117-481: The combined oral contraceptive pill ( COCP ), often referred to as the birth control pill or colloquially as " the pill ", is a type of birth control that is designed to be taken orally by women. It is the oral form of combined hormonal contraception . The pill contains two important hormones : a progestin (a synthetic form of the hormone progestogen / progesterone ) and estrogen (usually ethinylestradiol or 17β estradiol ). When taken correctly, it alters
234-480: A medical exam —including birth control pills, injectable or implantable birth control, and condoms. For example, a pelvic exam , breast exam , or blood test before starting birth control pills does not appear to affect outcomes. In 2009, the World Health Organization (WHO) published a detailed list of medical eligibility criteria for each type of birth control. Hormonal contraception
351-435: A mid-cycle LH surge. Inhibition of follicular development and the absence of an LH surge prevent ovulation. Estrogen was originally included in oral contraceptives for better cycle control (to stabilize the endometrium and thereby reduce the incidence of breakthrough bleeding), but was also found to inhibit follicular development and help prevent ovulation. Estrogen negative feedback on the anterior pituitary greatly decreases
468-493: A pacifier , and feeding solids all increase the chances of becoming pregnant while breastfeeding. In those who are exclusively breastfeeding, about 10% begin having periods before three months and 20% before six months. In those who are not breastfeeding, fertility may return as early as four weeks after delivery. Emergency contraceptive methods are medications (sometimes misleadingly referred to as "morning-after pills") or devices used after unprotected sexual intercourse with
585-424: A progestin ) and the progestogen-only pills (sometimes called minipills). If either is taken during pregnancy, they do not increase the risk of miscarriage nor cause birth defects . Both types of birth control pills prevent fertilization mainly by inhibiting ovulation and thickening cervical mucus. They may also change the lining of the uterus and thus decrease implantation. Their effectiveness depends on
702-434: A 6% first-year rate with the diaphragm. Condoms have the additional benefit of helping to prevent the spread of some sexually transmitted infections such as HIV/AIDS , however, condoms made from animal intestine do not. Contraceptive sponges combine a barrier with a spermicide. Like diaphragms, they are inserted vaginally before intercourse and must be placed over the cervix to be effective. Typical failure rates during
819-399: A UK study, when a three-month "bridge" supply of the progestogen-only pill was provided by a pharmacist along with emergency contraception after sexual activity, this intervention was shown to increase the likelihood that the person would begin to use an effective method of long-term contraception. Levonorgestrel pills, when used within 3 days, decrease the chance of pregnancy after
936-592: A backup method of contraception (e.g. condoms ) must be used in the interim. The effectiveness of COCPs appears to be similar whether the active pills are taken continuously or if they are taken cyclically. Contraceptive efficacy, however, could be impaired by numerous means. Factors that may contribute to a decrease in effectiveness: In any of these instances, a backup contraceptive method should be used until hormone active pills have been consistently taken for 7 consecutive days or drug-drug interactions or underlying illnesses have been discontinued or resolved. According to
1053-687: A base covered in oils or other gummy substances. Many of Soranus's methods were probably also ineffective. In medieval Europe, any effort to halt pregnancy was deemed immoral by the Catholic Church , although it is believed that women of the time still used a number of birth control measures, such as coitus interruptus and inserting lily root and rue into the vagina. Women in the Middle Ages were also encouraged to tie weasel testicles around their thighs during sex to prevent pregnancy. The oldest condoms discovered to date were recovered in
1170-408: A daily pill that contains two hormones, estrogen and progestogen. During the last 7 days of the cycle, users take daily placebo (biologically inactive) pills and these days are considered hormone-free days. Although these are hormone-free days, users are still protected from pregnancy during this time. Some COCP packs only contain 21 pills and users are advised to take no pills for the last 7 days of
1287-893: A given method during the first year, and sometimes as a lifetime failure rate among methods with high effectiveness, such as tubal ligation . Birth control methods fall into two main categories: male contraception and female contraception . Common male contraceptives are withdrawal , condoms , and vasectomy . Female contraception is more developed compared to male contraception, these include contraceptive pills (combination and progestin-only pill), hormonal or non-hormonal IUD , patch , vaginal ring , diaphragm , shot , implant , fertility awareness , and tubal ligation . The most effective methods are those that are long acting and do not require ongoing health care visits. Surgical sterilization, implantable hormones, and intrauterine devices all have first-year failure rates of less than 1%. Hormonal contraceptive pills, patches or vaginal rings, and
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#17327833078151404-489: A health care provider about medication frequency, forgotten to take the pill one day or not gone to the pharmacy in time to renew a COCP prescription. COCPs provide effective contraception from the very first pill if started within five days of the beginning of the menstrual cycle (within five days of the first day of menstruation ). If started at any other time in the menstrual cycle, COCPs provide effective contraception only after 7 consecutive days of use of active pills, so
1521-491: A man's erect penis and physically block ejaculated sperm from entering the body of a sexual partner. Modern condoms are most often made from latex , but some are made from other materials such as polyurethane , or lamb's intestine. Female condoms are also available, most often made of nitrile , latex or polyurethane. Male condoms have the advantage of being inexpensive, easy to use, and have few adverse effects. Making condoms available to teenagers does not appear to affect
1638-418: A pack of cyclical COCP treatment is completed, users start a new pack and new cycle. Most monophasic COCPs can be used continuously such that patients can skip placebo days and continuously take hormone active pills from a COCP pack. One of the most common reasons users do this is to avoid or diminish withdrawal bleeding . The majority of women on cyclic COCPs have regularly scheduled withdrawal bleeding, which
