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copied from Combined Oral Contraceptive Pill

The combined oral contraceptive pill (COCP), often referred to as combined oral contraceptives, the birth control pill, or colloquially as "the pill", is a type of birth control that is designed to be taken by mouth, every day. Each pill includes a combination of an estrogen (usually ethinylestradiol) and a progestogen (specifically a progestin). When taken correctly, it works to prevent pregnancy.

They were first approved for contraceptive use in the United States in 1960, and are a very popular form of birth control. They are currently used by more than 100 million women worldwide and by almost 12 million women in the United States.[1] As of 2012, 16% of U.S. women aged 15–44 reported being on the birth control pill, making it the most widely used contraceptive method among women of that age range.[2] Use varies widely by country,[3] age, education, and marital status. One third of women aged 16–49 in the United Kingdom currently use either the combined pill or progestogen-only pill,[4][5] compared with only 1% of women in Japan.[6][needs update]

Two forms of birth control pills are on the World Health Organization's List of Essential Medicines, which includes some of the most important medications needed in a basic health system.[7] The pill was a catalyst for the sexual revolution.[8]

Medical use

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Half-used blister pack of LevlenED

Non-contraceptive use

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The hormones in the pill have also been used to treat other medical conditions, such as polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, acne, hirsutism, amenorrhea, menstrual cramps, menstrual migraines, menorrhagia (excessive menstrual bleeding), menstruation-related or fibroid-related anemia and dysmenorrhea (painful menstruation).[9][10] Besides acne, no oral contraceptives have been approved by the U.S. FDA for the previously mentioned uses despite extensive use for these conditions.[11]

PCOS

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PCOS, or polycystic ovary syndrome, is a syndrome that is caused by hormonal imbalances. Women with PCOS often have higher than normal levels of estrogen all the time because their hormonal cycles are not regular.[12] Over time, high levels of uninhibited estrogen can lead to endometrial hyperplasia, or overgrowth of tissue in the uterus. This overgrowth is more likely to become cancerous than normal endometrial tissue.[13] Thus, although the data varies, it is generally agreed upon by most gynecological societies that due to the high estrogen levels that women with PCOS have, they are at higher risk for endometrial hyperplasia.[14] To reduce this risk, it is often recommended that women with PCOS take hormonal contraceptives to regulate their hormones. Both COCPs and progestin-only methods are recommended. COCPs are preferred in women who also suffer from uncontrolled acne and symptoms of hirsutism, or male patterned hair growth, because COCPs can help treats these symptoms.[12]

Endometriosis

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For pelvic pain associated with endometriosis, COCPs are considered a first-line medical treatment, along with NSAIDs, GnRH agonists, and aromatase inhibitors.[15] COCPs work to suppress the growth of the extra-uterine endometrial tissue. This works to lessen its inflammatory effects.[12] COCPs, along with the other medical treatments listed above, do not eliminate the extra-uterine tissue growth, they just reduce the symptoms. Surgery is the only definitive treatment. Studies looking at rates of pelvic pain reoccurrence after surgery have shown that continuous use of COCPs is more effective at reducing the recurrence of pain than cyclic use[16]

Adenomyosis

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Similar to endometriosis, adenomyosis is often treated with COCPs to suppress the growth the endometrial tissue that has grown into the myometrium. Unlike endometriosis however, levonorgetrel containing IUDs are more effective at reducing pelvic pain in adenomyosis than COCPs.[12]

Acne

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Oral contraceptives are sometimes prescribed as medication for mild or moderate acne, although none are approved by the U.S. FDA for that sole purpose.[17] Three different oral contraceptives have been FDA approved to treat moderate acne if the person is at least 14 or 15 years old, have already begun menstruating, and need contraception. They include Ortho Tri-Cyclen, Estrostep, and YAZ.[18][19]

Amenorrhea

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Although the pill is sometimes prescribed to induce menstruation on a regular schedule for women bothered by irregular menstrual cycles, it actually suppresses the normal menstrual cycle and then mimics a regular 28-day monthly cycle.

Women who are experiencing menstrual dysfunction due to female athlete triad are sometimes prescribed oral contraceptives as pills that can create menstrual bleeding cycles.[20] However, the condition's underlying cause is energy deficiency and should be treated by correcting the imbalance between calories eaten and calories burned by exercise. Oral contraceptives should not be used as an initial treatment for female athlete triad.[20]

Contraindications

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While combined oral contraceptives are generally considered to be a relatively safe medication, they are contraindicated for people with certain medical conditions. Estrogen in high doses can increase a person's risk for blood clots. Current formulations of COCP's do not contain doses high enough to increase the absolute risk of thrombotic events in otherwise healthy people, but people with any pre-existing medical condition that also increases their risk for blood clots makes using COCPs more dangerous.[12] These conditions include but are not limited to high blood pressure, pre-existing cardiovascular disease, history of thromboembolism or pulmonary embolism, cerebrovascular accident, migraine with aura, a familial tendency to form blood clots (such as familial factor V Leiden), and in smokers over age 35.[21] COCPs are also contraindicated for people with advanced diabetes, liver tumors, hepatic adenoma or severe cirrhosis of the liver.[21][10] COCP's are metabolized in the liver and thus liver disease can lead to reduced elimination of the drug. People with known or suspected breast cancer or unexplained uterine bleeding should also not take COCP's. Women who are known to be pregnant should not take COCP's. Postpartum women who are breastfeeding are also advised not to start COCPs until 4 weeks after birth due to increased risk of blood clots.[22] Severe hypercholesterolemia and hypertriglyceridemia are also currently contraindications, but the evidence showing that COCP's lead to worse outcomes in this population is weak.[22] [12]

Obesity is not considered to be a contraindication to taking COCPs .[22]

Hypertension

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People who have severe hypertension, defined as a systolic blood pressure higher than 160 or a diastolic blood pressure higher than 100, should not take COCPs. They are at higher risk of stroke, heart attack, People with less severe hypertension, systolic between 140-160 and diastolic between 90-110), are also often advised not to take COCPs.

