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Often referred to as simply “the Pill”, The Combined Oral Contraceptive Pill (COCP) is a combination of an estrogen and a progestin, and is taken orally to suppress normal fertility. Developed by Gregory Goodwin Pincus, John Rock, and Min Chueh Chang, the Pill was first approved for use as a contraceptive in 1960. Even today, they are a popular form of birth control, being used currently by over 100 million women worldwide.
COCPs work by preventing ovulation through progestogenic and estrogenic suppression of gonadotropin release. All combined hormonal contraceptives, which include COCPs, primarily suppress follicular development and prevent ovulation.
Originally, estrogen was included in oral contraceptives for better cycle control, but later it was also found to inhibit follicular development and help prevent ovulation. Negative feedback of estrogen on the anterior pituitary decreases the release of follicle-stimulating hormone (FSH). This in turn inhibits follicular development, thus helping to prevent ovulation.
Progestogen-containing contraceptives employ a secondary method of action. That is to increase the viscosity and decrease the amount of cervical mucous, thereby inhibiting sperm penetration.
There are two ways of assessing the effectiveness of COCPs. People who take the pills regularly and correctly fall under the perfect use or method effectiveness rate, whereas, actual use or typical use effectiveness rate, covers all users including those who take the pills irregularly, wrongly, or both.
The rate of perfect use pregnancy of COCPs is 0.3% per year. The rate of typical use pregnancy depends on the population being studied, and is between 2% to 8% per year.
There are several factors, which can cause typical use effectiveness to be lower than perfect use effectiveness. Mistakes on the part of the user, or consciously not following the instructions, or even wrong instructions being provided on how to use the method. As an example , we may consider an user who might just forget to take the pill one day, or simply not bother to go and fill out the prescription from the pharmacy. Another user may be using the pills wrongly because she has been given wrong or confusing instructions by her health care provider.
If the user takes the first pill within five days of the start of the menstrual cycle, COCPs can provide effective contraception; however, if she starts at any other time, COCPs start to provide effective contraception only after seven days of regular use. So, for the first seven days, the user must employ an alternate method of contraception. It is advisable to take COCPs at the same time everyday.
How may the efficacy of the contraceptive be impaired? By missing more than one active pill in a packet. By delaying the start of the next packet of active pills (extending the inactive or placebo pill or the pill-free period beyond 7 days. Abnormal absorption by the intestine of active pills due to vomiting or diarrhea. Drug interaction with active pills that decreases the estrogen or progestogen levels.
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