Adverse affects of combined Oral contraceptive pills (OCP'S) 1. Cardiovascular effects (Due to oestrogenic component) Myocardial infarction Cerebral thrombosis Venous thrombosis (with or without pulmonary embolism) Hypeension 2. Carcinogenesis Cervical cancer (increased risk). Breast cancer. 3. Metabolic effects (Due to progesterone component) Elevated blood pressure (hypeension) Altered lipid profile (reduced HDL) Blood clotting Hyperglycemia and increased plasma insulin. 3. Hepatocellular adenoma. 4. Gallbladder disease 5. Cholestatic jaundice 6. Monolial vaginitis (candidiasis) 7.Decline milk volume during lactation 8. Slight delay in return of feility (upon discontinuity) 9. Depression 10. Fetal bih defects. 11. General effects Breast tenderness Weight gain (due to water retention) Headache and migraine Bleeding disturbances Ref: Park 25th edition Pgno : 535-536