1755-590: A pregnancy, delivery and care of a newborn in the United States is on average $ 21,000 for a vaginal delivery and $ 31,000 for a caesarean delivery as of 2012. In most other countries, the cost is less than half. For a child born in 2011, an average US family will spend $ 235,000 over 17 years to raise them. Globally, as of 2009, approximately 60% of those who are married and able to have children use birth control. How frequently different methods are used varies widely between countries. The most common method in
1872-433: A previous delivery. Delaying another pregnancy after a miscarriage , however, does not appear to alter risk and women are advised to attempt pregnancy in this situation whenever they are ready. Teenage pregnancies , especially among younger teens, are at greater risk of adverse outcomes including early birth , low birth weight , and death of the infant . In 2012 in the United States 82% of pregnancies in those between
1989-483: A primary mechanism of action. Under normal circumstances, luteinizing hormone (LH) stimulates the theca cells of the ovarian follicle to produce androstenedione . The granulosa cells of the ovarian follicle then convert this androstenedione to estradiol. This conversion process is catalyzed by aromatase, an enzyme produced as a result of follicle-stimulating hormone (FSH) stimulation. In individuals using oral contraceptives, progestogen negative feedback decreases
2106-435: A primary method have backup methods available (such as condoms or emergency contraceptive pills). The lactational amenorrhea method involves the use of a woman's natural postpartum infertility which occurs after delivery and may be extended by breastfeeding . For a postpartum woman to be infertile (protected from pregnancy), their periods have usually not yet returned (not menstruating), they are exclusively breastfeeding
2223-421: A regular basis. Since they are formulated into daily doses, it is recommended that the medication should be taken at the same time every day to maximise efficacy . For 21-tablet packs, the general instruction is to take one tablet daily for 21 days, followed by a 7-day blank interval without taking HOCs before initiating another 21-tablet pack. For 28-tablet packs, the 1st tablet from a new pack should be taken on
2340-497: A result of rape, and public health efforts emphasizing abstinence to reduce unwanted pregnancy may have limited effectiveness, especially in developing countries and among disadvantaged groups . Deliberate non-penetrative sex without vaginal sex or deliberate oral sex without vaginal sex are also sometimes considered birth control. While this generally avoids pregnancy, pregnancy can still occur with intercrural sex and other forms of penis-near-vagina sex (genital rubbing, and
2457-825: A significant role, if any, in the observed effectiveness of COCPs. Oral contraceptives come in a variety of formulations, some containing both estrogen and progestins , and some only containing progestin . Doses of component hormones also vary among products, and some pills are monophasic (delivering the same dose of hormones each day) while others are multiphasic (doses vary each day). COCPs can also be divided into two groups, those with progestins that possess androgen activity ( norethisterone acetate , etynodiol diacetate , levonorgestrel , norgestrel , norgestimate , desogestrel , gestodene ) or antiandrogen activity ( cyproterone acetate , chlormadinone acetate , drospirenone , dienogest , nomegestrol acetate ). COCPs have been somewhat inconsistently grouped into "generations" in
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#17327833078152574-554: A single episode of unprotected sex or condom failure by 70% (resulting in a pregnancy rate of 2.2%). Ulipristal , when used within 5 days, decreases the chance of pregnancy by about 85% (pregnancy rate 1.4%) and is more effective than levonorgestrel. Mifepristone is also more effective than levonorgestrel, while copper IUDs are the most effective method. IUDs can be inserted up to five days after intercourse and prevent about 99% of pregnancies after an episode of unprotected sex (pregnancy rate of 0.1 to 0.2%). This makes them
2691-590: A survey of biological parents, 9% stated they would not have had children if they were able to do it over again. Although sterilization is considered a permanent procedure, it is possible to attempt a tubal reversal to reconnect the fallopian tubes or a vasectomy reversal to reconnect the vasa deferentia . In women, the desire for a reversal is often associated with a change in spouse. Pregnancy success rates after tubal reversal are between 31 and 88 percent, with complications including an increased risk of ectopic pregnancy . The number of males who request reversal
2808-474: A woman drink a copper salt dissolved in water, which it claimed would prevent pregnancy for a year. This method was not only ineffective, but also dangerous, as the later medical writer Soranus of Ephesus ( c. 98–138 AD) pointed out. Soranus attempted to list reliable methods of birth control based on rational principles. He rejected the use of superstition and amulets and instead prescribed mechanical methods such as vaginal plugs and pessaries using wool as
2925-401: A woman with PCOS's endometrial cancer risk. COCPs are preferred to progestin-only methods in women who also have uncontrolled acne, symptoms of hirsutism, and androgenic alopecia, because COCPs can help treat these symptoms. COCPs are sometimes prescribed to treat symptoms of androgenization, including acne and hirsutism. The estrogen component of COCPs appears to suppress androgen production in
3042-504: A year. Part of the reason that many women are without birth control is that many countries limit access due to religious or political reasons, while another contributor is poverty. Due to restrictive abortion laws in Sub-Saharan Africa, many women turn to unlicensed abortion providers for unintended pregnancy , resulting in about 2–4% obtaining unsafe abortions each year. The Egyptian Ebers Papyrus from 1550 BC and
3159-404: Is 0.2%; the typical use first failure rate is 6%. Barrier contraceptives are devices that attempt to prevent pregnancy by physically preventing sperm from entering the uterus . They include male condoms , female condoms , cervical caps , diaphragms , and contraceptive sponges with spermicide . Globally, condoms are the most common method of birth control. Male condoms are put on
3276-424: Is a prodrug of norethisterone in the body, with etynodiol occurring as an intermediate . Etynodiol, a related compound, was discovered in 1954, and etynodiol diacetate was introduced for medical use in 1965. The combination ethynodiol with mestranol (Ovulen) was approved for medical use in the United States in 1966. The combination ethinylestradiol with ethynodiol (Demulen) was approved for medical use in
3393-499: Is a synthetic estrane steroid and a derivative of testosterone . It is specifically a derivative of 19-nortestosterone and 17α-ethynyltestosterone , or of norethisterone (17α-ethynyl-19-nortestosterone), in which the C3 ketone group has been dehydrogenated into a C3β hydroxyl group and acetate esters have been attached at the C3β and C17β positions. Etynodiol diacetate
