Estrogens and progestins (combination oral contraceptives) are used as oral contraceptives. There are three types of estrogen and progestin combination oral contraceptives: monophasic, biphasic, and triphasic. The monophasic oral contraceptives provide a fixed dose of estrogen and progestin throughout the cycle. The biphasic and triphasic oral contraceptives deliver hormones similar to the levels naturally produced by the body (Table 52-1).
The oral contraceptives have changed a great deal since their introduction in the 1960s. Today the levels of hormones provide lower dosages of hormones compared with the older formulations, while retaining the same degree of effectiveness (>99% when used as prescribed).
Taking the contraceptive hormones provides health benefits not related to contraception, such as regulating the menstrual cycle and decreased blood loss, and incidence of iron deficiency anemia, and dysmenorrhea. Health benefits related to the inhibition of ovulation include a decrease in ovarian cysts and ectopic pregnancies. In addition, there is a decrease in fibrocyctic breast disease, acute pelvic inflammatory disease, endometrial cancer, ovarian cancer, maintenance of bone density, and symptoms related to endometriosis in women taking contraceptive hormones. Newer combination contraceptives such as norgestimate and ethinyl estradiol
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