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Oral hormonal contraceptives

Since its introduction in 1950[1], the oral contraceptive pill (OCP) has evolved through many combinations and dosages of active pharmaceutical ingredients, mainly progesterone and oestrogen. There are three main types of hormonal contraceptive formulations:

  • Combination tablets (Combined Oral Contraceptive Pill, COCP) contain both an oestrogen (typically ethinyl estradiol) and a progestin in a fixed dosage
  • Progestin-only tablets (Progestogen Only Pill, POP) which contain only progesterone in low dose
  • Phasic pills have a combination of oestrogen and progestin that varies throughout the cycle

The most popular form of hormonal contraception, the combined oral contraceptive pill (COCP) is known as “the pill”. It has been established that progestin combinations containing estrogen (30 to 35 mcg per day) are effective with limited side effects[2]. Subsequently formulations containing low-dose estrogen (<20 mcg) have been introduced and have been shown to effective in women of reproductive age.

OCPs are available in a variety of dosing schedules. For the 21-pill packet, a pill is consumed daily for three weeks, followed by a week of no pills. For the 28-pill packet, 21 pills are taken, followed by week of placebo or sugar pills or iron supplement. The placebo pills allow the user to take a pill every day remaining in the daily habit even during the week without hormones. Unlike OCPs, POPs are taken every day with no breaks or placebos.

Currently available hormonal emergency contraceptives (EC) are effective if taken within 72 hours of unprotected intercourse. Either a combined or progestin-only regimen may be taken, usually in two doses 12 hours apart. Levonorgestrel (progestin-only EC) may be used in a single dose (1.5 mg) instead of two split doses (0.75 mg)[3].

[1] Verma P, Dollin J. Half a century of the oral contraceptive pill: historical review and view to the future. Canadian Family Physician 52, 12 (2012): 757-760

[2] American Society of Reproductive Medicine. Hormonal contraception: recent advances and controversies. Fertility and Sterility 90, 3 (2008): 103-113

[3]Method of emergency contraception. Cochrane summaries. 23 Dec 2013.


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