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Combined hormonal contraception

Menstrual cycle regulation by hormonal pathways1,2

  1. Hypothalamus releases GnRH, stimulating the pituitary
  2. FSH slowly increases causing LH surge that stimulates ovulation
  3. Estrogen and progesterone provide negative feedback to the hypothalamus and pituitary, turning off GnRH, LH and FSH release

GnRH = gonadotropin releasing hormone ; FSH = follicle-stimulating hormone; LH = luteinizing hormone Used with permission from The Journal of Reproduction Medicine.


1Speroff L and Fritz MA. Regulation of the Menstrual Cycle. In: Clinical Gynecologic Endocrinology and Infertility; Philadelphia: Lippincott Williams & Wilkins, 2005
2Griesinger G et al. J Reprod Med. 2011;56:279-300

Combined oral contraceptive pills: mechanisms of action

Progestin: imitates progesterone increase in pregnancy

  • Inhibits ovulation by suppressing FSH and LH
  • Thickens the cervical mucus thereby preventing the migration of sperm into the uterus
  • Alters the endometrium, making it unsuitable for implantation even if the ovum is fertilized

Helps to maintain the stability of the endometrium and thereby decreases the risk of break-through bleedings


Speroff L. Oral contraception. In: Clinical Gynecologic Endocrinology and Infertility; Philadelphia:Lippincott Williams & Wilkins, 2005:861-942.


Thus Progesterone provides the Contraceptive Effect And Estrogen regulates the Bleeding Pattern
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