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of the endogenous hormone progesterone, is highly effective alone as a contraceptive, but may cause irregular bleeding. The addition of estrogen to progestin in combined methods results in more predictable bleeding patterns dueto stabilization of the endometrium. Estrogen as a single agent for contraception requires doses that may cause unacceptable risks of serious side effects, such as thromboembolic events and endometrial hyperplasia. The synergistic activity of estrogen and progestin makes it possible to combine these hormones in lower doses to produce successful contraception than would be possible using either hormone alone. None of the hormonal methods provide STI protection. For this reason, it is important to stress the concomitant use of barrier methods in women who are at risk of exposure to STIs. Benefits: benefits of hormonal methods include a decreased risk of several cancers (colon, ovarian, and endometrial) as well as a decreased risk of the serious diseases of endometriosis, adenomyosis, rheumatoid arthritis, and asthma. Protection against ovarian and uterine cancer may persist as long as 28 years after discontinuation of use of these methods. The preservation of bone density that occurs in ever-users of COCs may persist up to age 80. An increased risk of cervical cancer is seen in long-term COC users, though this risk returns to normal after cessation of use. Although an increased risk of a rare type of liver tumor is connected with COC use, the decreased risk of other, more common cancers may lead to an overall decrease in cancer-related mortality. During the first few postpartum weeks, the risk of venous thromboembolism (VTE; deep vein thromboses and pulmonary emboli) is greatly elevated in all women; consequently, estrogen-containing contraceptives are contraindicated during this time.Progestin-only methods may be initiated immediately postpartum. Combined Oral Contraception:Most of the COCs available today contain 10 to 35 mcg of ethinyl estradiol, although a few COCs contain 50 mcg of ethinyl estradiol or mestranol, the methyl ether of ethinyl estradiol. Approximately 30% of mestranol is lost when it is converted to ethinyl estradiol; thus a 50-mcg mestranol pill is bioequivalent to a 35-mcg ethinyl estradiol pill. Estradiol valerate is found in the new quadphasic COC. Drospirenone, the only non-testosterone-derived progestin, is an analogue of the diuretic spironolactone. Drospirenone has a mild potassium-sparing diuretic effect, necessitating that potassium levels be checked during the first cycle in women using angiotensin-converting enzyme (ACE) inhibitors, chronic daily non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin-II receptor antagonists, potassium-sparing diuretics, heparin, or aldosterone antagonists. Women with conditions that predispose them to hyperkalemia should not use COCs containing drospirenone. An increasingly popular alternative approach is to utilize a “quick start” by beginning the pill