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Affected by broad-spectrum antibiotics, the herb Hypericum (St.Johns Wort) and some anti-epileptics, also vomiting or diarrhoea. The Combined Oral Contraceptive Pill (COCP), often referred to as "the Pill", is a combination of an estrogen (oestrogen) and a progestin (progestogen), taken by mouth to inhibit normal fertility.
In 1939, Russell Marker, a professor of organic chemistry at Pennsylvania State University, developed a method of synthesizing progesterone from plant steroid sapogenins, initially using sarsapogenin from sarsaparilla which proved too expensive.
In early 1951, reproductive physiologist Gregory Pincus, a leader in hormone research and co-founder of the Worcester Foundation for Experimental Biology (WFEB) in Shrewsbury, Massachusetts, first met American birth control movement founder Margaret Sanger at a Manhattan dinner hosted by Abraham Stone, medical director and vice president of Planned Parenthood (PPFA), who helped Pincus obtain a small grant from PPFA to begin hormonal contraceptive research.
In March 1952, Sanger wrote a brief note mentioning Pincus' research to her longtime friend and supporter, suffragist and philanthropist Katharine Dexter McCormick, who visited the WFEB and its co-founder and old friend Hudson Hoagland in June 1952 to learn about contraceptive research there. Pincus and McCormick enlisted Harvard clinical professor of gynecology John Rock, chief of gynecology at the Free Hospital for Women and an expert in the treatment of infertility, to lead clinical research with women.
Pincus asked his contacts at pharmaceutical companies to send him chemical compounds with progestogenic activity.
Chemists Carl Djerassi, Luis Miramontes, and George Rosenkranz at Syntex in Mexico City had synthesized the first orally highly active progestin norethindrone in 1951. In December 1954, Rock began the first studies of the ovulation-suppressing potential of 5 – 50 mg doses of the three oral progestins for three months (for 21 days per cycle — days 5 – 25 followed by pill-free days to produce withdrawal bleeding) in fifty of his infertility patients in Brookline, Massachusetts.
Norethynodrel (and norethindrone) were subsequently discovered to be contaminated with a small percentage of the estrogen mestranol (an intermediate in their synthesis), with the norethynodrel in Rock's 1954-5 study containing 4-7% mestranol. The first contraceptive trial of Enovid led by Edris Rice-Wray began in April 1956 in Rio Piedras, Puerto Rico.[31][32][33] A second contraceptive trial of Enovid (and norethindrone) led by Edward T. On June 10, 1957, the FDA approved Enovid 10 mg (9.85 mg norethynodrel and 150 µg mestranol) for menstrual disorders based on data from its use by more than 600 women.
Although FDA-approved for contraceptive use, Searle never marketed Enovid 10 mg as a contraceptive. Although the FDA approved the first oral contraceptive in 1960, contraceptives were not available to married women in all states until Griswold v. On December 28, 1967, the Neuwirth Law legalized contraception in France, including the pill.[50] The pill is the most popular form of contraception in France, especially among young women. In Japan, lobbying from the Japan Medical Association prevented the Pill from being approved for nearly 40 years.
The Pill was approved for use in September 1999; the Pill prescription guidelines the government endorsed require Pill users to visit a doctor every three months for pelvic examinations and undergo tests for sexually transmitted diseases and uterine cancer.
The purpose of the placebo pills is that the user can take a pill on every day of her menstrual cycle, remaining in this daily habit even during the week without hormones. Failure to take pills during the placebo week has no effect on the effectiveness of the pill provided that daily ingestion of active pills is resumed at the end of the week.
The presence of placebo pills is thought to be comforting, as menstruation is a physical confirmation of not being pregnant. If the pill formulation is monophasic, it is possible to skip menstruation and still remain protected against conception by skipping the placebo pills and starting directly with the next packet.
Starting in 2003, women have also been able to use a three-month version of the Pill.[54] Similar to the effect of using a constant-dosage formulation and skipping the placebo weeks for three months, Seasonale gives the benefit of less frequent periods, at the potential drawback of breakthrough bleeding.
A version of the combined pill has also been packaged to completely eliminate placebo pills and withdrawal bleeds. The typical use pregnancy rate among COCP users varies depending on the population being studied, ranging from 2-8% per year.
For instance, someone using oral forms of hormonal birth control might be given incorrect information by a health care provider as to the frequency of intake, or by mistake not take the pill one day, or simply not bother to go to the pharmacy on time to renew the prescription. COCPs provide effective contraception from the very first pill if started within five days of the beginning of the menstrual cycle (within five days of the first day of menstruation).
Combined oral contraceptive pills were developed to prevent ovulation by progestogenic and estrogenic suppression of gonadotropin release.
