Oral Contraception Pills (OCP)

Oral contraceptives are used by approximately 14 million women in the United States; about 60 million women worldwide use oral contraceptive pills. Oral contraceptive pills contain both estrogen and progestorin. The action of oral contraceptives include the blockage of ovulation, the thickening of cervical mucus, and a flat and inactive endometrium. Oral contraceptives block ovulation through the hypthalamic suppression of FSH, LH and the LH surge. The thickening of cervical mucus is done to decrease sperm motility and penetration. The flat and inactive enodmetrium is to prevent implantation. There is also a decrease in tubal transport and sperm capacitation.

Side Effects of OCP

The most common side effect of OCP is breakthrough bleeding, bleeding outside of the menstrual cycle caused by estrogen and progesterone deficiency or missing pills. Side effects caused by excess estrogen may include nausea, water retention, and vascular headaches. Side effects caused by excess progestin may include an increase in appetite and weight gain, acne, depression, and pill amenorrhea. Newer anti-androgenic progestins may experience a decrease in libido. Most women experience mild to no side effects with low-dose formulations of less than 50 micrograms of ethinyl estradiol.

Complications of OCP

Complications of OCP may include cardiovascular complications, neoplasia or post-pill ammenorrhea. Cardiovascular complications include myocardial infarction, cerebrovascular accident, or thromboembolism. Cardiovascular complications take place in women over 35 who smoke and in some women who have underlying medical problems, particularly with conditions predisposing to thrombosis. Neoplasia can take place in the breast, cervix, endometrium, and ovary. Post-pill amenorrhea occurs in up to 3% of women who discontinue OCP.

Absolute Contraindications to Oral Contraceptives

Contraindications to oral contraceptives related to estrogen components include various conditions related to the heart, liver, lungs, and cancer. Individuals should be cautious when taking oral contraceptives if they have thromboembolic disorder, cerebrovascular accident, coronary artery disease, impaired liver function, hepatic adenoma, breast cancer, endometrial cancer, other estrogen-dependent malignancies, pregnancy, undiagnosed vaginal bleeding, or if they smoke more than 15 cigarettes per day over the age of 35. Taking oral contraceptives with these conditions can lead to further damage or more risks.


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Human Reproduction: A Clinical Approach Copyright © 2023 by Dr. Hala Bastawros, M.D is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.