Redisover O.C.P , Non-Contraceptive uses of OCPs

1. AAM AADMI’S NEED
Of today
DR. SHARDA JAIN
Sec. General
Delhi Gynaecologist Forum
Dr. Jyoti Agarwal
Dr. Jyoti Bhaskar

2. Aam Aadmi’s need.
• limit their & Get pregnant
when they want
- Practices like abstinence,
Coitus Interruptus,
Illegal / Induced abortions
Sterilizations
were Witnessed prior to 20th Century
• Unfortunately in India -- exist even today.
FAMILY SIZE.

3. Education & learning is the powerful weapon we
can use to change the world

4. Presentation
• Unwanted pregnancies
• Contraceptive trends in India
• O.C.P. advantages
- Selecting O.C.P.
- Myths & Misconceptions
- Contraindications
• Research tips

5. 50% unwanted
50% of these … used contraceptives & still got pregnant
Unintended Pregnancies
Big challenge !!

6. Implant Mirena
IUC
IUCD Patch DEPO Pill Ring Diaphragm Condom NFP
Top -0.2% Middle -<1% Lowest -18-20%
Big Question?
Effectiveness of Contraceptives
Every couple should know!!

7. – Total eligible couples = 197.4 million (March 2010)
• 50.3 million are Prone to higher order of birth (≥3)
(TARGET GROUP FOR STERILIZATION)
- Ref: Park’s textbook of Preventive and Social Medicine, 23rd Edition
Current Profile of India
– Unsterilized couples = 112.2 million
– (TARGET GROUP FOR SPACING METHODS)
We need - Very effective reversible contraceptives

8. • INDIA’s fertility rate is still high
& it adds up 73,498 live births per day
India is the First Country in the world to adopt
Family Planning Programme in 19522
• 1965-2009, contraceptive usage TRIPLED
(from 13% in 1970 to 48% in 2009, 54% - 2015)
• Unmet needs of contraception still remain Very HIGH.
Current Fertility and Contraceptive
TRENDS in India
1 http://countrymeters.info/en/India. Date 14/09/15
2 Chaurasia AR. Contraceptive use in India: A data mininig approach. Int J of Population Research.2014.
ONLY 54% Married women/men in the age
group of 15 to 45 years use a
contraceptive method

9. ONLY 54% Married women/men in the age group of
15 to 45 years use a contraceptive method
• Contraceptive methods are heavily skewed
towards
rather than birth planning
• THREE-FOURTHS of these were using
• female sterilization,
which is by far the MOST PREVALENT birth-
control method in India
terminal methods

10. Prevalence of contraception in currently
married, nonpregnant women aged
15-49 years in India.
Chaurasia AR. Contraceptive use in india : A data mining approach. Int JK of population .2014
Locality % All methods Terminal
methods
Modern
spacing
methods
Traditional
methods
Rural 78.0 56.4
39.6 9.5
7.2
Urban 22.1
65.3 39.6 18.0
7.6
Total 100.0 58.3 39.6 11.4 7.3
Tragic Scenario !!

11. Family Planning Methods
(Indian Data)
Methods 2009 – 2010 2012 – 2013
Sterilization 4.55 million 4.57 million
Vasectomy 0.23 million 0.12 million
Tubectomy 4.32 million 4.45 million
IUCD insertion 4.92 million 5.41 million
Condom users 8.0 million 13.96 million
Oral Pill users 4.47 million 6.2 million
Adapted from – Park’s Textbook of Preventive and Social Medicine, 23rd Edition

12. Increased female literacy is correlated strongly with a
decline in fertility
Awareness of contraception is near-universal among married.
MAJORITY of married Indians (76% in a 2009 study) reported
significant problems in ACCESSING a choice of
contraceptive methods
India’s Drawbacks….
LACK OF WIDESPREAD AVAILABILITY OF
BIRTH-CONTROL METHODS
LOW FEMALE LITERACY LEVELS

13. DOUBT
Uncertainty
Apprehension

14. OCPs (100 million users)
• Oral contraceptive pills are meant for 21 Days in a cycle
• MODE OF ACTION:
– Inhibition of Ovulation – Synergistic effect of estrogen and
progesterone on HPO axis blocking the release of GnRH by
negative feedback mechanism
– Endometrial Hypoplasia – endometrium nonreceptive to embryo
– Cervical Mucus Alteration – Hostile environment for sperm
penetration
– Tubal Motility Interference
Monophasic, Biphasic and Triphasic pills –
Monophasic pills regimen preferred

