Ideal contraceptive Pill over the ages??

Q. 10 : The following guidelines   may be of help to the readers for initial selection of most suitable brand for the contraceptive seekers. The considerations one has to follow are 1) her age 2)    no of Pill free days, 3) kind of progesterone and 4) weight of ethinyl oestradiol.  Therefore depending upon the indication and age of woman OCP is selected on individualized basis as shown below. I hope, such a policy will be helpful   in choosing   the best OC formulation with minimal discontinuation rate.  Basically as these are hormone containg pills and many a women if benefitted will continue such prescribed drugs for years together without the knowledge of medical practioner or subsequent follow up with first prescriber so great caution is worthy  . It is   generally recommended to use   the lowest effective dose.  It is also worth remembering that as women ages   there are different   issues both contraceptives and noncontraceptive issues that affect   proper   selection of an OC formulation.

Q. 11 Ideal Pill for New  start  otherwise Healthy    women

A)                   Adolescents : The general principles :-- There is a medical temptation to select brands containg  very low dose of EE in such tender age . But we don’t do that.  Why not ethinyl oestradiol with 20 mcg (Loette) or 15 mcg (Minesse-Wyeth) or say 25 mcg EE which are available abroad ?? The reason for not using 15 mcg or 20 mcg EE as initial choice in teenagers is that initiating   with such   lowest dose 20 ug , however attractive seems to be but in practice  the first choice brand   EE OCPs  in adolescents will be those with 30 mcg EE( Novelon, I-Con, Ovral-L, Arpan, apsara, Ovipauz-L ) and drospirenone containg Progesterone with 30 mcg EE  OCPs like  Crisanta, Yasmin, Dronis-30, Padimini, etc) . These COC are unlikely to be associated    BTB (midmenstrual bleeding). By contrast those OCP containg 15/ 20 mcg if started as first start COC in this young age who lead a very active life     eventually discontinuation of OCP  as such low oestrgen containg pills may  cause BTB and Hypomenorrhoea . In this population starting with a 25   or 30 ug EE OC may be associated seem more rational .Such OCP will have better   bleeding control   and ultimately better compliance. However the biphasic or monophasic   20 ug OCs(Femilon, )  with shortened pill free   intervals are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          associated with improved  bleeding    control  and may    be a good   option  to consider. Minesse pack is of 28 tab 24 active pills with 4 dummy (inactive pills)  is not suitable as it contains too little EE.(15 mcg) .

Q. 12: What will be the  first choice of COC where primary  indication is Dysmenorrhea:  Ans:   In young adults   who lead an active life besides controlling dysmenorrhea we have t keep in mind that bleeding    control if of essence. All OC brands  will  show benefit  in regard to dysmenorhoea be it  25 and 30 ug  OCs  may have better  bleeding  control than  traditional 20 ug OCs with a 7 day pill free  interval. Reviews have   shown   that OCs   with levonorgestrel have good bleeding control. If theta is clinical suspicion of minimal pelvic endometriosos then such girls oi even young women may be offered Dienogest containg OCP like Oesroplus.

Q. 13: What will be the  first choice of COC where primary symptom r indication is Acne   androgenic problems  Unmarried young women &  Adolescents: In such women  OCPs are often   used who are not  at risk for pregnancy  because  to achieve  of the many    non  contraceptive    benefits e g : . All OCPs   brands will exhibit some benefit but  35 mcg EE containg OCP  Diane-35/ Ginette -35 / Harmoni/ My Pill/ Carpel (rips)  , (at abroad ortho Tri  Cyclen is approved   by the Food  and Drug   administration to treat acne   vulgaris) . It is believed high dose of EE in Ginette 35/My Pill will increase SHBG from liver and hopefully will decrease serum free Testosterone. Thereby acne and hair growth will decrease.  If symptoms are  severe  or continue to be a problem  while on an Cyproterone containg Pills  then some other OCP   one may switch over to   OCP  with   formulation  containing  a low   androgenic  progestin desogestrel .Such brands with desogestrel are Intimacy-plus-3, Femilon) or Acne is exacerbated on OC switch    to OC with Norgestimate DSG or DRSP    ortho Tri Cyclenis FDA    approved to treat acne vulgaris. In case such unmarried young women are  at risk of STD or HIV   exposure   need additional protection and   should use  condoms and OCs . Gestodene (Femovan-Bayers- GSD 75 mg, &EE 30 mcg : cost Rs 180/-)  is biologically active in its native form.

Q.14.   What are the improved metabolic parameters seen with this new generation of progestogens? Ans:- improvement of   Among the improvements in metabolic parameters seen with this new generation of progestogens are a lack of impact on blood pressure, a balanced effect on coagulation, and a reduced impact on carbohydrate metabolism compared with earlier, higher-dose formulations. The new pills also seem to produce no negative effects on lipid and lipoprotein biosynthesis, and perhaps even improve the ratio of low-density lipoprotein to high-density lipoprotein. Acne    androgenic problems all OCs  show benefit Consider low androgenic    progestin OCs    if severe or if nonresponsive  to other  OCs   Ortho  Tri cyclen is FDA   approved  to treat   acne vulgaris.