Progress And Application Of Short-acting Combined Oral Contraceptive Pill

Short-acting combined oral contraceptive pill (abbreviated as COC) are steroid hormonal contraceptive methods with a wide variety of products, a long time to market, rapid progress, and widespread use, and their use in China is increasing. In order to enable medical staff to better understand the performance characteristics of various COC products, to help clients choose appropriate products informedly, and to ensure medication safety, this article summarizes the progress and application of COC for reference by service providers.

Progress

At present, the short-acting combined oral contraceptive pill widely used at home and abroad mainly contain ethinyl estradiol. The first marketed short-acting combined oral contraceptive pill, called Enovid, contains ethinyl estradiol methyl ether equivalent to 150 μg of ethinyl estradiol. Because the side effects and thrombotic risk of COC are more related to estrogen, the dose of estrogen in COC continues to decrease without affecting contraceptive efficacy. In the 1960s and 1970s, the dose of ethinyl estradiol in most COCs in the world was 50 μg, and by the end of the 1980s, 80% of COCs contained ethinyl estradiol below 50 μg. The dose of ethinyl estradiol in the vast majority of COCs currently in use is 20-35 μg.

China began to develop short-acting combined oral contraceptive pill in the 1970s. At first, it was mainly imitation, but in clinical trials, it was found that the side effects were relatively large, and then it turned to the development of reduced-dose COCs that reduce the doses of estrogen and progesterone at the same time. The dose of ethinyl estradiol in 1/4 dose of compound norethisterone, 1/4 dose of compound megestrol and compound ethinyl estradiol tablets developed and produced in China is 35μg, and this dose has been used until now. In addition, 20 μg of ethinyl estradiol COC products have been registered and marketed in China, one is compound desogestrel, and the other is drospirenone and ethinyl estradiol tablets II. The limited evidence available suggests that lower-dose ethinylestradiol products are not associated with increased contraceptive failure rates and safety, but that changes in bleeding patterns are more pronounced in the first few months of use than with the low-dose control products.

Clinical application

1. COC is the preferred contraceptive method for women who need contraception in the short term

In recent years, the use of long-acting and reversible contraceptive methods has been advocated internationally for women who have no childbearing plans in the near future (usually 2 years). Relatively speaking, women who have a family plan within 2 years, but do not want or should not become pregnant immediately, can be called the service target who needs contraception in the short term, and COC can be preferred. The reasons for using it as the preferred method are: firstly, COC has a good contraceptive effect, and secondly, its effect is reversible. Stopping short-acting combined oral contraceptive pill can enter the state of pregnancy preparation.

2. Strengthen the pre-use screening of COC

Since the listing of COC, its safety has always attracted much attention. The results of the numerous safety studies conducted to date show that the main health risks of COC that can be confirmed by the current international data are deep vein thrombosis, stroke and heart attack. In order to ensure the safety of medication to the greatest extent, most countries have listed the applicable levels of COC as level 3 and level 4 in the "Medical Standards for the Choice of Contraceptive Methods" formulated by WHO as screening items. Screening on a case-by-case basis during consultation. After the free provision of contraceptives was included in basic public health services, medical institutions became the main channel for distributing COCs, improving the feasibility of routine use of screening forms.

3. Help clients choose suitable COC products

As there are many types of short-acting combined oral contraceptive pill, helping clients choose suitable products is a necessary part of counseling services. As far as contraception is concerned, under the condition of persistence and correct use, various products can achieve high-efficiency contraception. According to the progress of COC introduced above, ultra-low-dose estrogen products can be recommended to clients who use COC for the first time, or clients who have concerns about estrogen and use products containing 30 μg ethinyl estradiol with obvious early pregnancy reactions.

Conclusion

There is no special requirement for COC users to regularly return to the clinic for physical or auxiliary examinations. By using telephone or new media to maintain regular interaction with service objects, the purpose of continuous service can be achieved, which is helpful to effectively improve the COC renewal rate.