SYMPTOMATIC SIDE EFFECTS OF COMBINED ORAL CONTRACEPTIVE PILLS

Abstract

A prospective study was carried out during nine-month period (from 1st of December 2001 until the end of August 2002) in Basrah Maternity and Children Teaching Hospital. The aim is to assess the timing, frequency and severity of symptomatic effects of combined oral contraceptive (COC) users specifically to compare 21 days of active pill intervals with 7 days of hormone- free intervals in both current (COC user for ≥12 months) and new users (COC user for 3 months). Current users had pattern of symptoms that were observed significantly worse during hormone-free interval than during the three active-pill weeks for both 1st and 2nd cycles. 57% and 56% of them experienced mild pelvic pain during free period versus 19% and 16% during active-pills weeks in both cycles respectively (P=0.001), while moderate to severe pelvic pain, the corresponding percentages were 22% and 22% versus 9% and 8% (P=0.042). For Nausea, the percentages were 48% and 46% versus 31% and 30%. For bloating the corresponding percentages were 46% and 46% versus 18% and 16% (P>0.0001) and for breast tenderness the corresponding percentage in free period were 29% and 29% versus 16% and 15% in active pill interval in both cycles respectively (P=0.0004). The reverse was true when other symptoms were assessed like headache and mood changes. Regarding headache the corresponding percentages were 35% and 33% during free period versus 60% and 58% during active pill interval in both cycles respectively, and for mood changes, the percentages were 21% and 19% versus 50% and 47% respectively. Similar patterns for all previous symptoms were observed in new start COC users in both cycle 1 and 2 for pelvic pain, nausea, bloating and breast tenderness. These symptoms increased and became worse during hormone free interval while headache and mood changes became more severe during active hormone period than during hormone free interval. Breakthrough vaginal bleeding occurred more frequently in new start COC in comparison to current users. The percentages were 20% and 16% versus 5% and 3% in both cycles respectively. Menstrual flow decreased significantly in current users in comparison to new start COC (5% and 16%) respectively (Table-4). This study confirmed that most symptoms assessed were significantly worse during the 7 day hormone-free interval than during the 21 day of hormone-containing pills.