Combined estrogen-progestin oral contraceptives (COCs)

-Estrogen used in most COCs: Ethinyl estradiol

-Most available progestins have both progestogenic and androgenic activity

-Mechanism of action: Suppression of GnRH, pituitary gonadotropin secretion; Inhibition of the midcycle luteinizing hormone (LH) surge, preventing ovulation; making endometrium less suitable for implantation.

-Typical-use failure rate: 8 percent

-Hormonal contraception can be continued until the age of menopause (average age 50 to 51 years) in healthy, nonsmoking, normal-weight women

-COC use has been associated with increased risks of myocardial infarction, hypertension,stroke, increase risk of venous thromboembolism.

-Contraindications for COC initiation:

Migraines with aura

Age > 35 years



Venous thromboembolism

Known thrombogenic mutations

Ischemic heart disease or severe valvular heart disease

History of stroke

Current breast cancer

Liver cancer or cirrhosis

Non-Contraceptive Benefits of COCs: improves abnormal uterine bleeding, premenstrual syndrome, dysmenorrhea, painful ovarian cysts, acne, hirsutism, polycystic ovary syndrome,bone density, reduces the risk of endometrial and ovarian cancer;

Don’t Get Confused: COCs and Cancer: They increase the risk for developing cervical cancer; They reduce the risk of developing ovarian and endometrial cancers. Overall, the pill is not associated with an increased risk of cancer.

Initiation: COCs can be started anytime during the cycle after excluding the pregnancy.

Quick Start method: begin taking COCs on the day she is given the prescription.

Sunday Start method: start the pill on the first Sunday after her period

-Drugs which decrease the efficacy of a COC: Phenobarbital, Phenytoin,topiramate, primidone Griseofulvin, Rifampin

-Only antibiotic proven to decrease serum ethinyl estradiol and progestin levels in women taking COCs: Rifampin

Belgium euthanizing autistic individuals

Doctors in Belgium now euthanizing autistic individuals. Welcome to the new brave world where a psychiatrist can determine whether you are an individual worth living or should be killed for the greater good of the society. If we forget that God created us in His image, we are inevitably led to a utilitarian society like Belgium.