Combined Oral Contraceptive Pill (COCP)
Background
B.C. type	Hormonal
First use	1960
Failure rates (first year)
Perfect use	0.3%
Typical use	8%
Usage
Duration effect	1-4 days
Reversibility	Yes
User reminders	Taken within same 12 hour window each day
Clinic review	6 months
Advantages and Disadvantages
STD protection	No
Periods	Regulates, and often lighter and less painful
Weight	No proven effect
Benefits	Reduced ovarian and endometrial cancer risks. May treat acne, PCOS, PMDD, endometriosis
Risks	Increased DVTs; Increased strokes & MIs if other risk factors present
Medical notes
Affected by broad-spectrum antibiotics, the herb Hypericum (St.Johns Wort) and some anti-epileptics, also vomiting or diarrhoea. Caution if history migraines.

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. 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. They are currently used by more than 100 million women worldwide and by almost 12 million women in the United States.^[2][3] Usage varies widely by country,^[4] age, education, and marital status: one quarter of women aged 16 – 49 in Great Britain currently use the Pill (combined pill or minipill),^[5] compared to only 1% of women in Japan.^[6] Look up Pill in Wiktionary, the free dictionary. ... Image File history File linksMetadata Download high resolution version (2148x1324, 1279 KB) fr: Plaquettes de pilules contraceptives. ... Ovarian cancer is a malignant tumor (a kind of neoplasm) located on an ovary. ... Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). ... Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5–10% of women. ... Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome, afflicting 8% of all women. ... This article is about Deep-vein thrombosis. ... For other uses, see Stroke (disambiguation). ... Heart attack redirects here. ... Estriol. ... Estrogens (or oestrogens) are a group of steroid compounds that function as the primary female sex hormone. ... A progestin is a synthetic progestagen. ... Progestagens (also spelled progestogens or gestagens) are hormones similar in effect to progesterone, the only natural progestagen. ... Gregory Goodwin Pincus Gregory Goodwin Pincus (April 9, 1903 - August 22, 1967), American physician, biologist, and researcher, was co-inventor of the contraceptive pill. ... This article or section is not written in the formal tone expected of an encyclopedia article. ... Wikipedia does not have an article with this exact name. ... For other uses, see Birth control (disambiguation). ... Progestogen Only Pills or Progestin Only Pills (POP) are contraceptive pills that only contain synthetic progestogens (progestins) and do not contain oestrogen. ...

History

American zoologist, Samuel Leeson Leonard, is known for discovering that estrogen could be used as a female contraceptive in the late 1920s.^[7][8]

By the 1930s, scientists had isolated and determined the structure of the steroid hormones and found that high doses of androgens, estrogens or progesterone inhibited ovulation, but obtaining them from European pharmaceutical companies produced from animal extracts was extraordinarily expensive.^[9] This article is about the chemical family of steroids. ... Hormone is also the NATO reporting name for the Soviet/Russian Kamov Ka-25 military helicopter. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates. ... Estrogens (or oestrogens) are a group of steroid compounds that function as the primary female sex hormone. ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... Ovulation is the process in the menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum (also known as an oocyte, female gamete, or casually, an egg) that participates in reproduction. ... A pharmaceutical company is a licensed drug company, licensed to discover, develop, markets and distribute drugs. ...

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. 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. 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. Syntex broke the monopoly of European pharmaceutical companies on steroid hormones, reducing the price of progesterone almost 200-fold over the next eight years.^{[9][10][11][12][13][14][15][16][17][18][19][20][21]} Russell Marker (1902 – 1995) was an American chemist who invented the octane rating system when he was working at the Ethyl Corporation. ... Organic chemistry is a specific discipline within chemistry which involves the scientific study of the structure, properties, composition, reactions, and preparation (by synthesis or by other means) of chemical compounds consisting primarily of carbon and hydrogen, which may contain any number of other elements, including nitrogen, oxygen, halogens as well... This article is about the state-related university. ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... Binomial name Killip & Morton Sarsaparilla (Smilax regelii and other closely related species of Smilax) is a plant that comes in vine and, in the case of Aralia nudicaulis L., bush variants that bears roots with many useful properties. ... Saponins are the glycosides of 27 carbon atom steroids, or 30 carbon atom triterpenes. ... This article, image, template or category should belong in one or more categories. ... Binomial name Dioscorea villosa This is a species that is found wild in the United States. ... Location within Mexico Country Capital Municipalities 212 Largest City Veracruz Government  - Governor Fidel Herrera Beltrán (PRI)  - Federal Deputies PRI: 6 PAN: 11 PRD: 2 Convergencia: 2  - Federal Senators PRD: 1 PAN: 1 Convergencia: 1 Area Ranked 11th  - Total 71,699 km² (27,683. ... Orizaba is a city in Veracruz, Mexico. ... Parke-Davis was a pharmaceutical company which was previously a subsidiary of Warner-Lambert prior to Warner-Lamberts acquisition by Pfizer in 2000. ... Laboratorios Syntex SA was a pharmaceutical company formed in Mexico City in 1944 by Russell Marker to manufacture therapeutic steroids from the Mexican yam. ... Nickname: Motto: Capital en movimiento Location of Mexico City in south central Mexico Coordinates: , Country Federal entity Boroughs The 16 delegaciones Founded c. ...