3510-486: Is a high concern, using two methods at the same time is reasonable. For example, two forms of birth control are recommended in those taking the anti- acne drug isotretinoin or anti-epileptic drugs like carbamazepine , due to the high risk of birth defects if taken during pregnancy. Contraceptive use in developing countries is estimated to have decreased the number of maternal deaths by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% of deaths if
3627-585: Is also a form of birth control, but abstinence-only sex education may increase teenage pregnancies if offered without birth control education, due to non-compliance. In teenagers , pregnancies are at greater risk of poor outcomes. Comprehensive sex education and access to birth control decreases the rate of unintended pregnancies in this age group. While all forms of birth control can generally be used by young people, long-acting reversible birth control such as implants, IUDs, or vaginal rings are more successful in reducing rates of teenage pregnancy. After
Combined oral contraceptive pill - Misplaced Pages Continue
3744-433: Is at least 14 or 15 years old, has already begun menstruating, and needs contraception. These include Ortho Tri-Cyclen , Estrostep , Beyaz , and YAZ . Hirsutism is the growth of coarse, dark hair where women typically grow only fine hair or no hair at all. This hair growth on the face, chest, and abdomen is also mediated by higher levels or action of androgens. Therefore, COCPs also work to treat these symptoms by lowering
3861-403: Is available in a number of different forms, including oral pills , implants under the skin, injections , patches , IUDs and a vaginal ring . They are currently available only for women, although hormonal contraceptives for men have been and are being clinically tested. There are two types of oral birth control pills, the combined oral contraceptive pills (which contain both estrogen and
3978-575: Is available in the form of tubal ligation for women and vasectomy for men. Tubal ligation decreases the risk of ovarian cancer . Short term complications are twenty times less likely from a vasectomy than a tubal ligation. After a vasectomy, there may be swelling and pain of the scrotum which usually resolves in one or two weeks. Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1–2% of men. With tubal ligation, complications occur in 1 to 2 percent of procedures with serious complications usually due to
4095-428: Is based on a review of pregnancy rates in clinical trials, and the typical use failure rate is based on a weighted average of estimates from the 1995 and 2002 US National Surveys of Family Growth (NSFG), corrected for underreporting of abortions. Several factors account for typical use effectiveness being lower than perfect use effectiveness: For instance, someone using COCPs might have received incorrect information by
4212-414: Is between 2 and 6 percent. Rates of success in fathering another child after reversal are between 38 and 84 percent; with success being lower the longer the time period between the vasectomy and the reversal. Sperm extraction followed by in vitro fertilization may also be an option in men. Behavioral methods involve regulating the timing or method of intercourse to prevent introduction of sperm into
4329-520: Is etynodiol), while ethynodiol diacetate is its USAN Tooltip United States Adopted Name , BAN Tooltip British Approved Name , and JAN Tooltip Japanese Accepted Name . It is also known by its former developmental code names CB-8080 and SC-11800. Etynodiol diacetate is or has been marketed under brand names including Conova, Continuin, Demulen, Femulen, Kelnor, Lo-Malmorede, Luteonorm, Luto-Metrodiol, Malmorede, Metrodiol, Ovulen, Soluna, Zovia, and others. Etynodiol diacetate
4446-439: Is imperative. In the developing world, birth control increases economic growth due to there being fewer dependent children and thus more women participating in or increased contribution to the workforce – as they are usually the primary caregiver for children. Women's earnings, assets, body mass index , and their children's schooling and body mass index all improve with greater access to birth control. Family planning , via
4563-476: Is made impossible and contraception is achieved. In comparison, Progesterone is more efficacious than Oestrogen not only because of its additional action in impeding LH, but also its ability to modulate the cervical mucus into sperm-repellent. Combined oral contraceptive pills were developed to prevent ovulation by suppressing the release of gonadotropins . Combined hormonal contraceptives, including COCPs, inhibit follicular development and prevent ovulation as
4680-413: Is permitted so that the release of mature ovum from follicle is triggered. In secretory phase on day 14-28, this follicle then transforms into corpus luteum and continues releasing Oestrogen with Progesterone into bloodstream. While Oestrogen and Progesterone primarily aid the maintenance of thickness in uterine lining, the negative feedback in pituitary allows them to inhibit FSH and LH secretion. In
4797-418: Is recommended that birth control be continued for one year after the last menstrual period . About 222 million women who want to avoid pregnancy in developing countries are not using a modern birth control method. Birth control use in developing countries has decreased the number of deaths during or around the time of pregnancy by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% if
Combined oral contraceptive pill - Misplaced Pages Continue
4914-405: Is recommended to take folic acid supplementation in the months prior to pregnancy to decrease the likelihood of neural tube defect in infants. If the pill formulation is monophasic, meaning each hormonal pill contains a fixed dose of hormones, it is possible to skip withdrawal bleeding and still remain protected against conception by skipping the placebo pills altogether and starting directly with
5031-420: Is the 3β,17β- diacetate ester of etynodiol (17α-ethynylestr-4-ene-3β,17β-diol). Chemical syntheses of etynodiol diacetate have been published. Reduction of norethisterone ( 1 ) affords the 3,17-diol. The 3β-hydroxy compound is the desired product; since reactions at C3 do not show nearly the stereoselectivity as those at C17 by virtue of the relative lack of stereo-directing proximate substituents,
5148-648: Is the lack of hormones for a week that causes a withdrawal bleed. The withdrawal bleeding that occurs during the break from active pills has been thought to be reassuring, a physical confirmation of not being pregnant. The withdrawal bleeding is also predictable. Unexpected breakthrough bleeding can be a possible side effect of longer term active regimens. Since it is not uncommon for menstruating women to become anemic, some placebo pills may contain an iron supplement. This replenishes iron stores that may become depleted during menstruation. As well, birth control pills, such as COCPs, are sometimes fortified with folic acid as it
