COCP

MOA - contain both oestrogen and progesterone - cause HPO suppression by negative feedback = suppress ovulation and increase cervical mucous preventing pregnancy

Routes - Oral, transdermal, subdermal, IM

• Patches - discrete and comfortable, but less effective if becomes loose
  • the patch cycle lasts 4 weeks. For the first 3 weeks, the patch is worn everyday and needs to be changed each week. During the 4th week, the patch is not worn and during this time there will be a withdrawal bleed.
• IM/subdermal - convenient long acting doses every 12 weeks

Example - Synthetic oestrogen (Ethinylestradiol) + progestin (Desogestel)

Efficacy - When taken correctly - over 99% effective

Contraindications - 0-6 weeks post-partum and breast feeding, pregnancy, HTN, undiagnosed vaginal bleeding, smokers>35yrs, Hx of thrombotic events, migraines, breast cancer, liver disease, major surgery with prolonged immobilsation

Advantages - Ovarian cycling lost (increased QoL), doesnt interrupt sex, decreased risks of:

• ovarian cancer and endometrial cancer
• anaemia
• dysmenorrhoea
• menorrhagia
• PMS
• ectopic pregnancy

DIsadvantages - Major source of non-compliance, education essential, no STI protection, increased risk of thrombotic events (DVT, MI, PE, stroke), increased risk of breast and cervical cancer

• Oestrogen - nausea, breast tenderness, vaginal spotting
• progesterone - acne, increased apetite, decreased libido

POP