Midway through 20th century, the stage was set for the development of a hormonal contraceptive, but pharmaceutical companies, universities and governments showed no interest in pursuing research.^[13] Hormonal contraception refers to birth control methods that act on the hormonal system. ...

Studies of progesterone to prevent ovulation

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. Research started on April 25, 1951 with reproductive physiologist Min Chueh Chang repeating and extending the 1937 experiments of Makepeace et al. that showed injections of progesterone suppressed ovulation in rabbits. In October 1951, G. D. Searle & Company refused Pincus' request to fund his hormonal contraceptive research, but retained him as a consultant and continued to provide chemical compounds to evaluate.^[9][14] Physiology (in Greek physis = nature and logos = word) is the study of the mechanical, physical, and biochemical functions of living organisms. ... Gregory Goodwin Pincus (April 9, 1903 - August 22, 1967), American physician, biologist, and researcher, was co-inventor of the contraceptive pill. ... The Worcester Foundation for Experimental Biology is a now-defunct research center where the birth control pill was developed by Gregory Pincas and Min Chueh Chang. ... Location in Worcester County in Massachusetts Coordinates: , Country State County Worcester County Settled 1722 Incorporated 1727 Government  - Type Representative town meeting  - Town    Manager Daniel J. Morgado  - Board of    Selectmen Bruce Card Maurice DePalo Moira Miller John Lebeaux James A. McCaffrey Area  - Town  21. ... Margaret Higgins Sanger (September 14, 1879 – September 6, 1966) was an American birth control activist, an advocate of negative eugenics, and the founder of the American Birth Control League (which eventually became Planned Parenthood). ... For other uses, see Manhattan (disambiguation). ... This article is about Planned Parenthood Federation of America. ... Wikipedia does not have an article with this exact name. ... G.D. Searle & Company was a company focusing on life sciences, specifically pharmaceuticals, agriculture, and animal health. ...

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. Frustrated when research stalled from PPFA's lack of interest and meager funding, McCormick arranged a meeting at the WFEB on June 6, 1953 with Sanger and Hoagland where she first met Pincus who committed to dramatically expand and accelerate research with McCormick providing fifty times PPFA's previous funding.^[14][22] The term womens suffrage refers to an economic and political reform movement aimed at extending suffrage — the right to vote — to women. ... A philanthropist is someone who engages in philanthropy; that is, someone who donates his or her time, money, or reputation to a charitable cause. ... Katharine Dexter McCormick (August 27, 1875 – December 28, 1967) was a U.S. biologist, suffragette, philanthropist and, after her husbands death, heir to a substantial part of the McCormick fortune. ...

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. 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. In 1952, Rock induced a three-month anovulatory "pseudo-pregnancy" state in eighty of his infertility patients with continuous gradually increasing oral doses of estrogen (diethylstilbestrol 5 – 30 mg/day) and progesterone (50 – 300 mg/day) and within the following four months an encouraging 15% became pregnant.^[14][15][23] Harvard Medical School (HMS) is one of the graduate schools of Harvard University. ... Obstetrics and Gynaecology (often abbreviated to OB/GYN or O&G) are the two surgical specialties dealing with the female reproductive organs, and as such are often combined to form a single medical speciality and postgraduate training program. ... This article or section is not written in the formal tone expected of an encyclopedia article. ... Boston Lying-In Hospital building, part of Brigham and Womens Hospital, view from Longwood Avenue. ... Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. ... In medicine, anovulation is absence of ovulation when it would be normally expected (in a post-menarchal, premenopausal woman). ... Estriol. ... Diethylstilbestrol (DES) is a drug, a synthetic nonsteroidal estrogen that was first synthesized in 1938. ...

In 1953, at Pincus' suggestion, Rock induced a three-month anovulatory "pseudo-pregnancy" state in twenty-seven of his infertility patients with an oral 300 mg/day progesterone-only regimen for 20 days from cycle days 5 – 24 followed by pill-free days to produce withdrawal bleeding. 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. But 20% of the women experienced breakthrough bleeding and in the first cycle ovulation was suppressed in only 85% of the women, indicating that even higher and more expensive oral doses of progesterone would be needed to initially consistently suppress ovulation.^[24] Menstrual cycle The menstrual cycle is a recurring cycle of physiologic changes that occurs in the females of several mammals, including human beings and other apes. ... Menstrual cycle The menstrual cycle is a recurring cycle of physiologic changes that occurs in the females of several mammals, including human beings and other apes. ... Amenorrhoea (BE) or amenorrhea (AmE) is the absence of a menstrual period in a woman of reproductive age. ... Breakthrough bleeding is bleeding between regular menstrual cycles. ...

Studies of progestins to prevent ovulation

Pincus asked his contacts at pharmaceutical companies to send him chemical compounds with progestogenic activity. Chang screened nearly 200 chemical compounds in animals and found the three most promising were Syntex's norethindrone and Searle's norethynodrel and norethandrolone.^[25] A progestin is a synthetic progestagen. ... Norethynodrel was the progestin used in Enovid, the first oral contraceptive. ... Norethandrolone is an anabolic steroid. ...

