Combined Hormonal Contraception (CHC)
Background
In the UK and USA, CHCs Contraception are the most common way to avoid getting pregnant. They are made up of a synthetic oestrogen (most often ethinyl estradiol, or EE) and a synthetic progestogen, which is a form of progesterone. They come in three different forms: the “pill,” a “contraceptive patch,” and a “contraceptive ring.”
How something works
By lowering LH and FSH levels in the hypothalamic-pituitary-ovarian pathway, CHCs stop ovulation. To stop ovulation, a CHC method must be used for seven active, nonstop days.
How Effective
Because they only work for a short time and depend on the person using them, CHCs are not as good at preventing pregnancy as LARC methods. The combined oral contraceptive pill (COC), the combined vaginal ring (CVR), and the combined transdermal patch (CTP) all work about the same, according to a Cochrane study.
Not recommended
A CHC might not be helpful for some women, like those who are overweight or who have health problems like migraines with aura.
Health Issues
Cancer risk of contraception
Endometrial and ovarian cancer: Endometrial and ovarian cancer risks go down when you use the COC. Women who have taken COC for 15 years have about half the risk of getting these cancers as women who have never taken it. There is a short-term benefit that gets weaker after stopping, but it continues to protect for decades.
Colorectal Cancer: People who drink COC now or recently have a lower chance of getting colorectal cancer.
Some other benefits:
Using cannabis has a lot of health benefits for women. Some women may be able to get rid of their acne with CHC methods.
Health risks
Vein thromboembolism (VTE): VTE is a little more common in people who use a CHC than in people who don’t. When the procedure is first used for a few months, the chance is higher. The chance of VTE is low, and it goes back to normal levels quickly (within weeks) after the method stops.
CVS (cardiovascular) disease and stroke: A very small rise in the chance of MI (myocardial infarction) and stroke has been found in some studies of COC users. People who use COC and smoke are more likely to have a MI, and people who use COC and get migraines with aura are more likely to have an ischemic stroke. Things like high blood pressure and being overweight affect the risk of developing vascular disease.
Breast Cancer
A large meta-analysis found that current COC users have a slightly higher risk of breast cancer (relative risk 1.24), but this risk is not connected to how long they have used COC, drops to the level of non-users within 10 years of stopping, and is not linked to a higher risk of dying from breast cancer.
Cervical cancer
A small rise in the risk of cervical cancer is linked to using CHC. This risk rises with longer use and falls with time after stopping.
Death Rates due to contraception
The RCGP (Royal College of General Practitioners) Oral Contraception Study found that using COCs regularly cut death rates from all causes by 12%. Other studies have shown that using COCs does not have an adverse effect on death rates.
Side effects of contraception
People who use CHC methods often report minor side effects, but not all of them have a clear cause-and-effect link. They can lead to high dropout rates, so women need to be told about them before the method is used. Most of the time, side effects go away after three months of use. Different contraception have different levels of effectiveness.
Up to 20% of COC users experience bleeding that wasn’t planned, but it usually goes away on its own over time. It is very important to rule out other reasons for the bleeding, like not taking your pills, having a STI, or being pregnant. Even though there is no proof that CHC methods cause weight gain, why do people stop using them? So it is important to address this problem before starting the treatment. Most of the time, breast pain and nausea get better with time. Hormones from outside the body, like oestrogen and progesterone, can cause hyper-pigmentation to develop on parts of the face that are exposed to the sun. Being in the sun is the cause of it. The main goal of control is to keep the plant out of the sun but switching to a method that doesn’t use hormones may be better. Talking to a doctor can help you choose the best contraception for you.
How Drugs Interact
Inducers of hepatic enzymes: Drugs that turn on liver enzymes may make CHCs less effective because they break down faster. People who have been using CHC for a long time should switch to an intrauterine method or another method that is unaffected by these drugs. People who take these drugs for less than two months should be extra careful during treatment and for the next 28 days. Rifampicin and rifabutin are very good at starting enzymes, so women who are taking them should be told to use a method of birth control that doesn’t interact with them.
Non-hepatic enzyme inducing antibiotics: According to WHOMEC, USMEC (US medical qualifying standards), and UKMEC (UK medical eligibility criteria for contraceptive use), non-enzyme-inducing antibiotics can be given with CHCs without any extra safety measures.
Lamotrigine: Taking CHC at the same time can lower the amount of this seizure medicine in your blood, which can make seizures happen more often. Serum levels of lamotrigine go up after stopping CHC and during the week without pills. This can make side effects worse and increase the chance of drug poisoning. When lamotrigine is mixed with sodium valproate, this action is not seen. Because of this, CHC mixed with lamotrigine alone is given a UKMEC Category 3.
Ulipristal Acetate (UPA): This emergency birth control stops progesterone from working, which could make birth control pills that contain progesterone less effective. People who use CHC should use extra birth control for 14 days after they use UPA.
Other drugs: Some weight loss drugs can make you throw up or have bad diarrhoea, which can make COCs less effective by making it harder for the body to absorb the drugs.
Combined oral contraceptives (COC)
About 25% of women in the UK take “the pill.” This medicine has been available in the UK and the USA for more than 50 years. COCs have different amounts of oestrogen and different types of progestogens. COCs can give the same amount of oestrogen and progesterone in each pill (called monophasic or set dosage pills), or the dose can change from pill to pill (called phasic pills). There is no proof that phasic tablets are better than set-dose pills. Most of the COCs used in the UK have a set amount of 20–35 microgram of EE and a progestogen, like levonorgestrel.
