Low Estrogen Birth Control Pill Side Effects – Contraception is defined as actions or techniques that prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.

. Contraceptives are physical or medical products that promote contraception. There is a wide selection of contraceptives in the broad categories of barrier, hormonal, spermicidal, intrauterine and surgical methods.

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Tubal ligation, hysterectomy, and male vasectomy are irreversible surgical contraceptive measures, while other methods are reversible or temporary.

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The effectiveness of each reversible method depends on consistent and correct application; Thus, real-world performance is lower than predicted by ideal usage. Contraceptives that require daily administration, such as daily oral contraceptives or use before each intercourse, such as spermicides, are less effective because the chances of human error increase. Convenience and the likelihood of consistent adherence to a particular method are important considerations when choosing a contraceptive. This presentation will focus on oral hormonal contraceptives.

It is important to note that apart from condoms, no other contraceptive method reduces the risk of acquiring sexually transmitted infections (STIs). Condom use should be used in conjunction with other contraceptive methods to prevent STIs.

There are 2 general types of hormonal contraceptives: 1) combined – which contain both synthetic estrogen and progestin, and 2) progestin only.

Combined hormone contraceptives are available in Canada as a daily oral pill, transdermal patch, vaginal ring. Progestin-only contraceptives are available as a daily oral pill and as an intramuscular injection. Intrauterine devices (coils) can be progesterone-containing or non-medicated copper.

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Hormonal contraceptives work by stabilizing hormone levels that suppress the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). A sharp increase in LH and FSH is necessary for ovulation, and therefore hormonal contraceptives prevent ovulation. Figure 1 shows hormone levels in an average menstrual cycle. Hormonal contraceptives also cause changes in the lining of the cervix and endometrium to make sperm entry and implantation of a fertilized egg less favorable, as shown in Table 2 below.

* Oral contraceptives do not contain androgens (ie: testosterone) as an ingredient. However, progesterones can be metabolized in the body to testosterone and mediate androgenic effects. Different progestins have different rates of testosterone metabolism, so different oral hormonal contraceptives will have different androgenic activity depending on the amount and type of progestin.

Oral contraceptives, especially combined oral contraceptives (COCs), are the most common hormonal contraceptives used by women in North America. They are commonly referred to as births.

Before starting a COC, each woman should be evaluated for contraindications and additional risk factors, as well as the pros and cons of COC use.

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Advantages: non-invasive, easy to start and stop; Many strengths and product types are available (Table 3); Other potential health benefits

: cycle regulation; decrease in menstrual flow, iron deficiency anemia; reduction of dysmenorrhea, premenstrual or perimenopausal symptoms; reduction of acne, hirsutism (but may worsen depending on hormonal composition and individual compatibility); reduction of pelvic inflammatory disease; reduction of endometrial and ovarian cancer; Reduction of fibroids (but can also be aggravated depending on the hormonal composition and individual compatibility); Increasing bone mineral density – the effect of estrogen.

Disadvantages 4: very dependent on daily use at the same time for effect – vulnerable to human administration errors (progestin-only pills should be taken no more than 3 hours apart at the prescribed time each day); does not protect against STIs; Interactions with other medications, contraindications and side effects should be considered.

Risk factors 4, 7: breast cancer or hormone-dependent cancer -> use of non-hormonal methods; cerebrovascular disease, history of cerebrovascular accident; complicated valvular heart disease; current or past history of venous thromboembolism or pulmonary embolism, known thrombogenic or prothrombin mutations, and antithrombin deficiency; diabetes mellitus with microvascular complications; history or current MI or ischemic heart disease, vascular disease; use only progestin or barrier methods; Migraine with aura at any age; hypertension (SBP ≥160 mm Hg or DBP ≥100 mm Hg); severe cirrhosis or liver cancer; Smoker >35 years (≥15 cigarettes/day) -> use only progesterone or non-hormonal; current pregnancy; Unusual vaginal bleeding – may be a sign of an STI or cancer; certain medications [anticonvulsants – phenytoin, carbamazepine, primidone, phenylbutazone, felbamate, ozcarbazine and lamotrigine (lamotrigine levels are reduced by progestins); Antibiotics – rifampin/rifampicin; Antiviral drugs – ritonavir]

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The World Health Organization also recommends that women under the age of 35 who smoke use oral contraceptives containing 35 mcg or less of estrogen.