Chemists Carl Djerassi, Luis Miramontes, and George Rosenkranz at Syntex in Mexico City had synthesized the first orally highly active progestin norethindrone in 1951. Chemist Frank B. Colton at Searle in Skokie, Illinois had synthesized the orally highly active progestins norethynodrel (an isomer of norethindrone) in 1952 and norethandrolone in 1953.^[9] This article or section is not written in the formal tone expected of an encyclopedia article. ... Luis E. Miramontes ca. ... George Rosenkranz (born August 20, 1916, in Budapest) is a Mexican Ph. ... Frank Benjamin Colton (March 3, 1923 - November 25, 2003), American chemist who first synthesized norethynodrel, the progestin used in Enovid, the first oral contraceptive, at G. D. Searle & Company in Skokie, Illinois in 1952. ... For the film of the same name, see Skokie (Movie). ...

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. 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. Pincus and Rock selected Searle's norethynodrel for the first contraceptive trials in women citing its total lack of androgenicity versus Syntex's norethindrone's very slight androgenicity in animal tests.^[26][27] Location in Massachusetts Coordinates: , Country United States State Massachusetts County Norfolk County Settled 1638 Incorporated 1705 Government  - Type Representative town meeting Area  - Town  6. ...

Development of an effective combined oral contraceptive

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. 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. The norethynodrel and mestranol combination was given the proprietary name Enovid.^[27][28] Mestranol is the 3-methyl ether of ethinylestradiol. ...

The first contraceptive trial of Enovid led by Edris Rice-Wray began in April 1956 in Río Piedras, Puerto Rico.^[29][30][31] A second contraceptive trial of Enovid (and norethindrone) led by Edward T. Tyler began in June 1956 in Los Angeles.^[12][32] On January 23, 1957, Searle held a symposium reviewing gynecologic and contraceptive research on Enovid through 1956 and concluded Enovid's estrogen content could be reduced by 33% to lower the incidence of estrogenic gastrointestinal side effects without significantly increasing the incidence of breakthrough bleeding.^[33] Edris Rice-Wray Carson, M.D. attended Cornell University where she was a member of the Alpha Phi sorority. ... Río Piedras was a town in Puerto Rico which was absorbed by the city of San Juan and is now one of its districts. ... Flag Seal Nickname: City of Angels Location Location within Los Angeles County in the state of California Coordinates , Government State County California Los Angeles County Mayor Antonio Villaraigosa (D) Geographical characteristics Area     City 1,290. ...

Public availability

In June 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. Numerous additional contraceptive trials showed Enovid at 10, 5, and 2.5 mg doses to be highly effective. 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 FDA refused to consider the application until Searle agreed to withdraw the lower dosage forms from the application. On May 9, 1960, the FDA announced it would approve Enovid 10 mg for contraceptive use, which it did on June 23, 1960, by which time Enovid 10 mg had been in general use for three years during which time, by conservative estimate, at least half a million women had used it.^[16][29][34] “FDA” redirects here. ...

Although FDA-approved for contraceptive use, Searle never marketed Enovid 10 mg as a contraceptive. Eight months later, on February 15, 1961, the FDA approved Enovid 5 mg for contraceptive use. In July 1961, Searle finally began marketing Enovid 5 mg (5 mg norethynodrel and 75 µg mestranol) to physicians as a contraceptive.^[16][17]

Although the FDA approved the first oral contraceptive in 1960, contraceptives were not available to married women in all states until Griswold v. Connecticut in 1965 and were not available to unmarried women in all states until Eisenstadt v. Baird in 1972.^[13][17] Holding A Connecticut law criminalizing the use of contraceptives violated the right to marital privacy. ... Eisenstadt v. ...

The first published case report of a blood clot and pulmonary embolism in a woman using Enovid did not appear until November 1961, four years after its approval, by which time it had been used by over one million women.^[29][35][36] It would take almost a decade of epidemiological studies to conclusively establish an increased risk of venous thrombosis in oral contraceptive users and an increased risk of stroke and myocardial infarction in oral contraceptive users who smoke or have high blood pressure or other cardiovascular or cerebrovascular risk factors.^[16] These risks of oral contraceptives were dramatized in the 1969 book The Doctors' Case Against the Pill by feminist journalist Barbara Seaman who helped arrange the 1970 Nelson Pill Hearings called by Senator Gaylord Nelson.^[37] The hearings were conducted by Senators who were all men and the witnesses in the first round of hearings were all men, leading Alice Wolfson and other feminists to protest the hearings and generate media attention.^[17] Their work led to mandating the inclusion of patient package inserts with oral contraceptives to explain their possible side effects and risks to help facilitate informed consent.^[38][39][40] Today's standard dose oral contraceptives contain an estrogen dose that is one third lower than the first marketed oral contraceptive and contain lower doses of different, more potent progestins in a variety of formulations.^[16][17][18] A thrombus is the final product of blood coagulation, through the aggregation of platelets and the activation of the humoral coagulation system. ... Epidemiology (Greek epi = upon, among; demos = people, district; logos = word, discourse), defined literally, is the study of epidemics in humans. ... A venous thrombosis is a blood clot that forms within a vein. ... For other uses, see Stroke (disambiguation). ... Heart attack redirects here. ... The cigarette is the most common method of smoking tobacco. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... Seaman is a women’s health activist who, through persistent investigative journalism, reporting, and social organizing, has brought about significant changes in the relationship between the medical and pharmaceutical establishments and women in America. ... In 1970, Barbara Seaman brought the dangers of combined oral contraceptive pill use to the attention of Senator Gaylord Nelson with her book The Doctors Case Against the Pill. ... Gaylord Nelson Gaylord Anton Nelson (June 4, 1916 – July 3, 2005) was a Democratic American politician from Wisconsin. ... Alice Wolfson, a Barnard graduate and former Fulbright Scholar, is a veteran political activist in womens reproductive health issues, a lawyer, and a co-founder of the National Womens Health Network. ... A package insert or patient package insert (PPI) (in Europe, Patient Information Leaflet) is a document provided along with a prescription medication to provide additional information about that drug. ... Informed consent is a legal condition whereby a person can be said to have given consent based upon an appreciation and understanding of the facts and implications of an action. ...

