Combined Oral Contraceptive → DrGuide

Class: Hormonal Contraceptives

Indications

Prevention of pregnancy
Regulation of menstrual cycles
Management of conditions like polycystic ovary syndrome (PCOS), endometriosis, and acne
Reduction of premenstrual syndrome (PMS) symptoms

Mechanism of Action

Suppresses ovulation by inhibiting the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
Thickens cervical mucus, preventing sperm from reaching the egg
Alters endometrial lining, reducing the likelihood of implantation

Dosage and Administration

Typically taken as one tablet daily for 21-24 days, followed by 4-7 days of placebo or no pill (depending on the brand)
Start on the first day of menstruation or the first Sunday after menstruation begins
Consistent daily intake at the same time is crucial for effectiveness

Forms Available

Monophasic pills: Same hormone dose in each active pill (e.g., Microgynon, Yasmin)
Biphasic/Triphasic pills: Varying hormone doses to mimic the natural cycle (e.g., Ortho Tri-Cyclen)
Extended-cycle pills: Taken continuously for 84 days followed by a 7-day break (e.g., Seasonique)

Brand Names and Manufacturers

Cost

Contraindications

Precautions

Monitor for signs of blood clots, especially in women with risk factors such as obesity or prolonged immobility
Avoid in women with migraine with aura due to increased stroke risk
May affect glucose tolerance; use with caution in diabetic patients

Side Effects

Common: Nausea, headache, breast tenderness, mood changes, breakthrough bleeding
Less common: Weight changes, decreased libido, bloating
Serious: Blood clots (DVT, PE), stroke, liver tumors, hypertension

Drug Interactions

Enzyme-inducing drugs (e.g., rifampin, phenytoin): May reduce contraceptive effectiveness
Antiretrovirals and antibiotics (e.g., griseofulvin): Potential to decrease efficacy
Herbal supplements (e.g., St. John’s Wort): Can lower hormone levels
Warfarin and other anticoagulants: May alter effectiveness

Monitoring Parameters

Patient Counseling Points

Take at the same time daily to maintain hormone levels
If a pill is missed, take it as soon as remembered; follow specific instructions for missed pills in the product guide
Does not protect against sexually transmitted infections (STIs); use barrier methods if needed
Report severe symptoms such as chest pain, leg pain, sudden shortness of breath, or vision changes
Backup contraception (e.g., condoms) is needed for 7 days if pills are missed or after starting certain medications
Store at room temperature away from moisture and light

FAQs About Combined Oral Contraceptives
Q1: How effective are COCs in preventing pregnancy?

99% effective with perfect use, 91% effective with typical use
Q2: Can COCs help with acne?
Yes, certain formulations reduce androgen levels, improving acne symptoms
Q3: Can I take COCs while breastfeeding?
Not recommended in the first 6 weeks postpartum due to thromboembolism risk; progestin-only pills are preferred
Q4: What should I do if I miss two or more pills?
Take the most recent missed pill immediately and use backup contraception for 7 days
Q5: Can I stop taking COCs at any time?
Yes, but stopping may lead to irregular periods and an increased risk of pregnancy if no alternative method is used
Q6: Do COCs increase cancer risk?
Slightly increased risk of breast and cervical cancer, but reduced risk of ovarian and endometrial cancer
Q7: Can COCs cause weight gain?
Minimal or no significant weight gain is associated with modern low-dose pills

Combined Oral Contraceptive