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Apr 05 2016

Oral Contraception

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Produced By: Dr Lucas Luk, Dr Voon Hian Yan;
BM Version: Dr Faridah Hanim;
Edited By: Dr Harris N Suharjono, Dr Muniswaran Ganeshan

ORAL CONTRACEPTIVESoral contraceptives

Types:
A. Combined Oral Contraceptive Pill (COCP/’The Pill’)

  • – Contains both Estrogen and Progestogen hormones
  • – Examples: Yaz, Mercilon, Loette, Marvelon

B. Progesterone Only Pill (POP/’Mini-Pill’)

  • – Contains only Progestogen hormone
  • – Examples: Micronor, Norethindrone, Cerazette.

Disclaimer:
There are many types of oral contraceptives available, some of which are made available in government clinics and hospitals. It is important that you read carefully the drug information leaflet that is provided in the box of COCP/POP or ask your doctor or nurse should you have any questions. This patient information leaflet aims to address some common questions on oral contraceptives.

What are Oral Contraceptives (OCs) used for?
1. Prevent Pregnancy
2. Promote Regular Menstrual Bleeding

How & when does OCs work?
OCs prevents pregnancy through several ways. It prevents ovulation or the ‘eggs’ in your ovaries from developing. It may also prevent sperm from entering the uterus by making the mucus in your cervix thicker.

You have to take COCPs for 7 days before it is effective in preventing pregnancy. In POPs, it becomes effective after only 48 hours but it is important to take your POP pills at the same time daily.

How Effective are OCs?
85 out of 100 women who have regular sexual intercourse will get pregnant without contraception. If used correctly, oral contraceptive is one of the most effective methods of preventing pregnancy.

Can anyone use OCs?
Most women can. However, there is a small group of women who have risk factors such as heart disease, obesity, hypertension, diabetes, previous history of stroke, smokes regularly or have migraine with aura, who should consult their doctor first before taking it.

How should I start OCs?
Ideally, should be started from the 1st to 5th day of your menses. This way it is it offers protection from pregnancy immediately*. If you start the first pack anytime after the 5th day of your menses, additional contraception such as condoms should be used if you have sex within 7 days of starting the pill.

In the following cycles, the next pack of OC’s are started on the 8th day after completing the previous 21 pill pack. There is a 7 day ‘pill free’ period between packs. However, if it is a 28 pill OC pack, then continue with the next pack the next day after completing the previous pack.

What are the advantages of taking OCs?
Besides being a very effective contraception, it does not affect sexual pleasure, helps regulates menses and may provide relief from painful periods. It also decreases the risk of ovarian, endometrial and colorectal cancer.

What are the side effects of OCs?
The majority of women do not have any unpleasant side effects. A small of group of women may feel nauseated or boated. Some may complain of abdominal cramps, breast tenderness, headaches or having migraine.

*Consult your doctor or nurse if your symptoms become bothersome or you experience severe numbness/pain in your limbs, slurred speech or difficulty breathing.

Does OCs cause weight gain?
The answer is no. Research so far shows that there is no evidence of weight gain while taking OCs.

Does OCs increase the risk of Breast Cancer?
There has been no association between OCs and increased breast cancer risks in the general population. However, patients with history of breast cancer or who are genetically at risk should not take OCs.

Does OCs affect my chances of getting pregnant in the future?
The answer is no. The ability for a woman to get pregnant returns to normal once you stop taking the OCs.

* providing your normal cycle is more than 26 days

Can I take OCs while breastfeeding?
There is no conclusive evidence that OCs affect breast milk production once breastfeeding has been established. However, POPs is preferred while you are breastfeeding as it does not reduce breast milk production. It can be started from 28days or 4 weeks into your confinement. You can obtain your POPs from your clinic during your postnatal clinic visit scheduled at 4 weeks post delivery.