Luis E. Miramontes signed laboratory notebook. October 15, 1951

Image File history File links Download high resolution version (653x808, 92 KB) Summary This is the historical page of a laboratory notebook where Luis Miramontes describes the invention and synthesis of the chemical that would became into the first contraceptive pill. ... Image File history File links Download high resolution version (653x808, 92 KB) Summary This is the historical page of a laboratory notebook where Luis Miramontes describes the invention and synthesis of the chemical that would became into the first contraceptive pill. ...

France

In 1967, the Neuwirth Law legalized contraception in France, including the pill.^[41] The pill is the most popular form of contraception in France, especially among young women. The abortion rate has remained stable since the introduction of the pill.^[42]

Japan

In Japan, lobbying from the Japan Medical Association prevented the Pill from being approved for nearly 40 years. Two main objections raised by the association were safety concerns over long-term use of the Pill, and concerns that the Pill use would lead to diminished use of condoms and thereby potentially increase sexually transmitted infection (STI) rates.^[43] As of 2004, condoms accounted for 80% of birth control use in Japan, and this may explain Japan's comparably low rates of AIDS.^[6] Sexually-transmitted infections (STIs), also known as sexually-transmitted diseases (STDs), are diseases that are commonly transmitted between partners through some form of sexual activity, most commonly vaginal intercourse, oral sex, or anal sex. ...

The Pill was approved for use in 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. In the United States and Europe, in contrast, an annual or bi-annual clinic visit is standard for Pill users. ^[6] This article is about the year. ...

Use and packaging

Half-used blister pack of Levlen®ED

Combined oral contraceptive pills must be ingested at the same time each day. Contraceptive effectiveness may be reduced if a pill is taken more than 12 hours late.^[44] Most brands of combined pills are packaged in one of two different packet sizes, with days marked off for a 28 day cycle. For the 21-pill packet, a pill is consumed daily for three weeks, followed by a week of no pills. For the 28-pill packet, 21 pills are taken, followed by week of placebo or sugar pills. A woman on the pill will have a withdrawal bleed sometime during the placebo week. Photograph of a half-used blister pack of Levlen®ED oral contraceptive pill. ... For other uses, see Placebo (disambiguation). ...

Placebo pills

The purpose of the placebo pills is that the user, out of habit, can take a pill on every day of her menstrual cycle, instead of calculating the date she should start the next dose. Placebo pills may contain an iron supplement, as iron requirements increase during menstruation. For other uses, see Iron (disambiguation). ...

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. 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. Breakthrough bleeding also becomes a more common side effect as a woman attempts to go longer periods of time between menstrual periods. Menstrual cycle The menstrual cycle is a recurring cycle of physiologic changes that occurs in the females of several mammals, including human beings and other apes. ...

Less frequent placebos

Main article: Extended cycle combined oral contraceptive pill

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. Attempting this with bi- or tri-phasic pill formulations carries an increased risk of breakthrough bleeding and may be undesirable. It will not, however, increase the risk of getting pregnant. Extended cycle combined oral contraceptive pills are COCPs packaged to reduce or eliminate the withdrawal bleeding that occurs once every 28 days in traditionally packaged COCPs. ... Not to be confused with Mensuration. ... Breakthrough bleeding is bleeding between regular menstrual cycles. ...

Starting in 2003, women have also been able to use a three-month version of the Pill.^[45] 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. Seasonique is another version in which the placebo week every three months is replaced with a week of low-dose estrogen. Seasonale® (levonorgestrel/ethinyl estradiol) is a brand of birth control pill that reduces the frequency of menstrual periods from 13 per year to four per year. ...

A version of the combined pill has also been packaged to completely eliminate placebo pills and withdrawal bleeds. Marketed as Anya or Lybrel, studies have shown that after seven months 71% of users no longer had any breakthrough bleeding, the most common side effect of going longer periods of time without breaks from active pills.^[46]

Effectiveness

The effectiveness of COCPs, as of most forms of contraception, can be assessed two ways. Perfect use or method effectiveness rates only include people who take the pills consistently and correctly. Actual use, or typical use effectiveness rates are of all COCP users, including those who take the pills incorrectly, inconsistently, or both. Rates are generally presented for the first year of use.^[2] Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.^[47] The Pearl Index, also called the Pearl rate, is a technique used in clinical trials for measuring the effectiveness of a birth control method. ... Decrement tables, also called life table methods, are used to calculate the probability of certain events. ...

