Source: WHO 1996. 10
COCs: Who Should Not Use
COCs should not be used if a woman: Is a smoker and age 35 years or older Has diabetes (> 20 years duration) Has headaches (migraine) Has high blood pressure (> 180/110) Has breast cancer Has liver tumors Has to undergo major surgery with prolonged bed rest
Tri-Minulet
Side effects
Oestrogenic Nausea, dizziness, bloating, breast engorgement, vaginal discharge, premenstrual tension, migranes Change to a more progestogenic prep/ Reduce dose of oestrogen and inc dose of progesterone.
Biphasic: 21 active pills contain 2 different E/P combinations (e.g., 10/11)
Triphasic: 21 active pills contain 3 different E/P combinations (e.g., 6/5/10)
留些微的男 性化的潛在 影響。
Classification
Type of progesterone Monophasic pills
Triphasic pills
Levonorgestrel Norethisterone Norgestimate
Microgynon 30/EE Ovranette (30 EE) Eugynon (30 EE) Ovysmen / Brevinor (35 EE) Norimin( 35) Loestrin 20/30 Cilest (35 EE)
6
口服避孕藥的成分
動情素
Ethinyl estradiol
Mestranol 所謂的「低劑量」口服避孕
藥指其動情素劑量小於0.05 毫克(=50 ug)， 而黃體素劑 量小於0.15毫克(=150ug)。
黃體素
Levonorgestrel
Norethindrone 由睪脂酮改造合成。保
口服避孕藥的作用機轉
Suppress ovulation
Reduce sperm transport
Endometrium atrophy Thicken cervical mucus
Failure rate is 0.2-0.5 per 100 woman years
4
COCs: Contraceptive Benefits
Trinodial Logynon
Trinovum Binovum Synphase
Desogestrol Gestogene
Drospirenone
Mercilon 20 EE Marvelon 30 EE Femodene (30EE) Minulet (30 EE) Femodette(20 EE) Yasmin (30 EE)
COCs should not be used if a woman: Is pregnant (known or suspected) Is breastfeeding (< 6 weeks postpartum) Is jaundiced (symptomatic viral hepatitis or cirrhosis) Has ischemic heart disease or stroke (current or history of) Has blood clotting disorders (deep vein thrombophlebitis or pulmonary embolus)
口服避孕藥
什麼是「口服避孕藥」？
口服避孕藥是一種賀爾蒙製劑，依作用方 式分為二類 動情素與黃體素的綜合製劑
「單相型」(monophasic) 「多相型」(multiphasic)兩種 單純黃體素的பைடு நூலகம்劑
Types of COCs
Monophasic: All 21 active pills contain same amount of Estrogen/Progestin (E/P)
Progestogenic Vaginal dryness, inc wt, reduced libido, acne, mastalgia, depression/lethargy, scanty menses Change to more osetrogenic
COCs: Who Should Not Use
Highly effective when taken daily Effective immediately if started by day 7 of
menstrual cycle Do not interfere with intercourse Few side effects Convenient and easy to use Can stop use
1Hatcher et al 1998. 5
COCs: Noncontraceptive Benefits
Decrease menstrual flow (lighter, shorter periods) Decrease menstrual cramps May improve anemia Protect against ovarian and endometrial cancer Decrease benign breast disease and ovarian cysts Prevent ectopic pregnancy Protect against some causes of PID