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Low Dose Oral Contraceptives

Milan Choksey Medical Manager, Women’s Healthcare, Hormonal, Contraception & Nutrition & Medical Quality Oversight - Manager Obstetrics & Gynecology, Pfizer Ltd, Mumbai, Maharashtra 400013, India. , Milan Choksey1 , Sourabh Fulmali2

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Indian Journal of Obstetrics and Gynecology 6(6):p 628-633, Nov-Dec 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijog.2321.1636.6618.10

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Abstract

Combined oral contraceptives (COCs) offer a convenient, safe, effective, and reversible method of  contraception. While being highly effective, the early COC formulations were associated with significant adverse effects and cardiovascular risk. Reduction in the dose of estrogen is a commonly accepted approach to reduce the side effects of COC. Improvements in tolerability and safety have been achieved with similar effectiveness, mainly via hormone dosage reductions and the development of new progestins. Use of newer generation of progestins, such as gestodene, reduces the androgenic side effects generally  associated with progestogens. A COC with gestodene 60 g and ethinylestradiol (EE) 15 g showed overall good contraceptive efficacy and cycle control. Patients experienced significant improvement in well-being with respect to pre-menstrual complaints and symptoms. This COC regimen was safe, well-accepted and welltolerated, reduced both the intensity and duration of bleeding. With the progress of treatment cycles, the incidence of breakthrough bleeding reduces. Gestodene/EE low dose was associated with lower incidence of estrogen-related adverse events, such as headache, vomiting, pain, and nausea. Furthermore, COCs containing low dose of estrogen have not been associated with any adverse effect on haemostasis in healthy women. Ultra-low-dose COCs can be  considered in women who are at risk of developing estrogen-related side effects. Patients with obesity, heavy smokers and who are at a risk of developing stroke or myocardial infarction should be given these Oral Contraceptive Pills (OCPs). These formulations maintained efficacy, safety, showed good cycle control with shorter periods and lesser withdrawal bleed and enhanced the quality of life of patients.

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DOI: DOI: http://dx.doi.org/10.21088/ijog.2321.1636.6618.10

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