The typical use pregnancy rate among COCP users varies depending on the population being studied, ranging from 2-8% per year. The perfect use pregnancy rate of COCPs is 0.3% per year.^[2]

Several factors account for typical use effectiveness being lower than perfect use effectiveness:

• mistakes on the part of those providing instructions on how to use the method
• mistakes on the part of the user
• conscious user non-compliance with instructions.

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). 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. COCPs should be taken at approximately the same time every day.^[18][48] Menstrual cycle The menstrual cycle is a recurring cycle of physiologic changes that occurs in the females of several mammals, including human beings and other apes. ... Not to be confused with Mensuration. ...

Contraceptive efficacy may be impaired by: 1) missing more than one active pill in a packet, 2) delay in starting the next packet of active pills (i.e. extending the pill-free, inactive or placebo pill period beyond 7 days), 3) intestinal malabsorption of active pills due to vomiting or diarrhea, 4) drug interactions with active pills that decrease contraceptive estrogen or progestogen levels.^[18] In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... Malabsorption is the state of impaired absorption of nutrients in the small intestine. ... Emesis redirects here. ... Diarrhea, also spelled diarrhoea (see spelling differences), is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause of death in developing countries (particularly among infants), accounting for 5 to 8 million deaths...

Mechanism of action

Combined oral contraceptive pills were developed to prevent ovulation by progestogenic and estrogenic suppression of gonadotropin release. Combined hormonal contraceptives, including COCPs, inhibit follicular development and prevent ovulation as their primary mechanism of action.^{[2][18][49][50][51]} Ovulation is the process in the menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum (also known as an oocyte, female gamete, or casually, an egg) that participates in reproduction. ... Gonadotropins are protein hormones secreted by gonadotrope cells of the pituitary gland of vertebrates. ... Menstrual cycle The follicular phase (or proliferative phase) is the phase of the estrous cycle, (or, in humans and great apes, the menstrual cycle) during which follicles in the ovary mature. ...

Progestogen 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. Decreased levels of FSH inhibit follicular development, preventing an increase in estradiol levels. Progestogen negative feedback and the lack of estrogen positive feedback on LH release prevent a mid-cycle LH surge. Inhibition of follicular development and the absence of a LH surge prevent ovulation.^[2][18][49] This article does not cite any references or sources. ... Gonadotropin-releasing hormone 1 (GNRH1 also called LHRH) is a peptide hormone responsible for the release of FSH and LH from the anterior pituitary. ... The hypothalamus links the nervous system to the endocrine system via the pituitary gland (hypophysis). ... Follicle stimulating hormone Follicle stimulating hormone (FSH) is a hormone synthesised and secreted by gonadotropes in the anterior pituitary gland. ... Luteinizing hormone (LH) is a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland. ... The anterior pituitary (also called the adenohypophysis, from Greek adeno, gland; hypo, under; physis, growth; hence, glandular undergrowth) comprises the anterior lobe of the pituitary gland and is part of the endocrine system. ... Estradiol (17β-estradiol) (also oestradiol) is a sex hormone. ... Positive feedback is a feedback system in which the system responds to the perturbation in the same direction as the perturbation (It is sometimes referred to as cumulative causation). ... Menstrual cycle The menstrual cycle is a recurring cycle of physiologic changes that occurs in the females of several mammals, including human beings and other apes. ...

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. Estrogen negative feedback on the anterior pituitary greatly decreases the release of FSH, which inhibits follicular development and helps prevent ovulation.^[2][18][49]

A secondary mechanism of action of all progestogen-containing contraceptives is inhibition of sperm penetration through the cervix into the upper genital tract (uterus and fallopian tubes) by decreasing the amount of and increasing the viscosity of the cervical mucus.^[51] A spermatozoon or spermatozoan ( spermatozoa), from the ancient Greek σπέρμα (seed) and (living being) and more commonly known as a sperm cell, is the haploid cell that is the male gamete. ... The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ... The human females reproductive system. ... This article is about female reproductive anatomy. ... The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges (singular salpinx) are two very fine tubes leading from the ovaries of female mammals into the uterus. ... For other uses, see Viscosity (disambiguation). ... The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ...

Although endometrial effects have been hypothesized as a possible mechanism of action of combined hormonal contraceptives, insufficient evidence exists on whether cellular or biochemical changes in the endometrium could actually prevent implantation. However, the possibility of fertilization during COCP use is very small. Hence, endometrial changes are unlikely to play an important role, if any, in the observed effectiveness of COCPs.^[51] The endometrium is the inner membrane of the mammalian uterus. ...

