Combined oral contraceptive pill (COCP)

Question 1

1) Name 2 of the 3 MoA of the COCP
2) How does the COCP prevent ovulation?

Answer 1

1) Preventing ovulation, thickening the cervical mucus (progesterone), inhibiting proliferation of the endometrium (progesterone)
2) Oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary, suppressing the release of GnRH, LH and FSH. Without the effects of LH and FSH, ovulation does not occur

Question 2

Monophasic and multiphasic pills are the 2 broad categories of COCP - how do these 2 types differ?

Answer 2

Monophasic pills contain the same amount of hormone in each pill, multiphasic pills contain varying amounts of hormone to match the normal cyclical hormonal changes more closely

Question 3

1) Different formulations of the COCP vary in which 2 aspects?
2) Name the type of progesterone used in 1 of the 2 NICE recommended 1st line COCP
3) Why are these 2 first line?

Answer 3

1) How much ethinyloestradiol they contain and the type of progesterone
2) Levonorgestrel or norethisterone first line (e.g. Microgynon or Leostrin)
3) Lower VTE risk

Question 4

1) COCPs containing what are considered first-line for premenstrual syndrome?
2) This type of progesterone has anti-mineralocorticoid and anti-androgen activity - name 2 symptoms this can improve
3) COCPs containing cyproterone acetate can be considered in the treatment of what?
4) What is the negative aspect of this pill?

Answer 4

1) Drospirenone
2) Bloating, water retention and mood changes
3) Acne and hirsutism
4) Higher VTE risk

Question 5

Name 3 side effects/risks of the COCP

Answer 5

• Unscheduled bleeding (first three months)
• Breast pain and tenderness
• Mood changes and depression
• Headaches
• Hypertension
• Venous thromboembolism
• Small increased risk of breast and cervical cancer (returns to normal ten years after stopping)
• Small increased risk of MI and stroke

Question 6

Name 3 benefits of the COCP

Answer 6

• Effective contraception
• Rapid return of fertility after stopping
• Improvement in premenstrual symptoms, menorrhagia and dysmenorrhoea
• Reduced risk of endometrial, ovarian and colon cancer
• Reduced risk of benign ovarian cysts

Question 7

Name 3 contraindications for the COCP

Answer 7

• Uncontrolled hypertension
• Migraine with aura (risk of stroke)
• History of VTE
• Aged > 35 and smoking > 15 cigarettes per day
• Major surgery with prolonged immobility
• Vascular disease or stroke
• IHD, cardiomyopathy or AF
• Liver cirrhosis and liver tumours
• SLE and antiphospholipid syndrome