Progestagen negative feedback decreases the pulse frequency of gonadotropin-releasing hormone (GnRH) release by the hypothalamus, which decreases the release of follicle-stimulating hormone (FSH) and greatly decreases the release of luteinizing hormone (LH) by the anterior pituitary. Estrogen was originally included in oral contraceptives for better cycle control (to stabilize the endometrium and thereby reduce the incidence of breakthrough bleeding), but was also found to inhibit follicular development and help prevent ovulation.
Some drugs reduce the effect of the Pill and can cause breakthrough bleeding, or increased chance of pregnancy.
The traditional medicinal herb St John's Wort has also been implicated due to its upregulation of the P450 system in the liver.
Many clinicians consider the public perception of weight gain on the Pill to be inaccurate and dangerous. Current medical reference textbooks on contraception[20] and major organizations such as the American ACOG,[70] the WHO,[71] and the United Kingdom's RCOG[72] agree that current evidence indicates low-dose oral contraceptives are unlikely to increase the risk of depression, and unlikely to worsen the condition in women who are currently depressed.



However, a recent study found that women taking the oral contraceptive pill are almost twice as likely to be depressed than those not on the Pill. Other possible side effects are: vaginal discharge, changes in menstrual flow, breakthrough bleeding, nausea, vomiting, headaches, changes in the breasts, changes in blood pressure, loss of scalp hair, skin problems and skin improvements.
Oral contraceptives may influence coagulation, increasing the risk of deep venous thrombosis (DVT) and pulmonary embolism, stroke and myocardial infarction (heart attack). The large 1996 collaborative reanalysis of individual data on over 150,000 women in 54 studies of breast cancer found that: "The results provide strong evidence for two main conclusions.
The hormones in "the Pill" can be used to treat some medical conditions, such as polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, anemia related to menstruation, and painful menstruation (dysmenorrhea). Combined oral contraceptive use reduces the risk of ovarian cancer by 40% and the risk of endometrial cancer by 50% compared to never users. While the Pill was approved by the FDA in the early 1960s, its use was limited to married women. Claudia Goldin, among others, argue that this new contraceptive technology was a key player in forming women's modern economic role, in that it prolonged the age at which women first married allowing them to invest in education and other forms of human capital as well as generally become more career-oriented. Because the Pill was so effective, and soon so widespread, it also heightened the debate about the moral and health consequences of pre-marital sex and promiscuity. A backlash against oral contraceptives occurred in the early and mid-1970s, when reports and speculations appeared that linked the use of the Pill to breast cancer. At the same time, society was beginning to take note of the impact of the Pill on traditional gender roles.
Combined oral contraceptives were developed by Gregory Goodwin Pincus, John Rock, and Min Chueh Chang.[1] They were first approved for contraceptive use in the United States in 1960, and are still a popular form of birth control. After three years of extensive botanical research he discovered a much better starting material, the aglycone moiety of the saponin, diosgenin, from inedible Mexican wild yams found in the jungles of Veracruz near Orizaba.
Research started on April 25, 1951 with reproductive physiologist Min Chueh Chang repeating and extending the 1937 experiments of Makepeace et al.
At a scientific conference in 1952, Pincus and Rock, who had known each other for many years, discovered they were using similar approaches to achieve opposite goals.
This produced the same encouraging 15% pregnancy rate during the following four months without the troubling amenorrhea of the previous continuous estrogen and progesterone regimen.
5 mg doses of norethindrone or norethynodrel and all doses of norethandrolone suppressed ovulation but caused breakthrough bleeding, but 10 mg and higher doses of norethindrone or norethynodrel suppressed ovulation without breakthrough bleeding and led to a 14% pregnancy rate in the following five months. When further purifying norethynodrel to contain less than 1% mestranol led to breakthrough bleeding, it was decided to intentionally incorporate 2.2% mestranol, a percentage that was not associated with breakthrough bleeding, in the first contraceptive trials in women in 1956. Numerous additional contraceptive trials showed Enovid at 10, 5, and 2.5 mg doses to be highly effective. Eight months later, on February 15, 1961, the FDA approved Enovid 5 mg for contraceptive use. Connecticut in 1965 and were not available to unmarried women in all states until Eisenstadt v. In the United States and Europe, in contrast, an annual or bi-annual clinic visit is standard for Pill users. If one or more tablets are forgotten for more than 12 hours, contraceptive protection will be reduced.[53] Most brands of combined pills are packaged in one of two different packet sizes, with days marked off for a 28 day cycle. The 28-day pill package also simulates the average menstrual cycle, though the hormonal events during a pill cycle are completely different from those of a normal ovulatory menstrual cycle, and the bleeding is triggered by different hormonal cues. Attempting this with bi- or tri-phasic pill formulations carries an increased risk of breakthrough bleeding and may be undesirable. Seasonique is another version in which the placebo week every three months is replaced with a week of low-dose estrogen. Perfect use or method effectiveness rates only include people who take the pills consistently and correctly. If started at any other time in the menstrual cycle, COCPs provide effective contraception only after 7 consecutive days use of active pills, so a backup method of contraception must be used until active pills have been taken for 7 consecutive days.
