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Oral Contraceptives

Overview :

Oral contraceptives (birth control pills) come in a wide range of estrogen-progestin combinations. The pills in use today contain much lower doses of estrogen than those available in the past, and this change has reduced the likelihood of serious side effects. Some pills contain only progestin. These are prescribed mainly for women who need to avoid estrogens and may not be as effective in preventing pregnancy as the estrogen-progestin combinations.

These medicines come in tablet form, in containers designed to help women keep track of which tablet to take each day. The tablets are different colors, indicating amounts of hormones they contain. Some may contain no hormones at all. These are included simply to help women stay in the habit of taking a pill every day, as the hormone combination needs to be taken only on certain days of the menstrual cycle. Keeping the tablets in their original container and taking them exactly on schedule is very important. They will not be as effective if they are taken in the wrong order or if doses are missed.

Oral contraceptives are available only with a physician's prescription. Some commonly used brands are Demulen, Desogen, Loestrin, Lo/Ovral, Nordette, Ortho-Novum, Ortho-Tri-Cyclen, Estrostep, Orthocept, Alesse, Levlite and Ovcon.

The dose schedule depends on the type of oral contraceptive. The two basic schedules are a 21-day schedule and a 28-day schedule. On the 21-day schedule, take one tablet a day for 21 days, then skip 7 days and repeat the cycle. On the 28-day schedule, take one tablet a day for 28 days; then repeat the cycle. Be sure to carefully follow the instructions provided with the medicine. For additional information or explanations, check with the physician who prescribed the medicine or the pharmacist who filled the prescription.

Taking doses more than 24 hours apart may increase the chance of side effects or pregnancy. Try to take the medicine at the same time every day. Take care not to run out of pills. If possible, keep an extra month's supply on hand and replace it every month with the most recently filled prescription.

Try not to miss a dose, as this increases the risk of pregnancy. If a dose is missed, follow the package directions or check with the physician who prescribed the medicine for instructions. It may be necessary to use another form of birth control for some time after missing a dose.

Taking this medicine with food or at bedtime will help prevent nausea, a side effect that sometimes occurs during the first few weeks. This side effect usually goes away as the body adjusts to the medicine.

Taking oral contraceptives may have several benefits outside of their ability to prevent pregnancy. Research indicates that with 10 to 12 years of oral contraceptive use, a woman's risk of ovarian cancer is reduced by up to 80%. There may also be an approximate 50% decrease in the rate of endometrial cancers in women. One other well-known, noncontraceptive benefit of oral contraceptives is an improvement in acne. The combination oral contraceptive ethinyl estradiol/norgestimate has been approved by the Food and Drug Administration for the treatment of acne. Another positive effect of oral contraceptive use is improvement in abnormal uterine bleeding. Older women may also benefit from using oral contraceptives, because the pills can increase bone mass as women enter their menopausal years, when osteoporosis is a growing concern.

Oral contraceptives may also be used on an emergency basis as a means of preventing pregnancy in women who have had unprotected intercourse. Two products specifically designed for this purpose are Preven and Plan B. In 2001, the American College of Obstetricians and Gynecologists (ACOG) recommended that emergency oral contraceptives be available as an over-the-counter medicine. The Food and Drug Administration, however, has not yet approved any measures that would allow this to happen.

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