5265-532: Is the most common method). Use of COCPs, however, varies widely by country, age, education, and marital status. For example, one third of women aged 16–49 in the United Kingdom use either the combined pill or progestogen-only pill (POP), compared with less than 3% of women in Japan (as of 1950–2014). Combined oral contraceptives are on the World Health Organization's List of Essential Medicines . The pill
5382-556: Is the practice of ending intercourse ("pulling out") before ejaculation. The main risk of the withdrawal method is that the man may not perform the maneuver correctly or in a timely manner. First-year failure rates vary from 4% with perfect usage to 22% with typical usage. It is not considered birth control by some medical professionals. There is little data regarding the sperm content of pre-ejaculatory fluid . While some tentative research did not find sperm, one trial found sperm present in 10 out of 27 volunteers. The withdrawal method
5499-544: Is the use of methods or devices to prevent pregnancy . Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century. Planning, making available, and using human birth control is called family planning . Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable. The World Health Organization and United States Centers for Disease Control and Prevention provide guidance on
5616-550: Is used as birth control by about 3% of couples. Sexual abstinence may be used as a form of birth control, meaning either not engaging in any type of sexual activity, or specifically not engaging in vaginal intercourse, while engaging in other forms of non-vaginal sex. Complete sexual abstinence is 100% effective in preventing pregnancy. However, among those who take a pledge to abstain from premarital sex , as many as 88% who engage in sex, do so prior to marriage. The choice to abstain from sex cannot protect against pregnancy as
5733-525: Is vaginal bleeding mimicking users' menstrual cycles with the exception of lighter menstrual bleeding compared to bleeding patterns prior to COCP commencement. As such, a study reported that out of 1003 women taking COCPs approximately 90% reported regularly scheduled withdrawal bleeds over a 90-day standard reference period. Withdrawal bleeding usually occurs during the placebo, hormone-free days. Therefore, avoiding placebo days can diminish withdrawal bleeding among other placebo effects. This section demonstrates
5850-498: The Kahun Papyrus from 1850 BC have within them some of the earliest documented descriptions of birth control: the use of honey, acacia leaves and lint to be placed in the vagina to block sperm. Silphium , a species of giant fennel native to north Africa, may have been used as birth control in ancient Greece and the ancient Near East . Due to its desirability, by the first century AD, it had become so rare that it
5967-635: The anesthesia . Neither method offers protection from sexually transmitted infections. Sometimes, salpingectomy is also used for sterilization in women. Non-surgical sterilization methods have also been explored. Fahim et al. found that heat exposure, especially high-intensity ultrasound, was effective either for temporary or permanent contraception depending on the dose, e.g. selective destruction of germ cells and Sertoli cells without affecting Leydig cells or testosterone levels. Chemical, e.g. drug-based methods are also available, e.g. orally-administered Lonidamine for temporary, or permanent (depending on
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#17327833078156084-573: The lactational amenorrhea method (LAM), if adhered to strictly, can also have first-year (or for LAM, first-6-month) failure rates of less than 1%. With typical use, first-year failure rates are considerably higher, at 9%, due to inconsistent use. Other methods such as condoms, diaphragms, and spermicides have higher first-year failure rates even with perfect usage. The American Academy of Pediatrics recommends long acting reversible birth control as first line for young individuals. While all methods of birth control have some potential adverse effects,
6201-533: The menstrual cycle to eliminate ovulation and prevent pregnancy . COCPs were first approved for contraceptive use in the United States in 1960, and remain a very popular form of birth control. They are used by more than 100 million women worldwide including about 9 million women in the United States. From 2015 to 2017, 12.6% of women aged 15–49 in the US reported using COCPs, making it the second most common method of contraception in this age range ( female sterilization
6318-426: The menstrual cycle , inhibiting ovulation , and altering cervical mucus to impede sperm mobility; combined pills have extra effects in menstrual cycle regulation and menstrual pain relief. Common off-label uses include menstrual suppression and acne relief, with Combined Oral Contraceptives having additional benefits in relieving menstrual migraine . Progesterone-only pills ( POPs ) utilise progestin ,
6435-412: The placebo pills is two-fold: to allow the user to continue the routine of taking a pill every day and to simulate the average menstrual cycle . By continuing to take a pill every day, users remain in the daily habit even during the week without hormones. Failure to take pills during the placebo week does not impact the effectiveness of the pill, provided that daily ingestion of active pills is resumed at
6552-879: The progesterone and androgen receptors and acts as a rapidly converted prodrug of norethisterone , with etynodiol occurring as an intermediate . Upon oral administration and during first-pass metabolism in the liver , etynodiol diacetate is rapidly converted by esterases into etynodiol, which is followed by oxygenation of the C3 hydroxyl group to produce norethisterone. In addition to its progestogenic activity, etynodiol diacetate has weak androgenic activity, and, unlike most progestins but similarly to norethisterone and noretynodrel , also has some estrogenic activity. The pharmacokinetics of etynodiol diacetate have been reviewed. Etynodiol diacetate, also known as 3β-hydroxy-17α-ethynyl-19-nortestosterone 3β,17β-diaceate, 3β-hydroxynorethisterone 3β,17β-diacetate, or 17α-ethynylestr-4-ene-3β,17β-diol 3β,17β-diacetate,
6669-407: The workforce , and/or less use of scarce resources. Birth control methods include barrier methods , hormonal birth control , intrauterine devices (IUDs), sterilization , and behavioral methods. They are used before or during sex while emergency contraceptives are effective for up to five days after sex. Effectiveness is generally expressed as the percentage of women who become pregnant using
6786-506: The US Centers for Disease Control and Prevention (CDC) guidelines, a pill is considered "late" if a user takes the pill after the user's normal medication time, but no longer than 24 hours after this normal time. If 24 hours or more have passed since the time the user was supposed to take the pill, then the pill is considered "missed". CDC guidelines discuss potential next steps for users who missed their pill or took it late. The role of
