Combined Oral Contraceptives (COC)
Combined Oral Contraceptives (COCs) contain 21 tablets of low doses of two hormones: a progestin and an oestrogen. The COC supplied by MoHP contains 30mcg (0.3 mg) ethinylestradiol, 150 mcg (0.15 mg) LNG and seven iron-containing tablets.
The COC is moderately effective. There is no delay in return of fertility once the pill is stopped.
How to use the COC?
Take the first tablet on the first day following menses, and then daily at the same time each day, for the first pack; repeat a new pack after the first pack is completed. Continue every day without any interruption as long as contraception is desired.
When to start COC?
- Within first five days of menstruation
- Any day of menstruation if it is reasonably certain the woman is not pregnant
- Day one of MVA/spontaneous abortion
- After delivery
(a) If lactating – start after six months
(b) If not lactating – start after six weeks.
What if a pill is missed?
If a woman misses one or more pills, she should take a missed hormonal pill as soon as possible and keep taking pills as usual, one each day. In addition:
- If one or two pills are missed (or a new pill pack is started one or two days late): Take a hormonal pill as soon as possible.
- If three or more pills are missed in the first and second rows/weeks (or a new pill pack is started three or more days late): Take a hormonal pill as soon as possible, use a back-up method for the next seven days (e.g. condom) and use an ECP if there has been unprotected sexual intercourse in the past five days.
- If three or more pills are missed in the third row/week: Take a hormonal pill as soon as possible, finish all
remaining hormonal pills in the pack, throw away the seven non-hormonal pills, start a new pill pack the next day, use a back-up method (e.g. condom) for the next seven days, and use an ECP there has been unprotected sexual intercourse in the past five days.
Who should not use COC?
Precaution for the use of COC:
The Medical Eligibility Criteria (MEC) for contraceptive use provides guidance on whether women with certain medical conditions can safely and effectively use specific contraceptive methods.
Avoid use: use other methods if available (MEC – 3)
- Smoker and >35 years of age, <15 cigarettes per day
- <6 months post-delivery and breastfeeding
- High BP: SBP 140–159mm Hg or DBP 90–99mm Hg
- Past breast cancer
- Current symptomatic gall bladder disease
- Using antibiotics, rifampicin or rifabutin or anti-convulsant.
COC contraindicated (MEC – 4)
- Smoker and >35 years of age, >15 cigarettes per day
- Migraine headache with aura
- Current breast cancer
- Postpartum less than six weeks and breastfeeding
- High BP: SBP >160mm Hg or DBP >100mm Hg
- History of thromboembolism (DVT/PE), acute thromboembolism (DVT/PE)
- Major surgery with prolonged immobilisation
- Stroke, current and past history of ischaemic heart disease
- SLE (Positive (or unknown) antiphospholipid antibodies
- Liver tumours (hepatoma, adenoma)
- Acute flare-up of hepatitis, severe cirrhosis.
Other Uses of COC
For Emergency Contraception (ECP)
- Unscheduled (irregular or increased) bleeding following use of IUCD and other hormonal contraceptives
- Abnormal uterine bleeding (see RH Protocol for ANMs/SN and RH Protocols for Paramedics)
- Reduces menstrual blood loss, and thus reduce anaemia
- Relieves dysmenorrhea and premenstrual symptoms
- Regularises menstrual cycles
- Reduces the chances of ectopic pregnancies
- Provides some protection against pelvic infection, and ovarian cysts
- Reduces the chances of developing ovarian and endometrial cancer
- May decrease the risk of colorectal cancer
- Reduces hirsutism, acne.
Side Effect of COC
- Spotting or bleeding
- Pain in the breast
Refrence: Standard Treatment Protocol Nepal
- How to Use Mifepristone and Misoprostol
- List of Free Medicine in Nepal
- National Immunization Schedule of Nepal