Family planning in India is based on efforts largely sponsored by the Indian government. India adds up to 1000000 people to its population every 20 days. Low female literacy level is hampering the use of contraception in India. Awareness of contraception is universal among married women in India. They have a significant problem in the choice of contraception. Oral contraceptives also known as ipill, is the most preferred contraception among females.

Oral Contraceptive pills:

Oral contraceptives are indications that prevent pregnancy. They are one method of birth control. Oral contraception are hormonal preparations that may contain combinations of hormones oestrogen and progesterone – two female sex hormone.

Mode of action:

Combination of oestrogen and progesterone work by preventing ovulation that means they prevent release of eggs from the ovaries. They also change the living of uterus (womb) to prevent implantation from developing and change the mucan at the cervix. Cervix is lower part or opening of uterus entering. It has its effect on the motility and secretion of the fallopian tubes.

It has 99% efficacy if taken in proper dose oestrogen inhibits the secretion of FSH via negative feeback mechanism on the antipitutary and then support development of ovarian follicle. Progesterone inhibits the secretion of LH and thus prevents ovulation oestrogen and progesterone.

Types of Pills:

• Monophasic Pills: Pill contains a fixed amount of oestrogen and progesterone.
• Biphasic Pills: Each tablet contains a fixed amount of oestrogen but amount of proestrone increases in the second of half of cycles.
• Triphasic Pills: Amount of oestrogen may be fixed or variable while the amount of progesterone oestrogen most commonly used is Ethinyl estradiol. Although a few contain oestrol progesterone may be non ethylstyrene; Levonorgestrel, estradiol or gestodene. Oestrogen content is generally 20-50ug of Ethinyl estradiol or its equivalent. The lowest dose of oestrogen and prosterogen is chosen that is well tolerated and good cycle control.
• The Progesterone Only Pill: It includes non ethinyl Levonorgestrel or estradiol. To be taken daily.
• Saheli: This includes ormeloxifene, is a selective oestrogen receptor modulator (SERM). This is taken once a week.
• Post Coital Pill:Iit is emergency contraception levonorgestrel alone 150 mg usually combined with oestrogen. If taken within 72 hrs of unprotected intercourse, repeat after.

Beneficial effects:

• The combined pill markedly decreases the menstrual symptoms such as irregular periods and inter-menstrual bleeding.
• Iron deficiency anaemia and premenstrual tension is reduces
• It is helpful in benign breast diseases, uterine fibroids and functional cysts of the ovaries, endometriosis, ectopic pregnancy, PID, increase bone density have been reported, reduce rheumatoid arthritis. Athletes may be prescribed OCO without any loss of performance. Additional advantage is protection against bone loss.

Common adverse effects:

• Nausea
• Vomiting
• Stomach cramps or bloating
• Diarrhoea
• Constipation
• Loss or gain of appetite
• Weight gain due to fluid retention or an anabolic effect
• Brown or black patches
• Acne
• Hair growth
• Bleeding or spotting between menstrual periods, break through bleeding
• Change in menstrual flow
• Breast tenderness, enlargement or discharge.

If you are planning the use of oral contraceptive pills, it is recommended that you consult a gynaecologist who knows your medical history. She or he will be best to advice on the best choice and brand for contraception.