OCP (Oral contraceptive pill) – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.

Table of Contents

OCP (Oral contraceptive pill)

Oral contraceptives, abbreviated OCPs, also known as birth control pills, are medications taken by mouth for the purpose of birth control.

OCP mean Oral contraceptive pill. Hormonal contraceptives used are the most effective spacing methods of contraception. Oral contraceptives of combined types are almost hundred percent effective in preventing pregnancy.

Types of OCP (Oral contraceptive pill):

A. Combined pills:-It is 100% effective, Contain oestrogen and progesterone
B. Mini pill:- It is 97-98% effective, it contain only progesterone
C. Morning after pill
D. It contain only oestrogen.

Advantages of OCP (Oral contraceptive pill):

1. 99% effective- low failure rate (0.1/100 wy)
2. Aesthetically attractive.
3. Sense of well-being.
4. Not interference with sexual act.
5. Reversible.
6. Reasonably cheap & available..
7. It is self-administered.
8. Does not impair subsequent fertility.
9. Some nor-contraceptive advantages eg. protection against:

Benign breast disease
Fibroadenoma of breast
Endometriosis
Ovarian carcinoma
PID
Iron deficiency anaemia
Dysmenorrhoea
Premenstrual tension
Idiopathic hirsuitism.

Disadvantages /Adverse Effect/ Side Effect/Complication of OCP:

A. Minor disadvantages:
1. Nausea & vomiting.
2. Weight gain.
3. Break through bleeding or spotting.
4. Reduced menstrual bleeding.
5. Absence of withdrawal bleeding.
6. Others- headache, dizziness, breast tenderness, chloasma, abdominal cramps, emotional changes such as depression

B. Major disadvantages:

1. Cardiovascular effects	OCP causes increased risk of Thromboembolism. Coronary artery diseases, Atherosclerosis.
2. Metabolic effects	JHDL ↑Cholesterol effect of oestrogen ↑LDL
3. Hepatic effects	Gall stone Chlolestatic jaundice. Ca of liver.
4. Psychological effects	Depression – due lack of vit. B6.

Indications of Oral Pill:

A. Contraceptive use.
B. Non-contraceptive uses / benefits:

To reduce premenstrual tension.
Dysmenorrhoea.
Abnormal uterine bleeding.
Dysfunctional uterine bleeding.
Functional ovarian cyst.
Benign breast disease.
Sterility.
Endometriosis.
Menopause.

Contra-Indications of OCP:

1. Absolute(WHO category-4)	History of CVS disease Liver disease (ch. Hepatitis) Breast cancer DVT Pulmonary embolism Migraine Liver adenoma
2. Relative(WHO category-3)	HTN Obesity Migraine Endogenous smoking Heavy smoking Unexplained vaginal bleeding Past breast cancer
3. Special precaution(WHO-2)	DM Collagen diseases Osteosclerosis Severe varicose veins Sickle cell disease Surgical operation History of depression Age over 35 years. Cancer cervix or CIN

Select cases for prescribing combined oral pill

To select a patient for prescribing OCR through history, examination and some investigations are needed to exclude contra-indication.

A. Age of the patient is important.

she is more than 35 years of age she should be prescribed with caution & regular checkup is needed.
In smokers it is to be prescribed with caution as it is associated with increased incidence of thromboembolism

B. Menstrual history is to be taken to exclude pregnancy, undiagnosed uterine diseases etc.
C. Family history of cerebro-vascular disease including hypertension, breast cancer & hyperlipidaemia should be excluded.
D. Medical history regarding thrombo-embolic episodes, jaundice, epilepsy, HTN, DM, allergic condition, migraine should also be-excluded
E. Examination of breast for any nodule. Blood pressure and weight should be noted.
F. Pelvic examination to exclude fibroid or cervical pathology is manditory.
G. Investigation- vaginal cytology if facilities are available.

From the above mentioned examination to screen if it is revealed that the woman is free from any systemic disease and contraindication she is suitable candidate for OCP therapy.

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Minipill:

Minipill is devoid of oestrogen compound. It contains very low dose of a progestin in any one of the following form-

Levonorgestril 75mg or Norethisterone 350mg
Desogestril 5mg, lynesterol 500mg or Norgestril

Mechanism of action:
It works mainly by making cervical mucous thick and viscous, thereby prevents sperm penetration Endometrium becomes atrophic, so blastocyst implantation is also hindered. In about 2% of cases ovulation is inhibited.

How to prescribe minipill:
The first pill hasMo be taken on the first day of the cycle and then continuously. It has to be taken regularly and at the same time of the day. There must be no break between the packs.

Advantages:

Side effects attributed to oestrogen in combined pill are totally eliminated.
No adverse effect on lactation
Easy to take
It may be prescribe in patient having, hypertension, fibroid, diabetes, epilepsy and H/O thromboembolism.
Reduces the risk of PID and endometrial cancer.

Drawbacks:

Acne
Break through bleeding
Amenorhoea
Simple cyst of ovary
Failure rate 0.5-2 per 100-womenyears of use.

Name of Available OCP:

Commercial name	Estrogen	Progesterone
Shukhi (28)	Ehinyloestrodiol 30mcg	Levonergestrel 150 mcg FeSO4 75 mg
Ovacon (28)	Ethinyloestrodiol 35mcg	Norathindorne 150mcg FeSO4 75mg
Maya (28)	Mestranol 50 mcg	Norathindorne 150mcg FeSO4 75mg
Norquest (28)	Ethinyloestrodiol 35mcg	Norathindorne 150mcg FeSO4 75mg
Ovostate(21)	Ethinyloestrodiol 35mcg	Lynestrenol 100mcg
Marvelon (21)	Ethinyloestrodiol 35mcg	Desogestrel 150mcg

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