Oral contraceptive pill

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The 'Pill' refers to pharmacological methods of contraception.

The 2 main types:

  1. Combined oral contraceptive pill
  2. Progestogen only pill

The definition could be stretched to include the morning after pill, though this should not be used for primary contraception.

Contents

Benefits

  • Unwanted pregnancy reduction
  • Can modulate hormone responsive conditions such as acne and menstruation

Risks

These have to be balanced by risks related to pregnancy and the postpartum period and psychosocial issues. Complex and individual to preparation and individual. Noncontraceptive benefits at 6 months of use predict continued use[1].

  • VTE - risk can be predicted[2]
  • No net increase in malignancy, and hormone responsive malignancy risk (eg breast cancer) goes back to baseline at 5 years[3]. Are likely to be different for the two pills. For British pill users of either type recruited about 1968 reduced incidence of:

with no cancer significantly increased over matched none pill users. However invasive cervical cancer was more common while a current pill user (not once use of OC had stopped) and breast cancer after pill use stopped[4]. There are convincing premenopausal breast cancer risk increases reported in other studies[5].

History

The pill evolved from 50 years of research and was a major factor in cultural evolution from the 1960s as it improved the effectiveness of reversible contraception by several orders of magnitude. The 6 landmark clinical trials were done on 897 women with no pregnancies when the pill was taken as directed[6]. Mercury to prevent pregnancy was known in ancient China and there is a long history of use of mineral and plant toxins as oral contraceptives.

  • 1952 Frank Colton makes norethynodrel which was to become a component in Enovid®
  • 1956 Puerto Rico human trials started by Edris Rice-Wray Carson who is concerned by side effects
  • 1957 Trials by Pincus and John Rock in Massachusetts, Haiti, Mexico and Los Angeles. Inhibition of ovulation in man widely publicized[11]
  • 1960 FDA approves first OCP, Enovid® for 2 year courses
  • 1961 Enavid® (same formulation as Enovid®) approved in UK
  • 1967 Thrombosis link recognised
  • 1969 Thrombosis link related to oestrogen level
  • 1970 Progestin only Mini- Pill
  • 1982 Multiphasic pill

External links

References

  1. McClain PE, Pearson AM, Miller ER, Dugan LR. Application of differential thermal analysis to the study of hydrothermal shrinkage in epimysial and corium collagen. Biochimica et biophysica acta. 1968 Sep; 168(1):143-149.(Print)
  2. McDaid A, Logette E, Buchillier V, Muriset M, Suchon P, Pache TD, Tanackovic G, Kutalik Z, Michaud J. Risk prediction of developing venous thrombosis in combined oral contraceptive users. PloS one. 2017 ; 12(7):e0182041.(Electronic-eCollection) (Link to article – subscription may be required.)
  3. Iversen L, Sivasubramaniam S, Lee AJ, Fielding S, Hannaford PC. Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners' Oral Contraception Study. American journal of obstetrics and gynecology. 2017 Jun; 216(6):580.e1-580.e9.(Print-Electronic) (Link to article – subscription may be required.)
  4. Hannaford PC, Selvaraj S, Elliott AM, Angus V, Iversen L, Lee AJ. Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner's oral contraception study. BMJ 2007;335:651-4 see online version for full statistics
  5. Kahlenborn C, Modugno F, Potter DM, Severs WB. Oral contraceptive use as a risk factor for premenopausal breast cancer: a meta-analysis. Mayo Clinic proceedings. Mayo Clinic. 2006 Oct; 81(10):1290-302.
  6. Junod SW, Marks L. Women's trials: the approval of the first oral contraceptive pill in the United States and Great Britain. Journal of the history of medicine and allied sciences. 2002 Apr; 57(2):117-60.
  7. Geschickter CF, Lewis D, Hartman CG. Tumors of the breast related to the oestrin hormone. The American journal of cancer. 1934; 21:828-59.
  8. Kurzrok R. The prospects for hormonal sterilization. The Journal of contraception. 1937 Feb; 2(2):27-9.
  9. Fremont-smith M, Meigs JV, Graham RM, Gilbert HH. Cancer of endometrium and prolonged estrogen therapy. Journal of the American Medical Association. 1946 Jul 6; 131(10):805-8.
  10. Djerassi C, Miramontes L, Rosenkranz G, Sondheimer F. Steroids. LIV. Synthesis of 19-Nor-17α-ethynyltestosterone and 19-Nor-17α-methyltestosterone". J Am Chem Soc 1954;76 (16): 4089-4091
  11. Junod SW, Marks L. Women's trials: the approval of the first oral contraceptive pill in the United States and Great Britain. Journal of the history of medicine and allied sciences. 2002 Apr; 57(2):117-60.
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