Provided by You Health

Combined Oral Contraceptives (COCs)

Consumer information use and disclaimer.

**This is a general medication overview that reviews the risks and benefits of combined oral contraceptives (COCs) for the prevention of pregnancy. Please make sure to read it in addition to the manufacturer’s pamphlet that comes with your COC pill pack.
Through the Hers platform, birth control pills are available to women between the ages of 18-50, if deemed appropriate by the healthcare provider **

What are combined oral contraceptives (COCs)?:

A birth control pill taken by mouth that contains 2 types of female hormones (ethinyl estradiol and a progestin) used to prevent pregnancy. In the United States, COC’s are available by prescription only.

How effective are COCs at preventing pregnancy?:

If COCs are taken perfectly (i.e., as prescribed), then they are 99% effective. However, most people don’t take their COCs perfectly! With typical use of COCs, they are 91% effective in preventing pregnancy.

How do COCs reduce the risk of pregnancy?:

  • Preventing ovulation
  • Keeping the mucus in the cervix thick and impenetrable to sperm
  • Keeping the lining of the uterus thin

Other benefits of COCs include:

  • Decreased menstrual blood loss
  • Decreased menstrual cramps or pain
  • Decreased risk of ovarian cancer or cancer of the endometrium (uterine lining)
  • Increased menstrual cycle regularity

What are the different types of COCs?:

  • Monophasic: one dose of hormone in each of the active pills
  • Biphasic: 2 different doses of hormone throughout the pill pack*
  • Triphasic: 3 different doses of hormone throughout the pill pack*
*Biphasic and Triphasic COCs are designed to mimic the natural rise and fall of hormones throughout the month
  • Monthly COCs: have a period each month
  • Extended-cycle COCs: have a period every 3 months to 1 year

When should I start taking my COCs?:

There are 2 ways to start COCs:
  • First day start: Start taking your COC on the first day of your menstrual period.
  • Sunday start: Start your COC on the Sunday following the start of your menstrual period. With the Sunday start method, you will need to use a back-up nonhormonal form of birth control (e.g., condoms) for the first 7 days. If your period starts on a Sunday, start taking your COC that same day.

How do I take my COCs?:

It is important to take your pill at the same time each day.
  • 21-day pill pack: Take one pill at the same time each day for 21 days. Wait 7 days before starting a new pack. During the week you are not taking the pill, you will have your period.
  • 28-day pill pack: Take one pill at the same time each day for 28 days. You will get your period during the last 7 days of the pack.
  • 91-day pill pack: Take one pill at the same time each day for 91 days. You will have your period during the last week of each 3-month pack.

What do I do if I forget to take my pill?

Your COC may not be as effective if you forget to take a pill(s). This can increase your risk of getting pregnant. Please refer to the package insert that accompanied your COC for instructions on how to handle a missed or skipped dose. It will also provide you with information regarding the need for back-up contraception. If you are unable to find adequate instructions, follow the missed dose procedures below. Contact your healthcare provider if you have further questions.

Missed Dose Instructions:

Remember to check your COC packaging first.

What are the common side effects of COCs?:

  • Breakthrough bleeding
  • Nausea/vomiting
  • Breast tenderness
  • Headache
  • Abdominal pain
  • Painful periods
  • Mood, affect and anxiety disorders
Oftentimes, these side effects are temporary and resolve within 3 months of starting the pill. However, if the symptoms persist beyond 3 months, please speak with a healthcare provider. You can send a message to a healthcare provider through the Hers platform at any time.

What are some of the risks associated with taking COCs?:

  • Myocardial infarction
  • Thromboembolism
  • Cerebrovascular disease
  • Carcinoma of the reproductive organs (breast, cervix): However, there is substantial evidence that combined oral contraceptives DO NOT increase the incidence of breast cancer. Some studies suggest that combined oral contraceptive use has been associated with an increase in the risk of cervical cancer. However, there continues to be controversy about the extent to which such findings may be due to differences in sexual behavior and other factors.
  • Hepatic neoplasias
  • Ocular lesions
  • Gallbladder disease
  • Elevated blood pressure
  • Headache
  • Bleeding irregularities
  • Carbohydrate and lipid metabolic effects
  • Hyperkalemia (specific to drospirenone-containing COCs)

Please seek immediate medical care if you experience any of the following symptoms while taking COCs:

  • Chest pain or pressure, sudden shortness of breath
  • Sudden, severe headache unlike your usual headaches
  • Sudden blindness, partial or complete
  • Severe leg pain that doesn’t go away
  • Yellowing of the skin or eyeballs
  • Weakness or numbness in an arm or leg, or trouble speaking
  • Sudden onset of abdominal pain

Certain medications can interact with COCs and should be avoided. This list includes, but is not limited to:

  • Rifampin or Rifabutin
  • Carbamazepine
  • Felbamate
  • Oxcarbazepine
  • Phenytoin
  • Primidone
  • Rufinamide
  • Topiramate > 200mg/day
  • Lamotrigine
  • St. John’s Wort
  • Ombitasvir/paritaprevir/ritonavir, with or without dasabuvir
  • Darunavir
  • Nelfinavir
  • Lopinavir/ritonavir
  • Efavirenz
  • Nevirapine
  • Modafinil
  • Griseofulvin
  • Bosentan
  • Barbiturates

Certain medications can interact with COCs containing drospirenone (e.g., Yasmin®, Yaz®, Ocella®, Nikki®, Gianvi®, Zarah®, Syeda®, Loryna®) and should be avoided. This list includes, but is not limited to:

  • Diuretics
  • ACE-Inhibitors
  • Angiotensin II antagonists
  • Aspirin or Nonsteroidal antiinflammatories
  • Spironolactone
  • triamterene
  • Eplerenone
  • Heparin
  • Potassium supplements

Please make sure to review all of the medicines that you are currently taking with your healthcare provider.

How soon after I give birth can I start using COCs:

Due to the increased risk of venous thromboembolism (VTE) postpartum, COCs should not be started in a breastfeeding woman < 21 days following delivery. The risk decreases to baseline by postpartum day 42. Through the Hers platform, COC’s are only available to women who are at least 42 days postpartum.

Can I use COC’s while I am breastfeeding?:

If you are breastfeeding, estrogen may affect your milk supply. It is recommended that you wait 30-42 days after giving birth, when breastfeeding has been well established. Through the Hers platform, COC’s are only available to breastfeeding women who are at least 42 days postpartum.

Will COCs protect me against sexually transmitted infections (STIs)?:

COCs DO NOT protect against STIs. In order to prevent STIs, additional barrier contraception (e.g., male or female latex condom) should be used.

How do I store my COCs?:

Store your COCs at room temperature (between 68℉ and 77℉) in the packaging provided by the pharmacy until you need it, away from heat and moisture. Keep out of reach of children.

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