Ideal woman & ideal Oral Pill -Its not a myth either

, 16:-What is the most safe OCP – the i.e. first choice COC for Early   reproductive Years in married women where the primary indication is contraception    :Ans:- Initial choice will be 20 , 25  ug EE OCs .  Admitting the fact that young women may  have increased bleeding problems on 20 ug  OCPs  with a  traditional    7 day pill free  interval   or a  25 ug  EE OCP but we should keep in mind that LNG containg pills   may result in better bleeding  control in contrast to Cyproterone, Desogestrel, Drospirenone , Gestodene (Femovan brand) containg Pills.

 LNG containg COC will  have acceptable   bleeding   control and will hopefully continue the pills after proper counseling. NSAID and or Tranexamic acid may be supplemented if BTB occurs at all or she can consume two pills per days on the days of BTB for two-three months provided1) BTB do not respond to Tx acid & NSAID and 2)  USG reveals no abnormality in the form of polyps .In such an even she has to  consume two packs for every 40-Days for two months .Later she can switch over 21 days pack.  Reviews have shown levonorgestrel  containing   OCs    to have good   bleeding  control .

Ideal COC in  Late    reproductive Years??  Ans: The    first choice menorrhagia is a problem: All OCPs show will exhibit some   benefit.  Initially start with 20-25 ug EE OCs at this age . But if   

Menorrhagia is not well controlled  with low dosed OCP and it remains a  problem with  first choice  OCP then one should  switch over to   OCP with  levonorgestrel ( like Mala-D,N, Ecroz, Ovipauz-L,  or Ovral-L one with    lower EE  dose( 20 mcg is Femilon) . Switching to pill with higher   progestin   to estrogen    ratio results   in less endometrial stimulation    and may result   in less menstrual   bleeding .

Bleeding problems all  COCs will exhibit    some  benefit if consumed properly and there is no organic pathology in uterus or in system (hypothyroidism, ITP, HTN) . . If  midcycle  bleeding and spotting   is a problem  while on OC  consider switching to an CO with stronger     progestin such as one  with levonorgestrel or consider   switching  to a higher EE dose  OC Estrogen increases   endometrial    growth and may  improve    bleeding control In   some instances  switching to   a   lower EE done   OC may be   effective   because   it lowers   endometrial  stimulation  which results    in less endometrial     tissue and less bleeding.

Right selection of COC in relatively elderly women:  > 35 yrs :-  We are aware that a  perfectly healthy woman   can safely continue the choiced COC upto the age of 45 yers keeping a gap of 1 yers after 7 yrs of continued use(my suggestion).  .But problem arises in case an a) relatively elderly woman including premenopausal woman is a smoker but < 35 yrs or b) smokers less than 5 cigarettes per day > 35 yrs of age  c) or having mild Hypertension: if any one of  such coexistent abnormality is associated the  wisest  choice will be  OCP with 20 mcg of EE( Loette, Femilon, Ovuloc, Intimacy plus 2, Yasmin, Yaz, Crisanta-LS= all however contain Drospirenone except Loette) and not high   dose EE containg Pills and that too for 2-3 yrs only.

  . What about high dosed of OCP?? Because of the higher   potency of EE i.e.   , OCPs   containing 30 / 35 ug EE age not ideal as first choice COC for such relatively elderly women. However, given choice, I shall vouch strongly for POPs.) minipills(oestrogen free pills)  or second generation POP Minikare -28 tab containg Lynesternol – 500 mcg -)  . There are other second generation POP which are relatively safe for women with mild HTN, DM & CVS diseases but unfortunately unavailable in India, Brand names are Micronor, Microoval, Femiluen& neogest .Such POPO are excellent options for smokers, those who can’t tolerate COC for nausea, mild DM  obese women and those who suffer from migraines as well.