Combination Birth Control Pills

About combination contraceptive pills

A commonly used and and effective method of birth control is the combination oral contraceptive (OC) pill. These pills contain a synthetic estrogen, usually ethinylestradiol, and a synthetic progesterone or progestin, of which several are available, combined in the same pill. Ethinylestradiol is used within the dose range that is known to prevent ovulation, but because different progestins have different potencies, their doses vary considerably.

Progestins also have different amounts of androgenic effects, which are actions that mimic the male androgen hormone and cause side effects, like acne and hirsutism (unwanted hair). Newer progestogens have very weak androgenic activity. The first generation progestin norethindone (norethisterone) has low progestational activity (prevents ovulation) and also some androgenic and estrogenic activity. Levonorgestrel and norgestrel are second generation progestins with high progestational and anti-androgen action. Desogestrel and norgestimate are third generation progestins with high progestational activity but minimal androgenic activity. Drospirenone is the newest and fourth generation progestin with a different structure, being derived from spirolactone instead of testosterone. It has high progestational activity but minimal androgenic activity and also has some effect on regulation of water and electrolytes, which helps prevent water retention.

Packs of OC pills contain one month’s supply usually 21 fixed dose combinations of hormone-containing pills, which are all the same, and 7 placebo (non-hormonal) pills, so that one pill is taken each day for a 28 day cycle. Some pills contain different dose combinations of each hormone, such that the dose of hormone increases through the month and the pills must all be taken in the correct order. Contraceptive pills are intended to be taken throughout the menstrual cycle and each monthly cycle should end with a withdrawal bleed and combination.

Combination contraceptive pills for menstrual problems

As a result of taking OC pills combining an estrogen and a progesterone, periods often become more regular, lighter, and less painful; also accompanied by an improvement in pre-menstrual symptoms, like bloating, and fluid retention. Because of this, combination OC pills may be used to treat irregular periods, primary dysmenorrhoea, which is very painful periods without a known cause, often accompanied by very heavy bleeding (menorrhagia), in women who also require contraception.

Combination contraceptive pills for androgen-related problems

Androgens are normally produced in women as well as men but usually only in small amounts. If levels are too high this can cause problems associated with excess androgen production, including hirsutism (unwanted hair), androgenic alopecia (hair loss), acne and seborrhoea (greasy skin from too much sebum). Combination pills containing an estrogen and an anti-androgen are used to combat the symptoms of androgenisation (overproduction of androgen) as well as providing effective contraception. They can also be used to treat polycystic ovary syndrome, which is caused by excess androgen. Cyproterone is the anti-androgen generally used in these combination pills and it also has some progesterone activity.