combined oral contraceptive pill

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A wide variety of different types of combined oral contraceptive pill are available. All contain synthetic:

  • oestrogen - either ethinyloestradiol or menstranol
  • a progestogen

The oestrogen content is 20 to 50 mcg. In general, a combined oral contraceptive pill with the lowest oestrogen and progestogen content which provides good cycle control and gives minimal side effects is chosen.

The combined pill can be given to women up to 50 years of age. In older women low strength preparations (containing 20 mcg of oestrogen) are appropriate. Low strength preparations are also appropriate for obese women.

The summary of product characteristics should be consulted before prescribing a particular combined oral contraceptive pill.

Dose and frequency of administration (1):

FSRH guidance states that COC can either be taken following a standard or tailored regimen. 

Individuals should be given information about both standard and tailored COC regimen to broaden contraceptive choice.

Monophasic COC products/regimen

  • Monophasic COC can either be taken as a standard regimen or in a tailored regimen depending on the choice of the individual.
  • The regimens which can be advised are detailed below:

Type of regimen

Period of COC use

Hormone (pill) free interval

Standard use

Standard use

21 days (21 active pills)

7 days

Tailored use

Shortened hormone-free interval

21 days (21 active pills)

4 days

Extended use (tri-cycling)

9 weeks (3x21 active pills)

4 or 7 days

Flexible extended use

Continuous use (>=21 days) of active pills until breakthrough bleeding occurs for 3-4 days

4 days

Continuous use

Continuous use of active pills

None

  • For the monophasic regimen detailed above a single tablet is to be taken at the same time each day starting on day 1-5 of the menstrual cycle with no need for additional precautions. The exception to this is Qlaira®, which should be started on day 1, or if not, additional precautions should be used for 9 days after starting. 
  • Thereafter the dosage regimen detailed above should be followed. Individuals should have access to clear information (either written or digital) to support tailored COC use.

Monophasic everyday, phasic and phasic everyday COC products/regimens

For monophasic everyday, phasic and phasic everyday regimens a single tablet is to be taken at the same time each day starting on day 1-5 of the menstrual cycle with no need for additional
  • precautions. The exception to this is Qlaira®, which should be started on day 1, or if not, additional precautions should be used for 9 days after starting. 
  • Thereafter follow manufacturer’s instructions for individual product use.

For all COC products/regimens

  • COC can be started at any time after day 5 of the menstrual cycle if it is reasonably certain that the individual is not pregnant. Additional precautions are then required for 7 days after starting (9 days for Qlaira®)
  • When starting or restarting the CHC as quick start after levonorgestrel emergency contraception, additional contraception is required for 7 days and a pregnancy test should be performed 21 days after the last unprotected sexual intercourse.
  • In line with FSRH guidance individuals using hormonal contraception should delay restarting their regular hormonal contraception for 5 days following ulipristal acetate use. Avoidance of pregnancy risk (i.e. use of condoms or abstain from intercourse) should be advised until fully effective. 

For guidance on changing from one contraceptive method to another, and when to start after an abortion and postpartum, refer to the FSRH guidance

Reference:

  • Patient Group Direction (PGD) (NHS Specialist Pharmacy Service). Supply of a combined oral hormonal contraceptive (COC) . (Accessed 17th March 2021).

Last edited 03/2021

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