Decreased levels of FSH inhibit follicular development, preventing an increase in estradiol levels.
Because neither the woman (who uses the Pill) nor her partner need take any special action before or during intercourse, it makes birth control "invisible" and sex spontaneous, more natural, or both.
Professor Jayashri Kulkarni from the School of Psychology, Psychiatry and Psychological Medicine at Monash University conducted a study with 62 women. The insert included with each pill packet usually has a more extensive list of recognized side effects. The main division is between combined oral contraceptive pills, containing both estrogen and progestins and progestin only pills.


First, while women are taking combined oral contraceptives and in the 10 years after stopping there is a small increase in the relative risk of having breast cancer diagnosed. In addition, oral contraceptives are often prescribed as medication for mild or moderate acne.[81] The pill can also induce menstruation on a regular schedule for women bothered by irregular menstrual cycles and certain disorders where there is dysfunctional uterine bleeding.
The risk reduction increases with duration of use, with an 80% reduction in risk for both ovarian and endometrial cancer with use for more than 10 years. It was only in the early 1970s, when the "age of majority" legally changed from 21 to 18, that the Pill truly became widespread.
Until then, many women in the feminist movement had hailed the Pill as an "equalizer" that had given them the same sexual freedom as men had traditionally enjoyed. Women now did not have to choose between a relationship and a career; singer Loretta Lynn commented on this in her 1974 album with a song entitled "The Pill", which told the story of a married woman's use of the drug to liberate herself from her traditional role as wife and mother. Unable to interest his research sponsor Parke-Davis in the commercial potential of synthesizing progesterone from Mexican yams, Marker left Penn State and in 1944 co-founded Syntex with two partners in Mexico City before leaving Syntex a year later.
On July 23, 1959, Searle filed a supplemental application to add contraception as an approved indication for 10, 5 and 2.5 mg doses of Enovid.
The British Family Planning Association (FPA) through its clinics was then the primary provider of family planning services in Britain and only provided contraceptives that were on its Approved List of Contraceptives (established in 1934). For the 21-pill packet, a pill is consumed daily for three weeks, followed by a week of no pills.
Breakthrough bleeding also becomes a more common side effect as a woman attempts to go longer periods of time between menstrual periods. Actual use, or typical use effectiveness rates are of all COCP users, including those who take the pills incorrectly, inconsistently, or both. Progestagen negative feedback and the lack of estrogen positive feedback on LH release prevent a mid-cycle LH surge. John Bancroft (a senior research fellow at the Kinsey Institute at Indiana University) estimates that one in four women on the pill experience some negative sexual effect. In the study depression symptom scores between users and non-users of combined oral contraceptives were compared. Combined oral contraceptive pills also come in varying types, including varying doses of estrogen, and whether the dose of estrogen or progestin changes from week to week. Second, there is no significant excess risk of having breast cancer diagnosed 10 or more years after stopping use. As its use diffused to even those young and non-married women, it generated an enormous social impact. For a couple using the Pill, intercourse became purely an expression of love, or a means of physical pleasure, or both; but it was no longer a means of reproduction. The FDA refused to consider the application until Searle agreed to withdraw the lower dosage forms from the application. These effects may include a decreased frequency of sexual thoughts, increased difficulty in becoming aroused, or decreased lubrication, which can make sex painful. In the first place, it was far more effective than any previous method of birth control, giving women unprecedented control over their fertility. While this was true of previous contraceptives, their relatively high failure rates and their less widespread use failed to emphasize this distinction as clearly as did the Pill.
A woman on the pill will have a withdrawal bleed sometime during the placebo week, and is still protected from pregnancy during this week.
Women in the survey were aged over 18 years, were not pregnant or lactating, had no history of clinical depression and had not used anti-depressant medication for the previous 12 months. Its use was separate from intercourse, requiring no special preparations at the time of sexual activity that might interfere with spontaneity or sensation, and the choice to take the Pill was a private one. The spread of oral contraceptive use thus led many religious figures and institutions to debate the proper role of sexuality and its relationship to procreation. This combination of factors served to make the Pill immensely popular within a few years of its introduction.
The Roman Catholic Church in particular, after studying the phenomenon of oral contraceptives, re-emphasized traditional Catholic teaching on birth control in the 1968 papal encyclical Humanae Vitae.



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