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THE OC PILL : Going Beyond Contraception!!

THE OC PILL : Going Beyond Contraception!!. Evolution Of The OC Pill. 1956 : Rock, Garcia and Pincus 50 microgram estrogen -Standard OC pills < / = 35 microgram estrogen - Low-dose Pills. Usage Of The OC Pill. 100 Million worldwide ( WHO1998) NFHS II 1999, India

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THE OC PILL : Going Beyond Contraception!!

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  1. THE OC PILL : Going Beyond Contraception!!

  2. Evolution Of The OC Pill • 1956 : Rock, Garcia and Pincus • 50 microgram estrogen -Standard OC pills • < / = 35 microgram estrogen - Low-dose Pills

  3. Usage Of The OC Pill • 100 Million worldwide ( WHO1998) • NFHS II 1999, India • 34% female sterilisation • OC use 2.19% • 30% girls have first child before age 19 years Promote SPACING Methods in young people to control population

  4. Studies Of Effects Of The OC Pill • RCGP Study : 23000 British women • Oxford/ FP Association Study : 9653 users versus 7379 users of IUD/ diaphragm • CASH Study : 8 different areas of USA • Mishell, 1982 : Review of studies of noncontraceptive health benefits • Organon contraceptive use study 1998

  5. User Benefits • Independent of Sexual Act • Reliable reversible method of contraception • Pearl index - 0.25 per HWYears • Failure rate - 0.3% to 8% ( Perfect versus Typical Use)

  6. Menstrual Effects • Cycle Stabilisation : • Predictable, regular, relatively light bleeding • Relief from Menstrual Disorders • 5 patterns of self-perceived abnormal menstruation (prolonged, heavy, frequent, irregular or painful bleeding) were reported less frequently in COC users than in users of other methods -Thorogood M, ET AL British Medical Bulletin, 1993 • Treatment and Control of Menorrhagia • Dysmenorrhea, “mittelschmerz” • Premenstrual syndrome

  7. Protection against Ovarian and Endometrial Cancer • Ovarian Cancer • 1.5 to 2 times less in pill users • CASH Study : effect within 6 months, increased to 5 times by 10 years use • Ex-use effect last for 15 years • Endometrial Cancer • 50% less risk • Effect even with 1 year use • Ex-use effect lasts 15 years - CASH study N. Engl. J. Med 1987

  8. Effect On Benign Tumors • Benign Breast Disease • 50-70% reduction by older studies • At least 25% less with low-dose OC too • Functional Ovarian Cysts • Follicular cysts 50% less • Corpus luteum cysts 80% less • Uterine Leiomyomas ?? - Mishell D.R. Jr. Am J Obstet Gynecol, 1982

  9. Preservation of Fertility • Due to favorable impact on • PID • Endometriosis • PCOD • Reduction of Ectopic Pregnancy

  10. Advantages of OC Pill in PCOD • Usually is the first line treatment • Normalize androgen levels in 18-21 days • Non androgenic OCP’s preferred • Suitable for contraception • Favorable effect on CHO and lipid metabolism • Corrects menstrual cycle disturbances •  incidence of anaemia • Frequency of dysmenorrhoea & pelvic inflammatory disease will be lowered •  in risk of endometrial and ovarian cancer

  11. Pelvic Inflammatory Disease • Barriers are better for STD/HIV protection • 50% reduction in PID with OC users versus non-users of any method • Mechanism • Effect on cervical mucus • Preventing unwanted pregnancies and deliveries • Reducing unsafe abortions

  12. Complications and Sequelae of PID • Tuboovarian abscess and peritonitis • Ectopic pregnancy • Infertility • Infection of sex partners • Dyspareunia and chronic pelvic pain • Menstrual abnormalities

  13. Infertility and PID • Rate of infertility increases with the degree of tubal inflammation and scarring produced, and with increasing numbers of episodes of infection • It is estimated to occur in 8-17% of all women with 1 episode of disease, which increases dramatically with repeat episodes of salpingitis, to 40-60% in women with 3 episodes of disease

  14. Ectopic Pregnancy and PID • The risk of ectopic pregnancy for a woman with prior salpingitis is 1:20 • One episode of salpingitis increases the risk of ectopic pregnancy by 7- to 10 fold • Approximately 50% of ectopic pregnancies occur in tubes damaged by salpingitis The Pill by reducing both, PID & Ectopic, helps preserve fertility

  15. Beneficial Effects of the OC pill Prevention Of • Iron Deficiency Anemia • Rheumatoid Arthritis • Osteoporosis • Thyroid disorders, Peptic ulcer ??

  16. Role of Providers • Importance of Counselling • Avoid “Over-screening” or not prescribing the pill due to perceived ( not necessarily real ) health risks - European Society of Contraception 1995 • Focus on Reproductive and Sexual Health of Youth

  17. Take Home Messages • Very Effective At Its Primary Job • Provides Many Other Health Benefits • Ideal for the youth • Especially in prevention of anaemia • Management of menstrual issues • Management of PCOS which is common in this age group

  18. Concept – Dr. Duru Shah • Contributors Dr. Reena Wani Dr. Anahita Chauhan • Editors Dr. Sangeeta Agrawal Dr. Reena Wani

  19. We acknowledge the efforts of our : Coordinators : Dr. Sangeeta Agrawal - Central Dr. Narendra Malhotra - North Dr. Hema Divakar - South Dr. P. C. Mahapatra - East Dr. Uday Thanawala - West In bringing the FOGSI YOUTH EXPRESS to your city.

  20. Charak Pharma Pvt. Ltd CIPLA Ltd. Emcure Pharmaceuticals Ltd GlaxoSmithKline Pharmaceuticals Limited Glenmark Pharmaceuticals Ltd. Metropolis Health Services (India) Pvt.Ltd. Organon India Ltd Roche Pharmaceuticals Ltd. Sandoz Private Limited USV Limited Wyeth Limited This Youth Express has been possible through an Educational Grant from :

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