  1. ^ Mosher WD, Martinez GM, Chandra A, Abma JC, Willson SJ (2004). "Use of contraception and use of family planning services in the United States: 1982–2002" (PDF). Adv Data (350): 1–36. PMID 15633582. all US women aged 15–44
  2. ^ "Contraceptive Use in the United States". Guttmacher Institute. 2004-08-04. Retrieved 2016-12-11.
  3. ^ UN Population Division (2006). World Contraceptive Use 2005 (PDF). New York: United Nations. ISBN 92-1-151418-5. women aged 15–49 married or in consensual union
  4. ^ David Delvin. "Contraception – the contraceptive pill: How many women take it in the UK?".
  5. ^ Taylor, Tamara; Keyse, Laura; Bryant, Aimee (2006). Contraception and Sexual Health, 2005/06 (PDF). London: Office for National Statistics. ISBN 1-85774-638-4. British women aged 16–49: 24% currently use the pill (17% use Combined pill, 5% use Minipill, 2% don't know type)
  6. ^ Aiko Hayashi (2004-08-20). "Japanese Women Shun The Pill". CBS News. Retrieved 2006-06-12.
  7. ^ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
  8. ^ Harris, Gardiner (2010-05-03). "The Pill Started More Than One Revolution". New York Times. Retrieved 2015-09-21.
  9. ^ CYWH Staff. "Medical Uses of the Birth Control Pill". Retrieved 1 February 2013.
  10. ^ a b Curtis, Kathryn M.; Tepper, Naomi K.; Jatlaoui, Tara C.; Berry-Bibee, Erin; Horton, Leah G.; Zapata, Lauren B.; Simmons, Katharine B.; Pagano, H. Pamela; Jamieson, Denise J. (2016). "U.S. Medical Eligibility Criteria for Contraceptive Use, 2016". MMWR. Recommendations and Reports. 65 (3): 1–103. doi:10.15585/mmwr.rr6503a1. ISSN 1057-5987. PMID 27467196.
  11. ^ "Information for Consumers (Drugs) - Find Information about a Drug". www.fda.gov. Retrieved 2017-12-13.
  12. ^ a b c d e f L., Callahan, Tamara (2013). Blueprints obstetrics & gynecology. Caughey, Aaron B. (6th ed.). Baltimore, MD: Lippincott Williams & Wilkins. ISBN 9781451117028. OCLC 800907400.{{cite book}}: CS1 maint: multiple names: authors list (link)
  13. ^ Barakat RR, Park RC, Grigsby PW, et al. Corpus: Epithelial Tumors. In: Principles and Practice of Gynecologic Oncology, 2nd, Hoskins WH, Perez CA, Young RC (Eds), Lippincott-Raven Publishers, Philadelphia 1997. p.859
  14. ^ Hardiman, Paul; Pillay, Ouma C.; Atiomo, William (2003-05-24). "Polycystic ovary syndrome and endometrial carcinoma". Lancet (London, England). 361 (9371): 1810–1812. doi:10.1016/s0140-6736(03)13409-5. ISSN 0140-6736. PMID 12781553. S2CID 27453081.
  15. ^ "ACOG Endometriosis FAQ".
  16. ^ Zorbas, Konstantinos A.; Economopoulos, Konstantinos P.; Vlahos, Nikos F. (2015-07-01). "Continuous versus cyclic oral contraceptives for the treatment of endometriosis: a systematic review". Archives of Gynecology and Obstetrics. 292 (1): 37–43. doi:10.1007/s00404-015-3641-1. ISSN 0932-0067. PMID 25644508. S2CID 23340983.
  17. ^ Huber J, Walch K (2006). "Treating acne with oral contraceptives: Use of lower doses". Contraception. 73 (1): 23–9. doi:10.1016/j.contraception.2005.07.010. PMID 16371290.
  18. ^ Chang, MD, Louise. "Birth Control of Acne". WebMD, LLC. Retrieved 1 February 2013.
  19. ^ "DailyMed - ORTHO TRI CYCLEN- norgestimate and ethinyl estradiol ORTHO CYCLEN- norgestimate and ethinyl estradiol". dailymed.nlm.nih.gov. Retrieved 2017-12-13.
  20. ^ a b American Medical Society for Sports Medicine (24 April 2014), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Medical Society for Sports Medicine, retrieved 29 July 2014
  21. ^ a b "Can Any Woman Take Birth Control Pills?". WebMD. Retrieved 8 May 2016.
  22. ^ a b c Selected practice recommendations for contraceptive use. World Health Organization. Reproductive Health and Research,, World Health Organization (Third ed.). Geneva. 12 January 2017. p. 150. ISBN 9789241565400. OCLC 985676200.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
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