Combined estrogen-progestin oral contraceptives (COCs)

-Estrogen used in most COCs: Ethinyl estradiol

-Most available progestins have both progestogenic and androgenic activity

-Mechanism of action: Suppression of GnRH, pituitary gonadotropin secretion; Inhibition of the midcycle luteinizing hormone (LH) surge, preventing ovulation; making endometrium less suitable for implantation.

-Typical-use failure rate: 8 percent

-Hormonal contraception can be continued until the age of menopause (average age 50 to 51 years) in healthy, nonsmoking, normal-weight women

-COC use has been associated with increased risks of myocardial infarction, hypertension,stroke, increase risk of venous thromboembolism.

-Contraindications for COC initiation:

Migraines with aura

Age > 35 years

Smoking

Hypertension

Venous thromboembolism

Known thrombogenic mutations

Ischemic heart disease or severe valvular heart disease

History of stroke

Current breast cancer

Liver cancer or cirrhosis

Non-Contraceptive Benefits of COCs: improves abnormal uterine bleeding, premenstrual syndrome, dysmenorrhea, painful ovarian cysts, acne, hirsutism, polycystic ovary syndrome,bone density, reduces the risk of endometrial and ovarian cancer;

Don’t Get Confused: COCs and Cancer: They increase the risk for developing cervical cancer; They reduce the risk of developing ovarian and endometrial cancers. Overall, the pill is not associated with an increased risk of cancer.

Initiation: COCs can be started anytime during the cycle after excluding the pregnancy.

Quick Start method: begin taking COCs on the day she is given the prescription.

Sunday Start method: start the pill on the first Sunday after her period

-Drugs which decrease the efficacy of a COC: Phenobarbital, Phenytoin,topiramate, primidone Griseofulvin, Rifampin

-Only antibiotic proven to decrease serum ethinyl estradiol and progestin levels in women taking COCs: Rifampin