6903-478: The US FDA for the previously mentioned uses despite extensive use for these conditions. The cause of PCOS, or polycystic ovary syndrome, is multifactorial and not well-understood. Women with PCOS often have higher than normal levels of luteinizing hormone (LH) and androgens that impact the normal function of the ovaries. While multiple small follicles develop in the ovary, none are able to grow in size enough to become
7020-443: The United States in 1970. In 2021, the combination with ethinylestradiol was the 276th most commonly prescribed medication in the United States, with more than 800,000 prescriptions. Etynodiol diacetate is used in combination with an estrogen such as ethinylestradiol or mestranol in combined oral contraceptives for women for the prevention of pregnancy. Etynodiol diacetate is virtually inactive in terms of affinity for
7137-536: The absence of LH, corpus luteum degenerates and ultimately causes blood Oestrogen and Progesterone levels to decline. Without these thickness maintaining agents, uterine lining breaks down and hence the presentation of menstruation. Progesterone and Oestrogen, either in combination or with Progesterone-only, are the active pharmaceutical ingredients found in a HOC formulation. These medications are orally administered for systemic absorption to exert their effects. An artificially enhanced level of Progesterone throughout
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#17327833078157254-412: The age of 30, about 6% regret their decision, as compared with 20–24% of women who received sterilization within one year of delivery and before turning 30, and 6% in nulliparous women sterilized before the age of 30. By contrast, less than 5% of men are likely to regret sterilization. Men who are more likely to regret sterilization are younger, have young or no children, or have an unstable marriage. In
7371-469: The age of onset of sexual activity or its frequency. In Japan, about 80% of couples who are using birth control use condoms, while in Germany this number is about 25%, and in the United States it is 18%. Male condoms and the diaphragm with spermicide have typical use first-year failure rates of 18% and 12%, respectively. With perfect use condoms are more effective with a 2% first-year failure rate versus
7488-867: The ages of 15 and 19 years old are unplanned. Comprehensive sex education and access to birth control are effective in decreasing pregnancy rates in this age group. Birth control methods, especially hormonal methods , can also have undesirable side effects. Intensity of side effects can range from minor to debilitating, and varies with individual experiences. These most commonly include change in menstruation regularity and flow, nausea, breast tenderness, headaches, weight gain, and mood changes (specifically an increase in depression and anxiety). Additionally, hormonal contraception can contribute to bone mineral density loss, impaired glucose metabolism, increased risk of venous thromboembolism. Comprehensive sex education and transparent discussion of birth control side effects and contraindications between healthcare provider and patient
7605-442: The benefit of less frequent periods, at the potential drawback of breakthrough bleeding. Seasonique is another version in which the placebo week every three months is replaced with a week of low-dose estrogen. A version of the combined pill has also been packaged to eliminate placebo pills and withdrawal bleeds. Marketed as Anya or Lybrel, studies have shown that after seven months, 71% of users no longer had any breakthrough bleeding,
7722-506: The brand name Ovulen among others, is a progestin medication which is used in birth control pills . The medication is available only in combination with an estrogen . It is taken by mouth . Etynodiol diacetate is a progestin, or a synthetic progestogen , and hence is an agonist of the progesterone receptor , the biological target of progestogens like progesterone . It has weak androgenic and estrogenic activity and no other important hormonal activity. The medication
7839-428: The cycle. Other COCP formulations contain 91 pills, consisting of 84 days of active hormones followed by 7 days of placebo ( Seasonale ). COCP formulations can contain 24 days of active hormone pills followed by 4 days of placebo pills (e.g. Yaz 28 and Loestrin 24 Fe) as a means to decrease the severity of placebo effects. These COCPs containing active hormones and a placebo/hormone-free period are called cyclic COCPs. Once
7956-411: The day of the cycle. They have typical first-year failure rates of 24%; perfect use first-year failure rates depend on which method is used and range from 0.4% to 5%. The evidence on which these estimates are based, however, is poor as the majority of people in trials stop their use early. Globally, they are used by about 3.6% of couples. If based on both basal body temperature and another primary sign,
8073-416: The delivery of a child, a woman who is not exclusively breastfeeding may become pregnant again after as few as four to six weeks. Some methods of birth control can be started immediately following the birth, while others require a delay of up to six months. In women who are breastfeeding, progestin-only methods are preferred over combined oral birth control pills . In women who have reached menopause , it
8190-524: The developed world is condoms and oral contraceptives, while in Africa it is oral contraceptives and in Latin America and Asia it is sterilization. In the developing world overall, 35% of birth control is via female sterilization, 30% is via IUDs, 12% is via oral contraceptives, 11% is via condoms, and 4% is via male sterilization. While less used in the developed countries than the developing world,
8307-485: The development of follicle in ovary in the female reproductive system . While follicle serves as the chamber of ovum development, it secretes Oestrogen , a hormone that not only triggers the thickening of uterine lining in preparation for implantation , but also inhibits the secretion of FSH in pituitary via a negative feedback mechanism . Specifically in ovulation, transient positive feedback by Oestrogen on FSH and Luteinising Hormone (LH) secretion from pituitary
8424-449: The dominant follicle and trigger ovulation. This leads to an imbalance of LH, follicle stimulating hormone, estrogen, and progesterone. Without ovulation, unopposed estrogen can lead to endometrial hyperplasia, or overgrowth of tissue in the uterus. This endometrial overgrowth is more likely to become cancerous than normal endometrial tissue. Thus, although the data varies, it is generally agreed upon by most gynecological societies that due to
8541-399: The dose) fertility management. Boris provides a method for chemically inducing either temporary or non-reversible sterility, depending on the dose, "Permanent sterility in human males can be obtained by a single oral dosage containing from about 18 mg/kg to about 25 mg/kg". The permanence of this decision may cause regret in some men and women. Of women who have undergone tubal ligation after