15. Progestogen Types in O.C.P.
• First Generation – Norethisterone, Norethisterone
acetate, lynestrenol
• Second Generation – Levonorgestrel, Norgestrel
• Third Generation – Desogestrel, Norgestimate,
Gestodene
• Fourth Generation (Newer) – Drosperinone, (Anti- androgenic)
Cyproterone acetate, ( Receptor -DHT)
Dienogest
Mala – D, Mala – NLow androgenic
Lowest – Androgenic
Activity

16. BIGGEST
Non-Contraceptive uses of OCPs
• Dysmenorrhoea
• Menstrual cycle regulation
• Premenstrual dysphoric disorder
(PMDD)
• Endometriosis
• Acne & Hirsutism

17. Some noticeable BENEFITS of
combined O.C.P.
• Increased Bone Density
• Reduced menstrual blood loss and improve
Anemia
• Decreased risk of ectopic pregnancy
• fewer premenstrual complaints
• Decreased risk of Endometrial ,Colonic And
Ovarian Cancer

18. • Reduction in various Benign Breast Diseases
• Inhibition of HIRSUITISM progression
• Improvement of ACNE
• Prevention of Atherogenesis
• DECREASE P.I.D.
• Decreased activity of RHEUMATOID ARTHRITIS
Some BENEFITS of combined O.C.P.

19. • Patient preference should be strongly
considered
• Generic formulations cost less than brand
name formulations and are bioequivalent
• Monophasic preparation are preferred
Tips for Selecting an O.C.P.
50 ug High Dose 30-35 ug Medium 20 ug Low Dose

20. • Of the available progestins, LNG (with 0.02 mg or
0.03 mg EE) VTE risk - the least
• 0.03 mg EE results in less unscheduled bleeding
and Lower Discontinuation Rates
• Relatively ANDROGENIC PROGESTINS like LNG &
Cyproterone Acetate to improve ACNE/
HIRSUITISM
Tips for selecting an O.C.P.
- Ref: Evans G, Sutton EL. Oral contraception. Women’s Health. May 2015

21. • is significantly different from that of older
married couples and is influenced by
- Educational
- Developmental
- Social
- Psychological factors
Contraceptive facts & Needs of
ADOLESCENT
Bottom Line : NO PREGNANCY PLEASE

22. SPECIAL POPULATION
Teenage Years
• 50% rise in the number of teen pregnancies
in the past four-five years
• Majority ---unintended , Unwanted
• ACOG recommends that adolescents be encouraged to
consider Long acting reversible contraceptives
- Ref: ACOG committee opinion no. 539: Obstet Gynaecol 2012;120(4):983-8
OCPs remain a reasonable choice for teens and offers
contraception,control of irregular and/or heavy periods with
added advantage
of improving ACNE / HIRSUITISM

23. SPECIAL POPULATION
PERIMENOPAUSE
• Annual chances of pregnancies in
mid 40s is around 10%,
• Contraception is needed for Pregnancy Prevention
• The estrogen component of OCPs can confer
NONCONTRACEPTIVE BENEFITS for perimenopause
related symptoms like Irregular cycles, Heavy menstrual
bleeding and Vasomotor symptoms
- Ref: ACOG committee opinion no. 539: Obstet Gynaecol 2012;120(4):983-8

24. Myths and/or Misperceptions
Women are concerned about the impact of Wt gain /
Cancers / Fertility side effects on their health and lives
* WT GAIN – Cochrane Database - INCONCLUSIVE
* CANCERS – Breast Cancer - Very Small ( Insignificant)
* FERTILITY - Cochrane Database- INCONCLUSIVE
• Women Care Providers are often Dismissive About Side
Effects, counseling that they are “Normal” or “nothing to
worry about.”