What if I am on other medications?
Effectiveness of OCs may be affected if you are taking other medications such as for epilepsy, HIV treatment or antibiotics. Likewise, certain medical conditions such as Inflammatory Bowel Disease and liver disease can render OCs less efficacious. So please let your doctor know if you are taking any medications concurrently or have any chronic medical condition.

What if I have vomiting or diarrhea?
Vomiting within 4 hours of consuming OCs may affect absorption and should be considered a ‘missed pill’. Severe diarrhea while on OCs should also be considered as a ‘missed ‘pills’. Please refer to the ‘Missed Pills’ rules.

What if I am fasting?
As long as you take it at the same time then it is alright. However, if the time of consumption has to be changed significantly then calculate the time difference and follow the ‘missed pills’ rules.

When is the best time of the day to take the OCs?
It is up to individual preference but it should be taken about the same time daily. Preferably, it should be taken when you are likely not to forget or when you are not ‘busy’ or in a ‘rush’. Don’t forget to bring your pills when you are travelling!

What is the difference between a 21 pill pack and the 28 pill pack?
All the tablets in a 21 pill pack are active pills that contain hormones. After completing the pack, you will break from taking OC pills for 7 days before you MUST start the next pack on the 8th day. It is very important that you do not forget to start the next OC pack on time.

In a 28 pill pack, there are 21 active tablets and 7 inactive pills for the last week. If you are taking this preparation, you need to start taking the next pack the next day after completing taking the previous pack. So there is no break in between OC packs. This preparation is to ensure you do not forget to take the next pack.

 


PIL PERANCANG

Jenis:
A. Pil kombinasi estrogen-progesteron (COCP/’The Pill’)

  • – Mengandungi hormon Estrogen dan Progestogen
  • – Contoh: Yaz, Mercilon, Loette, Marvelon

B. Pil progesteron sahaja (POP/’Mini-Pill’)

  • – Mengandungi hormon Progestogen
  • – Contoh: Micronor, Norethindrone, Cerazette.

Perhatian:
Terdapat pelbagai jenis pil perancang. Ada diantaranya boleh diperolehi dari klinik dan hospital kerajaan. Adalah penting untuk anda membaca arahan yang terdapat di dalam kotak pil perancang. Anda dinasihatkan berjumpa doktor atau jururawat sekiranya mempunyai sebarang kemusykilan.

Apakah kegunaan pil perancang?
1. Mencegah kehamilan

2. Mengatur kitaran haid

Bagaimana pil perancang berfungsi?
Pil perancang mencegah kehamilan melalui:
1. Mencegah ovulasi (pengeluaran telur dari ovari) setiap bulan.

2. Menyebabkan pangkal rahim menghasilkan lendir yang tebal supaya sperma tidak boleh memasuki rahim.

Pil kombinasi estrogen-progesteron (COCPs) mengambil masa 7 hari dan pil progesteron sahaja (POP) mengambil masa 48 jam sebelum berkesan untuk mencegah kehamilan.

Bagaimanakah keberkesanan pil perancang?
Jika pil perancang diambil setiap hari pada masa yang sama dan setiap pek baru bermula pada masa yang tetap, pil perancang adalah kaedah yang berkesan dalam mencegah kehamilan(99%)

Siapakah yang boleh menggunakan pil perancang?
Kebanyakan wanita boleh mengambil pil perancang. Walaubagaimanapun sekiranya anda mempunyai faktor risiko seperti penyakit jantung, darah tinggi, obesity, strok, merokok dan migrain, anda perlu mendapatkan nasihat doktor terlebih dahulu.

Bagaimana cara memulakan pil perancang?
Anda boleh memulakan pengambilan pil perancang di antara hari pertama hingga hari kelima kitaran haid.

Bagi pek 21 pil hormon, anda digalakkan untuk mengambil pil pada masa yang sama setiap hari selama 21 hari dan berehat selama 7 hari. Anda boleh memulakan pek baru selepas 7 hari berehat.

