Combined oral contraceptives (COCs) are pills that are taken once a day to prevent pregnancy. They contain the hormones estrogen and progestin.
How do COCs work? (mechanism of action)
Inhibit ovulation
Thicken cervical mucus (make it hard for sperm to penetrate cervix)
Change endometrium (make implantation less likely)
Who can use COCs?
Women of any reproductive age or parity who:
Want to use this method of contraception
Have no contraindications
Who should not use COCs?
Women who have the following conditions (contraindications):
Pregnancy
Breastfeeding, during first six weeks of postpartum (not a good method for women who want to continue breastfeeding)
Unexplained vaginal bleeding (before evaluation)
Current breast cancer
Liver tumors, active hepatitis or severe cirrhosis
Age 35 or older, who smoke heavily (20 cigarettes/day or more)
Greatly increased risk of cardio-vascular conditions: blood pressure of 180/110 and higher, diabetes with vascular complications, history or current deep venous thrombosis, stroke, ischemic heart disease, severe headache with focal neurologic symptoms
(For more information, see WHO eligibility criteria.)
Advantages
Safe and 99% effective if used consistently and correctly
Reversible, rapid fertility return
Easy to discontinue use
Pills do not interfere with intercourse
Have beneficial non-contraceptive effects (menstrual improvements, protection from ovarian and endometrial cancer, protection from ectopic pregnancy and symptomatic PID requiring hospitalization, protection from anemia and benign breast disease)
Disadvantages
Require daily use
Incorrect use is common (easy to miss the pill)
Require re-supply
Have common side effects (serious complications very rare)
No protection against STIs/HIV
Possible side effects
Headaches
Nausea
Breakthrough bleeding
Breast tenderness
Mood changes
Weight gain
Dizziness
Amenorrhea
Provide follow-up and counseling for:
Any client concerns
Any warning signs of complications (thrombosis/thrombembolism):
