-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
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