8658-470: The end of the week. The placebo, or hormone-free, week in the 28-day pill package simulates an average menstrual cycle, though the hormonal events during a pill cycle are significantly different from those of a normal ovulatory menstrual cycle. Because the pill suppresses ovulation (to be discussed more in the Mechanism of action section ), birth control users do not have true menstrual periods. Instead, it
8775-426: The estimated risk of getting pregnant is 0.3% which means that about 3 in 1000 women on COCPs will become pregnant within one year. However, typical use of COCPs by users often consists of timing errors, forgotten pills, or unwanted side effects. With typical use, the estimated risk of getting pregnant is about 9% which means that about 9 in 100 women on COCPs will become pregnant in one year. The perfect use failure rate
8892-460: The female reproductive tract, either altogether or when an egg may be present. If used perfectly the first-year failure rate may be around 3.4%; however, if used poorly first-year failure rates may approach 85%. Fertility awareness methods involve determining the most fertile days of the menstrual cycle and avoiding unprotected intercourse. Techniques for determining fertility include monitoring basal body temperature , cervical secretions , or
9009-430: The first generation of COCs, which made use of a high concentration of oestrogen only, were those invented in the 1960s. In the second generation of products, progestogens were introduced into the formulation while the concentration of oestrogen was reduced. Starting from the 1990s, the progression in the development of COCs has been directed towards varying the type of progestogen incorporated. These products are referred as
9126-514: The first year depend on whether or not a woman has previously given birth, being 24% in those who have and 12% in those who have not. The sponge can be inserted up to 24 hours before intercourse and must be left in place for at least six hours afterward. Allergic reactions and more severe adverse effects such as toxic shock syndrome have been reported. The current intrauterine devices (IUD) are small devices, often T-shaped, containing either copper or levonorgestrel , which are inserted into
9243-581: The formation of the desired isomer is engendered by use of a bulky reducing agent, lithium tri-tert-butoxyaluminum hydride. Acetylation of the 3β,17β-diol affords etynodiol diacetate ( 3 ). Etynodiol was first synthesized in 1954, via reduction of norethisterone , and etynodiol diacetate was introduced for medical use in 1965. Etynodiol diacetate is the generic name of the drug (the INN Tooltip International Nonproprietary Name of its free alcohol form
9360-454: The full demand for birth control were met. By lengthening the time between pregnancies, birth control can improve adult women's delivery outcomes and the survival of their children. In the developing world, women's earnings, assets, and weight, as well as their children's schooling and health, all improve with greater access to birth control. Birth control increases economic growth because of fewer dependent children, more women participating in
9477-428: The full demand for birth control were met. These benefits are achieved by reducing the number of unplanned pregnancies that subsequently result in unsafe abortions and by preventing pregnancies in those at high risk. Birth control also improves child survival in the developing world by lengthening the time between pregnancies. In this population, outcomes are worse when a mother gets pregnant within eighteen months of
9594-616: The hope of preventing pregnancy. Emergency contraceptives are often given to victims of rape. They work primarily by preventing ovulation or fertilization. They are unlikely to affect implantation, but this has not been completely excluded. A number of options exist, including high dose birth control pills , levonorgestrel , mifepristone , ulipristal and IUDs. All methods have minimal side effects. Providing emergency contraceptive pills to women in advance of sexual activity does not affect rates of sexually transmitted infections, condom use, pregnancy rates, or sexual risk-taking behavior. In
9711-543: The increased risk, they are included in decision tools such as the DASH score and PERC rule used to predict the risk of blood clots. The effect on sexual drive is varied, with increase or decrease in some but with no effect in most. Combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not change the risk of breast cancer. They often reduce menstrual bleeding and painful menstruation cramps . The lower doses of estrogen released from
9828-401: The infant, and the baby is younger than six months. If breastfeeding is the infant's only source of nutrition and the baby is less than 6 months old, 93–99% of women are estimated to have protection from becoming pregnant in the first six months (0.75–7.5% failure rate). The failure rate increases to 4–7% at one year and 13% at two years. Feeding formula, pumping instead of nursing, the use of
9945-510: The initiation of HOC dosing is recommended within the 1st-5th day from menstruation in order to discard other means of contraception . Specific to Progesterone only pills, even if dosing is initiated within five days, backup contraception is suggested in the first 48 hours since the first pill. In the case of dosing initiated after the 5th day from menstruation, effects usually take place after seven days and other contraceptive methods should remain in place until then. If used exactly as instructed,
10062-490: The injectable version should be used. Progestin-only pills may improve menstrual symptoms and can be used by breastfeeding women as they do not affect milk production . Irregular bleeding may occur with progestin-only methods, with some users reporting no periods . The progestins drospirenone and desogestrel minimize the androgenic side effects but increase the risks of blood clots and are thus not first line. The perfect use first-year failure rate of injectable progestin
10179-650: The levels of free circulating androgens. Studies have shown that COCs are effective in reducing both inflammatory and non-inflammatory facial acne lesions. However, comparisons between different COCs have not been studied to understand if any brand is superior than the others. Oestrogen decreases sebum production by shrinking the sebaceous gland , increasing SHBG production to reduce unbound testosterone , and regulating LH and FSH levels. Currently, no studies have shown that POPs are effective against acne lesions. Birth control Birth control , also known as contraception , anticonception , and fertility control ,
10296-521: The male before ejaculation . Sterilization, while highly effective, is not usually reversible; all other methods are reversible, most immediately upon stopping them. Safe sex practices, such as with the use of condoms or female condoms , can also help prevent sexually transmitted infections . Other methods of birth control do not protect against sexually transmitted infections. Emergency birth control can prevent pregnancy if taken within 72 to 120 hours after unprotected sex. Some argue not having sex