25. Recommendations - WHO
1. Methods can be used without restriction
2. Advantages of method generally outweigh risks
3. Method not usually recommended unless other
more appropriate methods are not available or
not acceptable
4. Method not to be used

26. Safety concerns with O.C.P
Venous Thrombo-embolism (VTE)
•Women should be advised that although the risk of VTE
with OCP is slightly higher than non-user, it is still
considerably lower than that in pregnancy and
postpartum
Myocardial infarction
•The increased risk of myocardial infarction in young
women taking OCP is marginal
•Additional risk factors such as age, hypertension, smoking,
diabetes, hyperlipidemia, and high BMI must also be taken
into account
Stroke
•Women should be counselled regarding a very small risk
of ischemic stroke with OCP use

27. Breast Cancer
– Recent studies have concluded that the OCP has – NO
influence or a very small influence on breast cancer
– History of benign breast disease or a family history of
breast cancer should not be regarded as contraindication
to OCP use
Cervical Cancer
• HPV is the main etiological factor for Cervical cancer and
women using COCs are more likely to be exposed to HPV
than those using barrier methods
• Regular screening reduces the chance of developing
cervical cancer
Safety concerns with O.C.P
The Federation of Obstetric & Gynaecological Societies of India: Good Clinical Practices Recommendations. Accessed from:
http://www.fogsi.org/images/stories/pdf/CHC-GCPR-Final-version.pdf

28. Dispelling myths/misperceptions
STROKE
Physician Friends Do Not Like O.C.P

29. • Strokes associated with oral contraceptives
were first reported in 1962.
• Early versions of the pill contained doses of
synthetic estrogen as high as 150ug
• Most birth control pills now contain as little
as 20 to 35 microgrames EE.
• None contain more than 50 micrograms of
synthetic estrogen.
DON’T POP BLINDLY

30. • Oral contraceptives in crease the risk of
ISCHEMIC STROKES , which are caused by
blood clots and account for about 85% of all
stroke.
• oral contraceptives do not appear to
increase the risk of hemorrhagic strokes.
ISCHEMIC STROKES

31. ISCHEMIC STROKES
• There are about 4.4 Ischemic Strokes for
every 1,00,000 women of childbearing age
• Birth control pills increase the risk 1.9
times, to 8.5 strokes per 100,000 women, to
a meta-analysis cited in the report.
Latest meta-analysis - 2015

32. Contraindications to the use of
Combined O.C.P.
• Uncontrolled hypertension
• Smokers older than 35 years
• Diabetes with vascular involvement
• Thrombogenic heart arrhythmias /
valvulopathies
• Cerebrovasular or coronary artery disease
• History of or Current deep – vein
thrombophlebitis or thrombotic disorders.
• Migraine
Use - Depo- Provera ,Mirena, POP

33. • Known or suspected Breast Carcinoma
• Cholestatic jaundice of pregnancy or jaundic
with pill use
• Hepatic adenomas or carcinomas, or active
liver disease with abnormal liver function
• Undiagnosed abnormal genital bleeding
• Carcinoma of the endometrium or other
known or suspected estrogen – dependent
neoplasia
Contraindications to the use of
Combined O.C.P.

34. Research Shows…
TRIGGERS
• Increased awareness/Peer Counselling
• Media advertisements
• Easy availability in chemist shops
BARRIERS
Influence from family members
Myths & misperceptions with OCP Such as
- Weight gain, Hormonal imbalance , Bleeding , Cancer & Stroke
risk
• Need to take daily
Awareness about Ocs is high , but they suffer from negative opinion
in general public, influencing the buying decisions

35. Research Shows…
Decision Influencers
• Husband
• Boyfriend
• Friend s
• Sister / sister in law
• Mother / Mother in law
•
BUYING BEHAVIOR
• Usually for one cycle
• In many cases bought by a male
• Repeat purchase is not very common
• Direct purchase from chemist
- Emergency contraceptive pill (I pill, unwanted 72) takes over OCP
Factors considered before
prescribing Contraceptives
• Age of the patients
• Weight of the patients
• Patients profile
• Medical history

37. Mylan Phase I Launch
3rd & 4th generation O.C.P.
• EE (0.02 mg) + Desogestrel (0.15 mg)
• EE (0.03 mg) + Desogestrel (0.15 mg)
• EE (0.03) + Drosperinone (3 mg)
• EE (0.035 mg) + Cyproterone acetate (2 mg)

38. I believe
that GOOD
things
come to
those who
work
Dr. Sharda Jain

39. ADDRESS
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CONTACT US
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