Administration: Usually, the COC regimen includes 21 active pills, one taken every day. After that, there is a 7-day pill-free period during which endometrial shedding causes a withdrawal bleed. This schedule was made to look like a “normal” menstrual cycle. However, it can be changed to include tricycling or constant CHC use without affecting the effectiveness of birth control or cutting down on the time without pills.
Advantages: The pros of COCs are that they are easy to find, don’t cost as much, and are cheaper than other CHC methods. COCs and CTPs both provide cycle control.
Drawbacks: It is common for all CHC treatments to end. The need to take a dose every day may make people not follow through.
“Natural” COCs : Qlaira® is a COC that contains dienogest (DNG) and estradiol valerate (E2V) in a continuous, four-dose schedule (26 active tablets and 2 control tablets). It is meant to mimic the normal changes in hormones that happen during the menstrual cycle, but there isn’t much proof that it works better than regular COCs. It costs more than other COCs and has a complicated schedule with four different limits for missed pills that could be hard to understand. Zoely® is a COC that only has one form. It contains 17β-estrodiol (hemihydrate) and nomegestrol acetate (NOMAC). It might not have as much of an effect on the breakdown of fats and carbohydrates as other COCs. It is taken all the time, with 24 active pills followed by 4 inactive pills. Withdrawal bleeding doesn’t happen very often. It costs more than a lot of well-known COCs.
Combined transdermal patch (CTP)
Combined patches that go on the skin, CTP is a matrix-shaped spot that covers 20 cm2. Every day, it makes 33.9 micrograms of EE and 203 micrograms of norelgestromin.
Administration of contraception
One patch is put on any dry skin area (except the breast) and changed every week for three weeks. One week after the third patch is taken off, there is a patch-free period during which withdrawal blood is often seen.
Advantages
Users of the CTP reported higher compliance rates than users of the COC in some studies. The CTP gives women who have trouble absorption because of intestinal problems an option because it doesn’t depend on the G system. There are many types of contraception, like pills and condoms.
Disadvantages of contraception
People who take CTP report more breast pain, sickness, vomiting, and irregular periods than people who take pills. It usually costs more than the COC.
Combined vaginal ring (CVR)
The cross-section of CVR is 4 mm, and its width is 54 mm. It is a flexible, clear ring that does not contain latex. Ethylene vinyl acetate copolymers and magnesium stearate make it up. It gives off 0.015 mg of ethinyl estradiol (EE) and 0.120 mg of etonogestrel (ENG). Contraception help prevent pregnancy.
Administration of Contraception
Someone puts one ring in the uterus and leaves it there for three weeks. Then it is stopped for seven days, which is usually when a withdrawal bleed happens. For physical activity as well as with tampons, it can be used. Birth control pills are a form of contraception taken daily.
Stored
Rings need to be kept in the fridge between 2 and 8 degrees Celsius until they are sent out. After that, they can stay at room temperature for up to 4 months.
Advantages of contraception
It’s possible that the CVR has better cycle control than the COC. Users report less nausea, acne, and mood changes compared to oral combination methods. This gives women who have trouble absorbing medicine another way to take it.
Disadvantages
Compared to other CHCs, CVR is linked to more vaginal flow and pain. Most of the time, CVRs cost more than COCs. Some places may limit how the gadget can be used because of limited storage space. Condoms are contraception used during sex to prevent pregnancy and STDs.
Information for CHC users
Beginning routines
Different contraception have different levels of effectiveness. If you are on day 5 of your period, you can start CHC treatments using EE without any extra safety measures. As long as the risk of pregnancy has been calculated and it is likely that the woman is not pregnant, CHCs can be started at any time during her period. If you start the process after day 5, you should either take extra steps or don’t do anything for 7 days (7-day rule). EE-containing CHC methods can be used as early as day 21 after giving birth (for women who are not breastfeeding) and as late as day 5 after an abortion, without any extra safety measures being needed. So, the seven-day rule is the same for both types of women. IUDs are long-term contraception placed in the uterus.
Advice if CHC has been incorrectly taken
Give help if CHC was taken in the wrong way. Take the missed pill as soon as possible and keep taking your other pills as planned if it’s more than 24 hours late. If only one pill is missing, you don’t need emergency birth control. If you miss two or more pills in a row, take the most recent missed pill first, then take the rest of the pills as planned. Use a condom until you’ve taken seven active pills in a row. Implants are small rods used as contraception placed under the skin of the arm.
Also, emergency contraception (EC) should be thought about if unsafe sexual activity (UPSI) happened during the pill-free time if the missed pills were in the first week (pills 1–7). If pills 15–21 are missed in the third week, the pill-free period should be skipped by ending the current pack and starting a new one the next day. CTP and CVR If the time between patches or rings is increased by 48 hours or if the patch or ring is taken off for 48 hours, no more defence is needed. More than 48 hours after removing a ring or patch (or a patch or ring-free time of more than 48 hours) calls for extra precautions with birth control and EC attention. Injections are another form of contraceptions given every 3 months.
Follow-up regarding Contraception
After three months of using the CHC method, women should be checked again to see how their blood pressure is doing and to deal with any problems or bad effects that come up. After that, they can give you a 12-month supply (3 months of CVR). As long as there are no safety concerns, women can use a CHC method until they are 50 years old. Patches are contraceptions worn on the skin and changed weekly.
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