Drug interactions

Some drugs reduce the effect of the Pill and can cause breakthrough bleeding, or increased chance of pregnancy. These include drugs such as rifampicin, barbiturates, phenytoin and carbamazepine. In addition cautions are given about broad spectrum antibiotics, such as ampicillin and doxycycline, which may cause problems "by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel" (BNF 2003).^[52] This article does not cite any references or sources. ... Breakthrough bleeding is bleeding between regular menstrual cycles. ... Rifampicin (INN) (IPA: ) or rifampin (USAN) is a bacteriocidal antibiotic drug of the rifamycin group. ... Barbituric acid, the basic structure of all barbiturates Barbiturates are drugs that act as central nervous system depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. ... Phenytoin sodium (marketed as Dilantin® in the USA and as Epanutin® in the UK, by Parke-Davis, now part of Pfizer) is a commonly used antiepileptic. ... Carbamazepine (CBZ) is an anticonvulsant and mood stabilizing drug, used primarily in the treatment of epilepsy and bipolar disorder. ... Ampicillin is a beta-lactam antibiotic that has been used extensively to treat bacterial infections since 1961. ... Doxycycline (INN) (IPA: ) is a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections. ... The human body contains a large number of bacteria, most of them performing tasks that are useful or even essential to human survival. ... Ethinylestradiol, also ethinyl estradiol (EE), is a synthetic derivative of estradiol. ... Otherwise known as the doctors prescribing Bible the British National Formulary (BNF) contains a wide spectrum of information on prescribing and pharmacology, among others indications, side effects and costs of the prescription of all medication drugs available on the National Health Service. ...

The traditional medicinal herb St John's Wort has also been implicated due to its upregulation of the P450 system in the liver. Binomial name Hypericum perforatum L. St Johns wort (IPA pronunciation: , rhyming with hurt, or ) used alone refers to the species Hypericum perforatum, also known as Klamath weed or Goat weed, but, with qualifiers, is used to refer to any species of the genus Hypericum. ... Cytochrome P450 Oxidase (CYP2E1) Cytochrome P450 oxidase (commonly abbreviated CYP) is a generic term for a large number of related, but distinct, oxidative enzymes (EC 1. ... For the bird, see Liver bird. ...

Side-effects

Different sources note different incidences of side effects. A University of New Mexico Student Health Center webpage says the majority (about 60%) of women report no side effects at all, and the vast majority of those who do, have only minor effects.^[53] A 1992 French review article said that as many as 50% of new first-time users discontinue the Pill before the end of the first year because of nuisance bleeding irregularity side effects such as breakthrough bleeding and amenorrhea.^[54] The University of New Mexico (UNM) is a public university in Albuquerque, New Mexico. ... Amenorrhoea (BE) or amenorrhea (AmE) is the absence of a menstrual period in a woman of reproductive age. ...

Weight

The same 1992 French review article noted that in the subgroup of adolescents 15–19 years of age in the 1982 National Survey of Family Growth (NSFG) who had stopped taking the Pill, 20–25% reported they stopped taking the Pill because of either acne or weight gain, and another 25% stopped because of fear of cancer.^[54] A 1986 Hungarian study comparing two high-dose estrogen (both 50 µg ethinyl estradiol) pills found that women using a lower-dose biphasic levonorgestrel formulation (50 µg levonorgestrel x 10 days + 125 µg levonorgestrel x 11 days) reported a significantly lower incidence of weight gain compared to women using a higher-dose monophasic levonorgestrel formulation (250 µg levonorgestrel x 21 days).^[55] National Center for Health Statistics (NCHS) is one of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services. ...

Many clinicians consider the public perception of weight gain on the Pill to be inaccurate and dangerous. The aforementioned 1992 French review article noted that one unpublished 1989 study by Professor Elizabeth Connell at Emory University of 550 women found that 23% of the 6% of women who discontinued the Pill because of poor cycle control experienced subsequent unwanted pregnancies.^[54] A 2000 British review article concluded there is no evidence that modern low-dose pills cause weight gain, but that fear of weight gain contributed to poor compliance in taking the Pill and subsequent unintended pregnancy, especially among adolescents.^[56] Emory University is a private university located in the metropolitan area of the city of Atlanta and in western unincorporated DeKalb County, Georgia, United States. ...

Sexuality

The Pill may have a positive effect on a woman's sexuality. 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.

However, some say the Pill can also have a negative effect on a woman's sexuality. Dr. 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. These effects may include a decreased frequency of sexual thoughts, increased difficulty in becoming aroused, or decreased lubrication, which can make sex painful. Recent research co-authored by Dr. Irwin Goldstein (a urologist in Boston) suggests such effects may continue for up to four months after a woman stops taking the Pill.^[57]

Depression

Low levels of serotonin, a neurotransmitter in the brain, have been linked to depression. High levels of estrogen, as in first-generation COCPs, and progestin, as in some progestin-only contraceptives, have been shown to promote the lowering of brain serotonin levels by increasing the concentration of a brain enzyme that reduces serotonin.^[2] Progestin-only contraceptives are known to worsen the condition of women who are already depressed.^[58] Serotonin (pronounced ) (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system (CNS) and enterochromaffin cells in the gastrointestinal tract of animals including humans. ... On the Threshold of Eternity. ...

Current medical reference textbooks on contraception^[18] and major organizations such as the American ACOG,^[59] the WHO,^[60] and the United Kingdom's RCOG^[61] 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. Contraceptive Technology states that low-dose COCPs have not been implicated in disruptions of serotonin or tryptophan.^[2] The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. ... WHO redirects here. ... The Royal College of Obstetricians and Gynaecologists is a medical institution in England which is responsible for training and regulating medical practitioners who specialise in obstetrics and gynaecology. ... Tryptophan is an essential amino acid involved in human nutrition. ...

