CHAPTER 1 - Combined Oral Contraceptives

Key Points for Providers and Clients
  • Take one pill every day. For greatest effectiveness a woman must take pills daily and start each new pack of pills on time.
  • Bleeding changes are common but not harmful. Typically, irregular bleeding for the first few months and then lighter and more regular bleeding.
  • Take any missed pill as soon as possible. Missing pills risks pregnancy and may make some side effects worse.
  • Can be given to women at any time to start later. If pregnancy cannot be ruled out, a provider can give her pills to take later, when her monthly bleeding begins.

What Are Combined Oral Contraceptives?

  • Pills that contain low doses of 2 hormones—a progestin and an estrogen—like the natural hormones progesterone and estrogen in a woman's body.
  • Combined oral contraceptives (COCs) are also called “the Pill,” low-dose combined pills, OCPs, and OCs.
  • Work primarily by preventing the release of eggs from the ovaries (ovulation).

How Effective?

Effectiveness depends on the user: Risk of pregnancy is greatest when a woman starts a new pill pack 3 or more days late, or misses 3 or more pills near the beginning or end of a pill pack.

  • As commonly used, about 8 pregnancies per 100 women using COCs over the first year. This means that 92 of every 100 women using COCs will not become pregnant.
  • When no pill-taking mistakes are made, less than 1 pregnancy per 100 women using COCs over the first year (3 per 1,000 women).

Return of fertility after COCs are stopped: No delay

Protection against sexually transmitted infections (STIs): None

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