Best Birth Control Pill For Young Adults – Oral contraceptives are a popular choice for many people; Providers should be aware of options to guide patients effectively.
Oral contraceptives are the most commonly used method of hormonal contraception in the United States. According to the National Family Growth Survey conducted in 2015-2017, 80.5% of sexually active women of childbearing age used oral contraceptives (OCPs) at some point.
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There are two general types of OCPs – the combined oral contraceptive (COC), which contains ethinyl estradiol (EE) and a progestin, and the oral contraceptive (POP), which contains only a progestin. Current COCs offer a variety of dosages and progestins to choose from.
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COCs are a moderately effective method of contraception. They have a failure rate of <1% in perfect use and 9% in normal use.
There are few data to directly compare the effectiveness of different progestins; however, some studies have shown no difference. 5,6 The typical failure rate may be higher for POP users due to the rigorous quantification timeframe, including the recommended 3-hour window for quantification.
EE and progestin work alone or in combination to provide contraceptive benefits. EE works primarily by inhibiting the release of follicle-stimulating hormone (FSH) from the pituitary gland, blocking the production of follicles.
It is also thought that EE may cause endometrial edema, which may interfere with implantation. EE has the added benefit of stabilizing the uterine lining and reducing spotting – a beneficial effect. Because EE enhances the effect of progestins, a smaller dose of progestin can be used in COCs.
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Progesterone works in three main ways: 1) It inhibits the release of GnRH from the hypothalamus, reducing the release of LH and FSH; 2) It prevents the increase of LH of the pituitary gland, preventing ovulation; 3) It thickens cervical mucus, preventing sperm from entering the uterus.
Tubal peristalsis and motility may also be inhibited to some extent. Progesterone can cause the lining of the uterus to contract, which may interfere with implantation. Each progestin has a different potency and dosage and can prevent ovulation. POPs rely on many of these mechanisms to prevent pregnancy.
While the birth control pill is a great option for many women, it’s important to be aware of conditions that may increase the risk for the user. We outline some of the risks below, and you can refer to the CDC’s Medical Eligibility Criteria Chart for more information.
It’s important to remember that the risks and benefits must be weighed individually for each woman, and that in most cases, pregnancy is more dangerous than taking the pill.
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For pregnant patients at high risk of adverse health outcomes (Table 1), long-acting reversible methods of contraception (LARC) may be the best option to avoid Unintended pregnancies. 10 It is also important to review the patient’s medication history, as there may be drug interactions that reduce the effectiveness of COCs and POPs.
EE has a procoagulant effect and is contraindicated in many cases. Progestins also pose risks to the user. Providers should screen for a personal or family history of VTE, as this increases the risk of blood clots in COC users.
Furthermore, because of hypercoagulability in postpartum women, COCs should not be used within 6 weeks of delivery. Women who smoke and are over 35 years of age, women with migraines with aura, or women with uncontrolled high blood pressure or vascular disease have a higher risk of stroke and should not use methods that have high blood pressure. contain estrogen.
Self-screening tools are available to check for COC eligibility, such as the one used in the study by Grossman et al., which showed a sensitivity of 83.2% and a specificity of 88.8 % for patients who used the survey to identify a true contraindication to COC use.
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These tools are useful to both providers and patients, especially as we increase the use of telehealth (Table 2).
As with any medical decision-making, it is important to use shared decision-making to select the correct method of contraception for each patient, which will increase satisfaction, encourage compliance and reduce unwanted pregnancy.
Decision sharing involves the patient and provider working together to make a decision by discussing all options, taking into account patient preferences.
Because of the wide range of methods of contraception, it is important to discuss values (including the possibility of an unwanted pregnancy if contraception fails), beliefs, frequency of medication use, considerations financial, risks and benefits of each method.
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Other considerations include how often a woman wants withdrawal bleeding and expected benefits such as improved menstrual cramps, acne, and mood symptoms. Multi-month prescriptions should be made available to all women to improve medication adherence.
