Pathophysiology

The combined hormonal contraceptive (CHCs) consists of two types of hormones derived from estrogen and progestin. Progestin-only contraceptives are available as well and offer similar efficacy to CHCs. CHCs are available in various dosing forms, including tablets, patches, intrauterine devices, and vaginal rings.

Both hormones act on the hypothalamic-pituitary-ovarian axis: Estrogen suppresses the production of follicle-stimulating hormone (FSH), preventing the development of a dominant follicle.

Progestin inhibits luteinizing hormone (LH), leading to the suppression of ovulation, thickening of the cervical mucus, a decrease in the motility of sperm in the fallopian tube, and altering the environment of the endometrium.

Overall these changes decrease the viability of a fertilization event occurring. Progestin is the leading player in contraception, with estrogen serving a synergistic role.13

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