Contains an oestrogen plus a progestin, the types and quantities of which may vary in different preparations.
Examples include Pilplan, Microgynon
Indications
- Women <35 years needing highly effective FP method
- Non-breastfeeding clients, or breastfeeding clients after 6 months postpartum
- Clients with dysmenorrhoea
- Clients with heavy periods or ovulation pain
- Clients concerned by irregular menstrual cycles
Contraindications
- Diastolic BP >100 mmHg
- Cardiac disease
- Thromboembolic disease (e.g. deep vein thrombosis)
- Active liver disease
- Within 2 weeks of childbirth
- When major surgery is planned within 4 weeks
- Unexplained abnormal vaginal bleeding
- Known/suspected cervical cancer
- Undiagnosed breast lumps or breast cancer
- Pregnancy (known or suspected)
Risk factors
If any 2 of the following, recommend progrestogen-only or non-hormonal FP method
- Smoking (especially if >10 cigarettes/day)
- Age >35 years
- Diabetes
Advantages and other potential health benefits/uses
- Protects against:
- Risk of unwanted pregnancy
- Cancer of the ovary or lining of uterus
- Symptomatic pelvic inflammatory disease
- Reduces:
- Menstrual cramps and bleeding problems
- Ovulation pain
- Excess hair on body/face, acne
- Symptoms of polycystic ovarian syndrome
Disadvantages and common side effects
- DOES NOT PROTECT AGAINST STIs
- Spotting, nausea, and vomiting within first few months
- Changes in bleeding patterns including: fewer days, irregular, lighter, infrequent, or no monthly bleeding
- May cause headaches, dizziness, weight gain
- Effectiveness dependent on regular daily dosage
- Mood changes
- Breast tenderness
- Suppresses lactation
- Medicine interactions reduce effectiveness including:
- Medicines which increase hepatic enzyme activity, e.g., rifampicin (especially), carbamazepine, griseofulvin, nevirapine, phenytoin, phenobarbital
- Short courses of some broad spectrum antibiotics, e.g., ampicillin, amoxicillin, doxycycline
An additional FP method must be used during course of treatment with these medicines and for at least 7 days
after completion.
Complications and warning signs
- Severe headaches, blurred vision
- Depression
- Acute severe abdominal pain
- Chest pain plus dyspnoea (pulmonary embolism)
- Swelling or pain in calf muscle (Deep vein thrombosis)
INSTRUCTIONS
- Give 3 cycles of COC and explain carefully:
- How to take the tablets
- Strict compliance is essential
- What to do if doses are missed or there are side effects or warning signs
If starting COC within 5 days of period
- Supply and show how to use back-up FP method
- Ask client to return when <7 tablets remain in last cycle
MANAGEMENT OF SIDE EFFECTS OF COCS
Nausea
- Assess for pregnancy and malaria
- Suggest taking COCs at bedtime or with food
- Take pill at same time daily
If symptoms continue:
- Consider locally available remedies (e.g. eating roasted grains, roasted cassava, boiled greens)
Breast Tenderness
- Assess for pregnancy
- Recommend that she wears a supportive bra
- Examine for cancer symptoms, such as breast infection, lumps, or nipple discharge
If breastfeeding, examine for breast infection
- If there is infection, use warm compresses. Refer for appropriate evaluation
- If the examination shows a suspicious lump or discharge, refer for appropriate evaluation
- Counsel her on non-hormonal FP methods
- Try hot or cold compresses
- Suggest ibuprofen, paracetamol, or other pain relievers
Mild Headaches
- Take proper history (explore when headaches occur, whether she can continue with her daily tasks, what
medicines relieve her headaches) - Take her blood pressure
If blood pressure is normal:
- Give pain relievers such as ibuprofen or paracetamol
- If headaches get worse or occur more often, refer for appropriate evaluation
Palpitations
- Rule out anaemia and check blood pressure and weight
- Reassure that this is common in COC users, and usually disappears in a few months
- Evaluate for other causes unrelated to the method, and refer if necessary
Chest Pain
- Evaluate for the cause and refer if necessary