10413-418: The medical literature based on when they were introduced. Combined oral contraceptive pills are a type of oral medication that were originally designed to be taken every day at the same time of day in order to prevent pregnancy. There are many different formulations or brands, but the average pack is designed to be taken over a 28-day period (also known as a cycle). For the first 21 days of the cycle, users take
10530-405: The menstrual cycle in females to prevent ovulation , and hence achieve contraception. In a 28-day menstrual cycle, there are the proliferative phase, ovulation, and then the secretory phase. Menstruation marks the beginning of proliferative phase in day 1-14. In this period, the pituitary gland located near the brain secretes follicle-stimulating hormone (FSH) into the bloodstream to signal
10647-410: The menstrual cycle inhibits the pituitary secretion of FSH and LH such that their actions in stimulating follicular development and ovulation are prevented. Similarly, a boosted Oestrogen level activates the negative feedback mechanism in reducing FSH secretion from pituitary and therefore prevents follicular development. In the absence of a developed follicle, ovulation cannot occur so that fertilisation
10764-411: The method is referred to as symptothermal. First-year failure rates of 20% overall and 0.4% for perfect use have been reported in clinical studies of the symptothermal method. A number of fertility tracking apps are available, as of 2016, but they are more commonly designed to assist those trying to get pregnant rather than prevent pregnancy. The withdrawal method (also known as coitus interruptus)
10881-764: The most common side effect of going longer periods of time without breaks from active pills. While more research needs to be done to assess the long term safety of using COCP's continuously, studies have shown there may be no difference in short term adverse effects when comparing continuous use versus cyclic use of birth control pills. The hormones in the pill have also been used to treat other medical conditions, such as polycystic ovary syndrome (PCOS), endometriosis , adenomyosis , acne, hirsutism, amenorrhea , menstrual cramps, menstrual migraines , menorrhagia (excessive menstrual bleeding), menstruation-related or fibroid-related anemia and dysmenorrhea (painful menstruation). Besides acne, no oral contraceptives have been approved by
10998-417: The most effective form of emergency contraceptive. In those who are overweight or obese , levonorgestrel is less effective and an IUD or ulipristal is recommended. Dual protection is the use of methods that prevent both sexually transmitted infections and pregnancy. This can be with condoms either alone or along with another birth control method or by the avoidance of penetrative sex . If pregnancy
11115-783: The most widely used form of reversible contraception, with more than 180 million users worldwide. Evidence supports effectiveness and safety in adolescents and those who have and have not previously had children. IUDs do not affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an abortion. Once removed, even after long term use, fertility returns to normal immediately. While copper IUDs may increase menstrual bleeding and result in more painful cramps, hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether. Cramping can be treated with painkillers like non-steroidal anti-inflammatory drugs . Other potential complications include expulsion (2–5%) and rarely perforation of
11232-525: The next day when the 28th tablet from an old pack was finished. While the 7-day blank period does not apply to 28-tablet packs, they will likely include tablets in distinctive colours indicating that they have an alternate amount of active ingredients, otherwise inactive ingredient or folate supplement only. The instruction for 91-tablet pack follows that of 28-tablet packs with some colour-distinguishable tablets which contain different amounts of medicine or supplement. To acquire immediate contraceptive effects,
11349-427: The next packet. Attempting this with bi- or tri-phasic pill formulations carries an increased risk of breakthrough bleeding and may be undesirable. It will not, however, increase the risk of getting pregnant. Starting in 2003, women have also been able to use a three-month version of the pill. Similar to the effect of using a constant-dosage formulation and skipping the placebo weeks for three months, Seasonale gives
11466-1006: The number of women using IUDs as of 2007 was more than 180 million. Avoiding sex when fertile is used by about 3.6% of women of childbearing age, with usage as high as 20% in areas of South America. As of 2005, 12% of couples are using a male form of birth control (either condoms or a vasectomy) with higher rates in the developed world. Usage of male forms of birth control has decreased between 1985 and 2009. Contraceptive use among women in Sub-Saharan Africa has risen from about 5% in 1991 to about 30% in 2006. As of 2012, 57% of women of childbearing age want to avoid pregnancy (867 of 1,520 million). About 222 million women, however, were not able to access birth control, 53 million of whom were in sub-Saharan Africa and 97 million of whom were in Asia. This results in 54 million unplanned pregnancies and nearly 80,000 maternal deaths
11583-399: The ovaries. Estrogen also leads to increased synthesis of sex hormone binding globulin, which causes a decrease in the levels of free testosterone. Ultimately, the drop in the level of free androgens leads to a decrease in the production of sebum, which is a major contributor to development of acne. Four different oral contraceptives have been FDA approved to treat moderate acne if the patient
11700-444: The overall rationalisation of dosing route and intervals of HOCs, please seek advice and follow instructions from healthcare professionals in administering specific HOCs. Considering the menstrual cycle as a 28-day cycle, HOCs are available in packages of 21, 28, or 91 tablets. These pills have typically undergone unit dose optimisation so that they follow the administration pattern of once daily, every day or almost every day on
11817-469: The penis exiting from anal intercourse ) where sperm can be deposited near the entrance to the vagina and can travel along the vagina's lubricating fluids. Abstinence-only sex education does not reduce teenage pregnancy . Teen pregnancy rates and STI rates are generally the same or higher in states where students are given abstinence-only education, as compared with comprehensive sex education . Some authorities recommend that those using abstinence as