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. Professor Jayashri Kulkarni from the School of Psychology, Psychiatry and Psychological Medicine at Monash University conducted a study with 62 women. In the study depression symptom scores between users and non-users of combined oral contraceptives were compared. Those that used the Pill had an average depression rating scale score that was 17.6, compared with 9.8 for the non-users. 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. The relatioship to depression and the Pill in the is study has been described as significant by the researcher. .^[62]

Other effects

Other possible side effects are: vaginal discharge, changes in menstrual flow, breakthrough bleeding, nausea, vomiting, headaches, changes in the breasts, changes in blood pressure, skin problems and skin improvements. The insert included with each pill packet usually has a more extensive list of recognized side effects. Not to be confused with Mensuration. ... Breakthrough bleeding is bleeding between regular menstrual cycles. ... For other uses, see Nausea (disambiguation). ... Emesis redirects here. ... A headache (cephalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... For other uses, see Breast (disambiguation). ... A sphygmomanometer, a device used for measuring arterial pressure. ... Dermatology (from Greek δερμα, skin) is a branch of medicine dealing with the skin and its appendages (hair, sweat glands, etc). ...

Formulations

Main article: oral contraceptive formulations

Oral contraceptives come in a variety of formulations. The main division is between combined oral contraceptive pills, containing both estrogen and progestins and progestin only pills. 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. Oral contraceptives come in a variety of formulations. ... Estriol. ... A progestin is a synthetic progestagen. ... Progestogen Only Pills or Progestin Only Pills (POP) are contraceptive pills that only contain synthetic progestogens (progestins) and do not contain oestrogen. ...

Cautions and contraindications

Oral contraceptives may influence coagulation, increasing the risk of deep venous thrombosis (DVT) and pulmonary embolism, stroke and myocardial infarction (heart attack). Combined oral contraceptives are generally accepted to be contraindicated in women with pre-existing cardiovascular disease, in women who have a familial tendency to form blood clots (such as familial factor V Leiden), women with severe obesity and/or hypercholesterolaemia (high cholesterol level), and in smokers over age 35. This article is about the clotting of blood. ... It has been suggested that Deep Vein Thrombosis be merged into this article or section. ... For other uses, see Stroke (disambiguation). ... Heart attack redirects here. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Factor V Leiden (sometimes Factor VLeiden) is the name given to a variant of human factor V that causes a hypercoagulability disorder. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ... The cigarette is the most common method of smoking tobacco. ...

Research into the relationship between breast cancer risk and hormonal contraception is complex and seemingly contradictory.^[63] 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. 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. Second, there is no significant excess risk of having breast cancer diagnosed 10 or more years after stopping use. The cancers diagnosed in women who had used combined oral contraceptives were less advanced clinically than those diagnosed in women who had never used these contraceptives."^[64] This data has been interpreted to suggest that oral contraceptives have little or no biological effect on breast cancer development, but that women who seek gynecologic care to obtain contraceptives have more early breast cancers detected through screening.^[65][66] Breast cancer is cancer of breast tissue. ... Hormonal contraception refers to birth control methods that act on the hormonal system. ...

It is generally accepted by medical authorities that the health risks of oral contraceptives are lower than those from pregnancy and birth,^[67] and "the health benefits of any method of contraception are far greater than any risks from the method".^[68] Some organizations have argued that comparing a contraceptive method to no method (pregnancy) is not relevant - instead, the comparison of safety should be among available methods of contraception.^[69]

Non-contraceptive uses

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). In addition, oral contraceptives are often prescribed as medication for mild or moderate acne.^[70] 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. Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects approximately one in ten women. ... Adenomyosis is a medical condition characterized by the presence of ectopic endometrial tissue (the inner lining of the uterus) within the myometrium (the thick, muscular layer of the uterus). ... Dysmenorrhea (or dysmenorrhoea), cramps or painful menstruation, involves menstrual periods that are accompanied by either sharp, intermittent pain or dull, aching pain, usually in the pelvis or lower abdomen. ... Dysfunctional Uterine Bleeding (DUB) is the most common cause of functional abnormal uterine bleeding, which is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable organic pathology. ...

Combined oral contraceptive use reduces the risk of ovarian cancer by 40% and the risk of endometrial cancer by 50% compared to never users. 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. The risk reduction for both ovarian and endometrial cancer persists for at least 20 years.^[18] Ovarian cancer is a malignant tumor (a kind of neoplasm) located on an ovary. ... Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). ...

Social and cultural impact

Introduced at the beginning of the tumultuous decade of the 1960s, the Pill had an enormous social impact. In the first place, it was far more effective than any previous method of birth control, giving women unprecedented control over their fertility. Its use was separate from intercourse, requiring no special preparations at the time of sexual activity that might interfere with spontaneity or sensation. This combination of factors served to make the Pill immensely popular within a few years of its introduction.^[10][17] The 1960s decade refers to the years from 1960 to 1969. ...

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. Never before had sexual activity been so divorced from reproduction. 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. 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. 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. 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. The encyclical reiterated the traditional Catholic teaching that artificial contraception distorted the nature and purpose of sex.^[71] This article is primarily about religious attitudes to sexual morality. ... Catholic Church redirects here. ... Year 1968 (MCMLXVIII) was a leap year starting on Monday (link will display full calendar) of the Gregorian calendar. ... Humanae Vitae (Latin Of Human Life) is an encyclical written by Pope Paul VI and promulgated on July 25, 1968. ...