The only antibiotic that consistently reduces the effectiveness of oral hormonal contraceptives is rifampin, also known as rifampicin.

. A backup method should also be used when using this medication as birth control. Other antibiotics are generally considered safe to use with oral hormonal contraceptives without backup

. The theory behind the potential interference of antibiotics with COCs is due to how estrogen is metabolized. Estrogen is metabolized in the liver and excreted in the bile. Bile is then used to digest food in the intestines. Bacteria in the normal intestinal flora can digest the modified estrogen to be reabsorbed by the body and thus contribute to blood estrogen levels. Antibiotics kill some of the normal flora when used, and there have been concerns that this may reduce estrogen levels in the body. For antibiotics other than rifampicin, this has not been shown to significantly reduce the effectiveness of COCs, although pharmacists and doctors may recommend using a backup method without caution.

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If antibiotics cause vomiting within 2 hours of taking oral contraceptives or severe diarrhea, this can reduce the absorption of the tablet and reduce its effectiveness. If this happens, backup contraceptives are recommended

Monophasic COCs are products that contain the same level of hormones in each active pill. Multiphasic COCs have active pills that contain different amounts of hormones on different days of the cycle. For example, Tri-Cyclen has the same amount of estrogen in each of the 21 tablets, but the amount of progestin varies (7 days 0.18 mg, then 7 days 0.215 mg, then 7 days 0.25 mg). Multiphasic COCs are designed to more closely mimic the natural rise and fall of hormone levels, but still suppress ovulation.

. The total monthly dose of hormones may be lower with polyphasic COCs compared to some monophasic ones. They may be useful for women who experience persistent side effects (Table 2) from monophasic COCs.

Most COCs can come in 21 or 28 tablet versions. In the 21-tablet version, there are 21 tablets containing hormones that last for 3 weeks. During the last 7 days of the cycle, there are no pills and menstruation occurs. In the 28 tablet version, there are 21 tablets with hormones and 7 tablets with placebo, which allows menstruation. The advantage of the 28-tablet version is that it helps maintain the habit of taking the tablets daily while allowing for a monthly menstrual period. There are several multiphasic and extended-release products that have different pill patterns.

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Oral contraceptives can be used by women who are trying to reduce the number of periods for medical or convenience reasons. So far, there is no scientific evidence that monthly menstruation is necessary for optimal health

. Therapeutic amenorrhea (suppression of menstrual periods by medical interventions) may have the benefit of reducing several conditions, including premenopausal syndrome (PMS), iron deficiency anemia, menstrual headaches, and chronic pelvic pain, among others.

Seasonale and Seasonique are products designed for extended use, 12 weeks of hormone-containing tablets per pack. Seasonique is formulated with 3 placebo tablets to induce menstruation every 12 weeks. Regular COCs can be used continuously to achieve the same results. Women used 21 hormonal tablets from each pack, then immediately started a new pack without a 7-day break or placebo pills.

Often in the early stages of therapy, breakthrough bleeding can often occur at an unpredictable time. For example, bleeding may occur without menstruation for 8-16 weeks with prolonged or continuous use. When heavier breakthrough bleeding or spotting occurs for several days at least 3 months after starting treatment, practitioners recommend discontinuing COCs for a maximum of 3 days to allow for a menstrual period. Do not take a break for up to 3 months. In the study, women generally achieved amenorrhea after 1 year of treatment

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. Prolonged and continuous use of COCs reduces the number of periods per year, however, when breakthrough bleeding occurs, it occurs at an unpredictable time.

Hormone levels affect mood. Women can experience mood swings when taking, changing, or stopping oral contraceptives.

. The changes are very individual and can be mood improvement or deterioration. Reducing PMS-related mood problems and mood swings is a potential benefit of hormonal contraceptives.

. There have been conflicting studies on the link between hormonal contraceptives (especially the progestin component in adolescents) and depression, with a recent study showing no support.

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. More research is needed in this area. Women who have major mood disorders or have high risk factors for mood disorders

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