As with any method, COCs and POPs have side effects and it is important to discuss these with patients as they decide which method is best for them. Among women who had ever stopped using COCs or POPs, 34% were dissatisfied and 64.4% discontinued due to side effects.
Some of the more common side effects discussed with women are breast tenderness, nausea, bloating, and sudden bleeding—all of which usually improve or go away completely after the first few months.
Women may not always discuss their choice to discontinue COCs or POPs, making it imperative for clinicians to inquire about previous experience with adverse events and offer precautionary guidance about the possibility side effects before starting a new method.
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After a woman and her provider decide to use a COC, there are several options. Patients who wish to reduce their periods may prefer to use a monthly pack of pills with a placebo, while patients who wish to reduce their periods may prefer continuous use without the placebo and may opt for extended cycles.
In addition, providers may identify other coexisting conditions that can be treated with COCs, such as acne, unwanted facial hair growth, bloating, and/or headaches. COCs may also help reduce the risk of ovarian cysts, uterine fibroids, and benign breast conditions.
As mentioned, all COCs contain progestin and EE ingredients, and the dosage varies by drug. The EE range for COC is between 10-35 mcg.
A systematic review found that COCs with a lower dose of EE had a higher discontinuation rate due to adverse events such as sudden bleeding. To reduce estrogen-induced risk, it is reasonable to start with 20 μg EE and increase as needed,15 although data in adolescents support the use of 30 μg EE or higher because lower doses of EE have associated with impaired bone acquisition.
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Providers should consider the progestogen component in the COC, or which progestogen alone is used in the POP, as this can lead to adverse side effects.
Some progestins are believed to have male hormone effects, and users report oily skin, facial hair growth, or acne. It’s worth noting that all COCs have been shown to work for acne, but if you’re concerned you should choose a pill with a lower androgen-like progestin and/or higher estrogen content.
The lower potency and half-life of first-generation progestins can lead to sudden bleeding. Although second-generation progestins are stronger and have a longer half-life, they can have a male hormone effect. Third generation progestins maintain high potency but have a lower androgenic effect.
Some third-generation formulations are even approved to treat mild to moderate acne. Finally, drospirenone, the only fourth-generation progestin, has anti-mineral and anti-androgen properties and is an emerging pure progestogen pill.
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It improved bleeding while being as effective as COCs and extended the missed dose interval to 12 hours for ease of use23 (Table 3).
Many of the common side effects of COCs go away on their own within the first few months. Therefore, patients should be encouraged to continue taking the drug for the first 3 months if there are no serious side effects. If these side effects persist or are particularly bothersome, Table 4 shows some options providers can use to address them.
In addition to bleeding pattern and progestin selection, COCs can also be monophasic or multiphasic. We recommend that most vendors start with a single-phase formulation for ease of use and scalability for continuous use, although some data suggest that three-phase formulations—especially are newer progestogen formulations—helps to reduce acne, frequent bleeding, and menorrhagia.
In addition to the contraceptive effect, COC also has a beneficial effect in addition to contraception for the patient. Among these benefits are improved menstruation, pain relief, and improved blood loss. Dysmenorrhea is the most common menstrual symptom, affecting 90% of women.
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COCs have been shown to reduce dysmenorrhea by up to 60% and even 60% (90%) in people with severe dysmenorrhea. This reduces absences from school or work and the patient’s need for pain medication. For women with dysmenorrhea, prolonged or continuous use of COC preparations is particularly helpful for further pain relief.
For patients, menorrhagia is less common but is still a problem because it can lead to iron deficiency anemia. COCs are particularly helpful in normalizing bleeding patterns and reducing bleeding volume and time.
However, other forms of birth control, such as the hormonal IUD, can have a similar effect—the patient needs to make a decision when deciding which hormonal method is right for her.
Other benefits of COCs include its ability to help women predict their bleeding episodes and skip them if needed. While older generation POPs often cause patients to experience abnormal bleeding, newer pills containing only drospirenone have more favorable bleeding characteristics.
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COC is okay
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