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. 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. This new development, however, caused many of them to denounce oral contraceptives as a male invention designed to facilitate male sexual freedom with women at the cost of health risk to women.^[72] At the same time, society was beginning to take note of the impact of the Pill on traditional gender roles. 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. Breast cancer is cancer of breast tissue. ... Feminism is a social theory and political movement primarily informed and motivated by the experience of women. ... Loretta Lynn (born Loretta Webb April 14, 1934) is an American country singer-songwriter and was one of the leading country female vocalists during the 1960s and 1970s and overall is revered as a country icon. ...

Environmental impact

Human excretion in urine and feces of the natural estrogens estrone and estradiol and excretion of the synthetic estrogen ethinylestradiol by women using COCPs are likely to play a role in causing endocrine disruption in wild fish populations in some segments of streams contaminated by treated sewage effluents.^[73][74] A review of activated sludge plant performance found estrogen removal rates varied considerably but averaged 78% for estrone, 91% for estradiol, and 76% for ethinylestradiol (estriol effluent concentrations are between those of estrone and estradiol, but estriol is a much less potent endocrine disruptor to fish).^[75] Effluent concentrations of ethinylestradiol are lower than estradiol which are lower than estrone, but ethinylestradiol is more potent than estradiol which is more potent than estrone in the induction of intersex fish and synthesis of vitellogenin in male fish.^[76] The kidneys are important excretory organs in vertebrates. ... Urine is liquid waste product of the body secreted by the kidneys by a process of filtration from blood and excreted through the urethra. ... Human feces (also faeces — see spelling differences), also known as stools, vary significantly in appearance, depending on the state of the whole digestive system, influenced by diet and health. ... Estriol. ... Estrone (also oestrone) is an estrogenic hormone secreted by the ovary. ... Estradiol (17β-estradiol) (also oestradiol) is a sex hormone. ... Ethinylestradiol, also ethinyl estradiol (EE), is a synthetic derivative of estradiol. ... Endocrine disruptors are substances which interfere with the endocrine system by mimicking, blocking or otherwise disrupting the function of hormones. ... For other uses, see Fish (disambiguation). ... Butchers Creek, Omeo, Victoria A stream, brook, beck, burn or creek, is a body of water with a detectable current, confined within a bed and banks. ... Sewage treatment, or domestic wastewater treatment, is the process of removing contaminants from wastewater, both runoff and domestic. ... In the context of creating Plutonium at the Hanford Site, effluent refers to the cooling water that is discharged from a nuclear reactor that may or may not be radioactive. ... Activated sludge is a process in sewage treatment in which air or oxygen is forced into sewage liquor to develop a biological floc which reduces the organic content of the sewage. ... Chemical structure of estriol Estriol (also oestriol) is one of the three main estrogens produced by the human body. ... This article needs to be wikified. ...

Footnotes

The New York Times is an internationally known daily newspaper published in New York City and distributed in the United States and many other nations worldwide. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 202nd day of the year (203rd in leap years) in the Gregorian calendar. ... See also August 19, 2004 - August 2004 - August 21, 2004 US Airways, struggling to avoid a second bankruptcy, asks pilots to accept a 16. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 163rd day of the year (164th in leap years) in the Gregorian calendar. ... The McGraw-Hill Companies, Inc. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 250th day of the year (251st in leap years) in the Gregorian calendar. ... For information on Wikipedia press releases, see Wikipedia:Press releases. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 235th day of the year (236th in leap years) in the Gregorian calendar. ... Organon is a pharmaceutical company headquartered in Roseland, New Jersey that is part of Akzo Nobel. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... April 7 is the 97th day of the year in the Gregorian calendar (98th in leap years). ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 313th day of the year (314th in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 362nd day of the year (363rd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 357th day of the year (358th in leap years) in the Gregorian calendar. ... The Royal College of Obstetricians and Gynaecologists is a medical institution in England which is responsible for training and regulating medical practitioners who specialise in obstetrics and gynaecology. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 177th day of the year (178th in leap years) in the Gregorian calendar. ... The University of New Mexico (UNM) is a public university in Albuquerque, New Mexico. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 290th day of the year (291st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 61st day of the year (62nd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 250th day of the year (251st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 79th day of the year (80th in leap years) in the Gregorian calendar. ... The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. ... WHO redirects here. ... The Royal College of Obstetricians and Gynaecologists is a medical institution in England which is responsible for training and regulating medical practitioners who specialise in obstetrics and gynaecology. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 90th day of the year (91st in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 60th day of the year (61st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 302nd day of the year (303rd in leap years) in the Gregorian calendar. ... The Family Planning Association, also known as fpa, is a UK registered charity (number 250187) working to promote sexual health. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 8th day of the year in the Gregorian calendar. ... The Lancet is one of the oldest and most respected peer-reviewed medical journals in the world, published weekly by Elsevier, part of Reed Elsevier. ... Look up who in Wiktionary, the free dictionary. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 280th day of the year (281st in leap years) in the Gregorian calendar. ...

External links

• The Birth Control Pill CBC Digital Archives
• The Pill. American Experience. Public Broadcasting Service. Retrieved on 2006-08-14.

PBS redirects here. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 226th day of the year (227th in leap years) in the Gregorian calendar. ...

See also