drugs such as the anticonvulsants, phenytoin, carbamazepine barbiturates the antituberculosis drug rifampin protease inhibitors and herbal preparations containing St. John s wort (H. perforatum)... 

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