Oral hormonal contraception is the use of oral medication containing one or two hormones for the purpose of pregnancy prevention. These hormones are basically the two female hormones oestrogen and progesterone. Oral hormonal contraceptive medication containing the two hormones is called combined oral contraceptive while that containing only progesterone is called progesterone only contraceptive pill. The focus here is going to be on the combined and progesterone only oral hormonal pills
For the introductory part of the series on contraception, please read here to catch up with the discussion.
HOW ORAL HORMONAL CONTRACEPTIVE MEDICATION WORKS
Oral hormonal contraceptive medication works by preventing ovulation (release of egg from the ovary), thickening the cervical mucus and thins the endometrium making it hostile for implantation. These medications mimic the natural female hormones; oestrogen and progesterone. When they are taken, they get into the blood stream and make the brain to feel like there is enough of the female hormones. This sends signals to stop further production by stopping the release of another set of hormones from the brain called the follicle stimulating hormone and luteinizing hormone. They are responsible for the maturation of the egg, production of oestrogen and release of the egg.
WHO IS ELIGIBLE FOR ORAL HORMONAL CONTRACEPTION?
Women of reproductive age who are in need of contraception can use either the progesterone only or combined pill. The use of combined oral pill is not recommended in the following conditions;
- Current or previous history of Venous thromboembolism
- Undergoing major surgery that may require one to be bedridden for a long time
- Breast cancer
- Liver cancer
- Acute hepatitis
- Migraine with aura
- Women ≥35years who smoke
- Certain medication for convulsion
- Women with ischemic heart disease
- Women with stroke or who have multiple risk factors for stroke
- Less than 6weeks after delivery and breastfeeding
The use of progesterone only pill is not recommended in the following condition;
- Breast cancer
- Liver cancer
- Acute venous thromboembolism
- Some medication for convulsion
ORAL CONTRACEPTIVES AND INTERACTION WITH OTHER MEDICATIONS
Some medication interact with oral hormonal contraceptive and decrease the efficacy of oral contraceptive pill. Speak with your doctor if you are on antibiotic for tuberculosis (rifampicin and rifabutin), seizure medication (carbamazepine, phenobarbital, phenytoin and topiramate) and human immune deficiency virus(HIV) medication.
EXAMINATION AND TEST DONE BEFORE COMMENCING THE PILLS
Pregnancy test is done to ensure the woman is not pregnant. Blood pressure check, weight and height to calculate the body mass index. The body mass index will be used to monitor the use of oral hormonal pills. Additional test may be needed for women with other medical conditions.
WHEN TO START TAKING ORAL CONTRACEPTIVE PILLS
The initiation of oral contraceptive pills can be at any time of the menstrual cycle. It is best started within the first five days of the onset of menses. After that, additional contraception should be used (condom) or avoid sex for the next seven days of commencement.
HOW SHOULD ORAL HORMONAL CONTRACEPTIVES BE TAKEN?
It is best you take your pill at a specific time of the day for effectiveness. This will help avoid lateness or missed pill as this will affect the effectiveness and increase the failure rate. The failure rate with perfect use of these pills (combined and progesterone only) is about 3 in 1000 women who used the method in one year. This means in one year, if 1000 women use this method the way it is supposed to be used, only three will be pregnant while on it.
For progesterone only pill, one pill should be taken daily preferably at the same time. After completion of a pack, the next pack should be started the next day at the same time. For combined oral pill, Start taking the pill from where the pack was marked start, take one daily till you complete the pack (28th pill). The last seven pills are inactive and you should see your menses while taking it. Start another pack the next day after completing the white inactive pills even if still menstruating.
WHAT TO DO WHEN YOU FORGET TO TAKE YOUR CONTRACEPTIVE PILL
A dose is considered missed if more than three hours for traditional progesterone,12hours for desogestrel pill and 24hours for combined oral pill have elapsed from the time the next dose should be taken. It is considered late if the time has elapsed from when the next dose should be taken but still within 3 or 12hours for progesterone only pill and within 24hours for combine oral pill.
So, take the late pill as soon as you remember and continue as scheduled even if it means taking two pills on the same day. No additional contraceptive protection is needed. Additional contraception should be considered if this occurs earlier in the cycle, or in the last week of the previous cycle if sex is contemplated or emergency contraception should be used if sexual intercourse occurred within the previous five days.
More so, for missed pill, even when two or more consecutive pills have been missed, take the most recent missed pill as soon as you remember and discard any other missed pills. Continue taking the pills as scheduled even if it means taking two pills on the same day. Avoid sexual intercourse or use backup contraception (condom) for the next seven consecutive days. if sexual intercourse had occurred within the previous 5days, emergency contraception is indicated.
If pills were missed in the last week (day 15 to 21) while on the 28days pill, continue taking the pill omitting the hormone free interval (white pills) after which you continue with a new pack the next day. If this is not feasible, use backup contraception or avoid sex until resumption of the new pack for seven consecutive days.
SIDE EFFECTS OF ORAL HORMONAL CONTRACEPTIVES
Abnormal menstrual bleeding
headache and migraine
breast tenderness and enlargement
HOW ORAL CONTRACEPTIVES ARE ELIMINATED FROM THE BODY?
These pills when taken orally are absorbed into the blood stream. They are eliminated from the body through faeces and urine after been broken down in the liver
NON CONTRACEPTIVE BENEFITS OF ORAL HORMONAL CONTRACEPTION
Combined oral pills can be used in women having heavy or painful menses and premenstrual syndrome. It also helps to regularize the menses in women with polycystic ovarian syndrome and reduce the symptoms of patient with endometriosis.
WHAT ORAL CONTRACEPTIVE PILL IS NOT USE FOR?
Oral contraceptive pill is not used as an abortifacient (to cause abortion) and it does not protect from sexually transmitted infection. Use additional barrier method if you are not sexually exclusive with your partner.