11934-402: The pulse frequency of gonadotropin-releasing hormone (GnRH) release by the hypothalamus , which decreases the secretion of FSH and greatly decreases the secretion of LH by the anterior pituitary . Decreased levels of FSH inhibit follicular development, preventing an increase in estradiol levels. Progestogen negative feedback and the lack of estrogen positive feedback on LH secretion prevent
12051-462: The reproductive system, but these have not been shown to contribute to their contraceptive efficacy: Insufficient evidence exists on whether changes in the endometrium could actually prevent implantation. The primary mechanisms of action are so effective that the possibility of fertilization during COCP use is very small. Since pregnancy occurs despite endometrial changes when the primary mechanisms of action fail, endometrial changes are unlikely to play
12168-466: The risk is less than that of pregnancy. After stopping or removing many methods of birth control, including oral contraceptives, IUDs, implants and injections, the rate of pregnancy during the subsequent year is the same as for those who used no birth control. For individuals with specific health problems, certain forms of birth control may require further investigations. For women who are otherwise healthy, many methods of birth control should not require
12285-602: The ruins of Dudley Castle in England, and are dated back to 1640. They were made of animal gut, and were most likely used to prevent the spread of sexually transmitted infections during the English Civil War . Casanova , living in 18th-century Italy, described the use of a lambskin covering to prevent pregnancy; however, condoms only became widely available in the 20th century. Etynodiol diacetate Etynodiol diacetate , or ethynodiol diacetate , sold under
12402-626: The safety of birth control methods among women with specific medical conditions. The most effective methods of birth control are sterilization by means of vasectomy in males and tubal ligation in females, intrauterine devices (IUDs), and implantable birth control . This is followed by a number of hormone-based methods including contraceptive pills , patches , vaginal rings , and injections . Less effective methods include physical barriers such as condoms , diaphragms and birth control sponges and fertility awareness methods . The least effective methods are spermicides and withdrawal by
12519-495: The secretion of FSH, which inhibits follicular development and helps prevent ovulation. Another primary mechanism of action of all progestogen-containing contraceptives is inhibition of sperm penetration through the cervix into the upper genital tract ( uterus and fallopian tubes ) by decreasing the water content and increasing the viscosity of the cervical mucus . The estrogen and progestogen in COCPs have other effects on
12636-441: The synthetic form of progesterone , as the only active pharmaceutical ingredient in the formulation. In the US, drospirenone and norethindrone are the most commonly used compounds in formulations. Combined oral contraceptives ( COCs ) are commonly classified into generations, referring to their order of development in history. This discussion may also help identify some key features in a variety of products. According to EMA ,
12753-418: The third and fourth generation. Oestrogen ingredients: estradiol , ethinylestradiol , estetrol . 1st generation progestin: norethindrone acetate , ethynodiol diacetate , lynestrenol , norethynodrel . 2nd generation progestin: levonorgestrel , dl-norgestrel . 3rd generation progestin: norgestimate , gestodene , desogestrel . Hormonal oral contraceptives (HOCs) interact with hormonal changes in
12870-433: The unopposed estrogen, women with PCOS are at higher risk for endometrial cancer. To reduce the risk of endometrial cancer, it is often recommended that women with PCOS who do not desire pregnancy take hormonal contraceptives to prevent the effects of unopposed estrogen. Both COCPs and progestin-only methods are recommended. It is the progestin component of COCPs that protects the endometrium from hyperplasia, and thus reduces
12987-506: The use of modern birth control, is one of the most cost-effective health interventions. For every dollar spent, the United Nations estimates that two to six dollars are saved. These cost savings are related to preventing unplanned pregnancies and decreasing the spread of sexually transmitted illnesses. While all methods are beneficial financially, the use of copper IUDs resulted in the greatest savings. The total medical cost for
13104-406: The user's adherence to taking the pills. Combined hormonal contraceptives are associated with a slightly increased risk of venous and arterial blood clots . Venous clots, on average, increase from 2.8 to 9.8 per 10,000 women years which is still less than that associated with pregnancy. Due to this risk, they are not recommended in women over 35 years of age who continue to smoke. Due to
13221-494: The uterus (less than 0.7%). A previous model of the intrauterine device (the Dalkon shield ) was associated with an increased risk of pelvic inflammatory disease ; however, the risk is not affected with current models in those without sexually transmitted infections around the time of insertion. IUDs appear to decrease the risk of ovarian cancer . Two broad categories exist, surgical and non-surgical. Surgical sterilization
13338-415: The uterus. They are one form of long-acting reversible contraception which are the most effective types of reversible birth control. Failure rates with the copper IUD is about 0.8% while the levonorgestrel IUD has a failure rates of 0.2% in the first year of use. Among types of birth control, they, along with birth control implants, result in the greatest satisfaction among users. As of 2007 , IUDs are
13455-433: The vaginal ring may reduce the risk of breast tenderness, nausea , and headache associated with higher dose estrogen products. Progestin-only pills, injections and intrauterine devices are not associated with an increased risk of blood clots and may be used by women with a history of blood clots in their veins. In those with a history of arterial blood clots, non-hormonal birth control or a progestin-only method other than
13572-598: Was a catalyst for the sexual revolution . Hormonal oral contraceptives are preventive medications taken orally to avoid pregnancy in sexually active active females by manipulating their sex hormones . The first oral contraceptive was approved by the FDA and sold to the market in 1960. There are two types of hormonal oral contraceptives, namely Combined Oral Contraceptives and Progesterone Only Pills. Oral contraceptives, be it combined or progesterone-only, can effectively prevent pregnancy by regulating hormonal changes in
13689-467: Was worth more than its weight in silver and, by late antiquity, it was fully extinct. Most methods of birth control used in antiquity were probably ineffective. The ancient Greek philosopher Aristotle ( c. 384–322 BC) recommended applying cedar oil to the womb before intercourse, a method which was probably only effective on occasion. A Hippocratic text On the Nature of Women recommended that
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