oral contraceptive

oral contraceptive, any of a class of synthetic steroid hormones that suppress the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior lobe of the pituitary gland in the female body. FSH and LH normally stimulate the release of estrogen from the ovaries, which in turn stimulates ovulation—the release of a mature egg from the female ovary (see menstruation). However, when FSH and LH are suppressed, the chances of ovulation and therefore fertilization by a male sperm cell are significantly reduced. When oral contraceptives are used correctly, they are between 92 and 99 percent effective in preventing an unintended pregnancy.

Although the principle of hormonal contraception was understood in the 1920s, it took another 30 years for American social reformer Margaret Sanger and American biologist and philanthropist Katharine McCormick to persuade reluctant scientists and physicians to create preparations of oral contraceptives. The first clinical report of the use of such preparations to suppress ovulation was published in 1956 by American endocrinologist Gregory Pincus and American gynecologist and researcher John Rock. Oral contraceptives were approved by the U.S. Food and Drug Administration in 1960, and marketing of the preparations in Britain began two years later.

There are many commercial preparations of oral contraceptives, but most of them contain a combination of an estrogen (usually ethinyl estradiol) and a progestin (commonly norethindrone). In general, oral contraceptives are taken in a monthly regimen that parallels the menstrual cycle. Protection from pregnancy is often unreliable until the second or third drug cycle, and during this time certain side effects such as nausea, breast tenderness, or bleeding may be evident. More serious side effects, including blood clots and a rise in blood pressure, are possible, especially in women over 34 years of age. However, the incidence of side effects from oral contraceptives has been significantly reduced by decreasing the amounts of estrogen and progesterone in the preparations. Normal ovulation usually commences two to three months after the drug is stopped.

Progestin-only preparations (the so-called Minipill) thicken the mucus lining the cervix and make it more acidic, thereby rendering it hostile to sperm. Progestin-only preparations are somewhat less reliable than the combination preparations but produce fewer side effects. Under certain circumstances, the progestin may be administered as an intramuscular deposit that gradually releases the hormone over the course of one to three months.