Bagi pek 28 pil hormon, ianya perlu diambil pada masa yang sama setiap hari selama 28 hari dan pek baru dimulakan pada esok hari.

Apakah manfaat penggunaan pil perancang?
Selain berfungsi untuk mencegah kehamilan, pil perancang boleh mengatur kitaran haid dan mengurangkan senggugut. Pil perancang juga boleh mengurangkan risiko kanser ovari, kanser rahim dan kanser usus.

Apakah kesan samping penggunaan pil perancang?
Pil perancang mungkin boleh menyebabkan loya, kembung perut, sakit dan tegang buah dada, sakit kepala dan migrain. Walaubagaimanapun kebanyakan wanita tidak mengalami kesan samping .

*Dapatkan nasihat doktor jika anda mengalami kesan samping yang teruk, kebas atau sakit betis dan sukar bernafas.

Adakah pil perancang menyebabkan pertambahan berat badan?
Kajian setakat ini menunjukkan pil perancang tidak menyababkan pertambahan berat badan.

Adakah pil perancang meningkatkan risiko kanser buah dada?
Tiada hubungan diantara pengambilan pil perancang dengan peningkatan risiko kanser buah dada dalam populasi umum. Sekiranya anda mempunyai sejarah kanser buah dada atau secara genetik mempunyai risiko kanser buah dada, pengambilan pil perancang perlu dielakkan.

Adakah pil perancang memberi kesan kepada peluang kehamilan pada masa akan datang?
Tidak. Peluang untuk hamil kembali normal sebaik sahaja anda berhenti mengambil pil perancang.

Bolehkah pil pperancang diambil ketika menyusu badan?
Jawapannya adalah boleh. Walaubagaimanapun pil progesteron sahaja (POPs) lebih sesuai kerana ia tidak mengurangkan susu badan. Ianya boleh dimulakan 4 minggu selepas bersalin.

Apakah yang berlaku jika pil perancang diambil bersama ubat-ubatan lain?
Pengambilan ubat-ubatan seperti antibiotik, ubat sawan dan ubat HIV mungkin mempengaruhi keberkesanan pil perancang. Penyakit seperti radang usus (Inflammatory Bowel Disease) dan penyakit hepar (hati) juga boleh memberi kesan kepada keberkesanan pil perancang. Maklumkan kepada doktor sekiranya anda mengambil ubat-ubatan atau mengalami penyakit tertentu.

Bagaimanakah jika anda muntah atau cirit-birit ketika mengambil pil perancang?
Jika anda muntah dalam jangkamasa 4 jam selepas mengambil pil perancang atau mengalami cirit-birit yang teruk, anda diandaikan sebagai tidak mengambil pil perancang (missed pil)

Bagaimanakah sekiranya anda berpuasa?
Berpuasa tidak mengganggu keberkesanan pil perancang selagi anda mengambilnya pada masa yang sama setiap hari.

Bilakah masa yang sesuai untuk mengambil pil perancang?
Ianya terpulang pada individu asalkan pil perancang diambil pada masa yang sama setiap hari. Tetapi anda disarankan untuk mengambilnya pada masa yang anda mungkin tidak lupa atau tidak sibuk. Jangan lupa untuk membawa pil perancang bersama jika anda meninggalkan rumah!

Apakah perbezaan diantara pek pil perancang yang mengandungi 21 pil hormon dengan 28 pil hormon?
Bagi pek 21 pil hormon, kesemua pil adalah aktif (mengandungi hormon). Anda hendaklah mengambil pil tersebut setiap hari dan berehat 7 hari. Pek pil perancang yang baru hendaklah dimulakan selepas 7 hari berehat.

Bagi pek pil perancang yang mengandungi 28 pil hormon, 21 pil adalah aktif dan 7 pil lagi adalah tidak aktif (tidak mengandungi hormon). Pil ini perlu diambil setiap hari selama 28 hari dan pek baru dimulakan pada esok hari.