Combination Oral Contraceptive Pills

Combination oral contraceptive pills (COCs) are a type of birth control medication that contains both estrogen and progestin hormones. They are designed to prevent pregnancy by suppressing ovulation, thickening cervical mucus, and altering the uterine lining.

How COCs Work

COCs work by:

• Suppressing the release of gonadotropin-releasing hormone (GnRH), which in turn suppresses the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), preventing ovulation.
• Thickening cervical mucus, making it more difficult for sperm to penetrate and fertilize an egg.
• Altering the uterine lining, making it less receptive to implantation of a fertilized egg.

Types of COCs

There are several types of COCs available, including:

• Monophasic pills: These pills contain the same amount of estrogen and progestin in each active pill.
• Biphasic pills: These pills contain two different levels of hormones, with a higher dose of estrogen in the first half of the pack and a lower dose in the second half.
• Triphasic pills: These pills contain three different levels of hormones, with varying doses of estrogen and progestin throughout the pack.
• Extended-cycle pills: These pills are designed to be taken for 84 days, followed by a 7-day break, reducing the frequency of menstrual periods.

Benefits of COCs

The benefits of COCs include:

• High effectiveness in preventing pregnancy (99% with perfect use).
• Regulation of menstrual cycles and reduction of menstrual cramps.
• Decreased risk of ovarian cysts and ectopic pregnancies.
• Improved acne and hirsutism symptoms.

Risks and Side Effects of COCs

The risks and side effects of COCs include:

• Nausea and vomiting.
• Headaches and migraines.
• Breast tenderness and mood changes.
• Increased risk of blood clots, stroke, and heart attack, particularly in women over 35 who smoke.
• Increased risk of cervical cancer and liver tumors.

Contraindications for COCs

COCs are contraindicated in women with:

• Pregnancy or suspected pregnancy.
• Current or past blood clots, stroke, or heart attack.
• Severe hypertension.
• Liver disease or liver tumors.
• Smoking over the age of 35.

Interactions with Other Medications

COCs can interact with other medications, including:

• Antibiotics, such as rifampicin and griseofulvin.
• Anti-seizure medications, such as phenytoin and carbamazepine.
• Anti-tuberculosis medications, such as rifabutin.

Missed Pills and Contraceptive Failure

If a pill is missed, the risk of contraceptive failure increases. Women should:

• Take the missed pill as soon as possible.
• Use a backup method of contraception for the next 7 days.
• Consult their healthcare provider if they have any concerns or questions.