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Combined Oral Contraceptives

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Combined Oral Contraceptives (COCs):
Answers to Your Questions

What are COCs?
Are they effective?
How do they work?
How do I use COCs?
How to begin using COCs
What to do if you miss taking a pill
Changes in menstrual periods and other side effects
Warning signs
What are the advantages and disadvantages of COCs?
Are COCs the right method for me?

The information provided here is meant to give you general information about COCs and does not replace the need to talk to a health care provider if you would like to use COCs as a contraceptive method.

What are COCs?

These are pills made from a combination of hormones that prevent pregnancy by stopping the eggs from leaving the woman's ovaries. The woman should take one pill orally each day according to instructions.

Are they effective?

If taken correctly, COCs are very effective.

NOTE: Contraceptive pills do not provide protection against HIV infection and other sexually transmitted infections. Aside from abstinence, latex condoms offer the best protection against these infections.

How do they work?

Hormones in the pills stop the egg from leaving the ovary every month. They also make it difficult for sperm to enter the womb. They do this by thickening the mucus at the entrance to the womb.

How do I use COCs?

As with any other method, you should talk to your doctor or a family planning counselor at a local clinic or hospital before using COCs as a contraceptive method. The following instructions are provided to help you decide whether COCs may be right for you.

How to begin using COCs:

Some medications interfere with the pill's effectiveness. Check with your health facility if you begin to take rifampin (rifampicin)--an antibiotic used to treat tuberculosis--or any medicine for convulsions or seizures. Bring the pill packets with you when you visit the health facility and tell the doctor or nurse that you are taking combined oral contraceptive pills. Your doctor, pharmacy, or family planning provider will give you a 28-day or 21-day packet of pills.
  • Always begin with the first pill in the packet.
  • Take the first pill on any of the first seven days of your menstrual period. For many women, it is easiest to remember to take the first pill on the first day.
  • Use another contraceptive method, such as condoms, until you have taken the pills for seven days in a row.
  • Swallow one pill each day at the same time of day, even if you do not have sexual intercourse.
  • Do not skip a single day between packets, even if you are still menstruating. Always start a new packet the day after finishing the last packet.
  • If this is the first time you have taken COCs and you have no problems, return to the health facility when your health provider suggests for a check-up and to get a new supply of pills. Bring the empty pill packets with you when you return.
  • Talk to a health care provider if:
    • You are not happy with the method
    • You think you are pregnant
    • You want information about or want to start using another family planning method
    • You think there is any chance you may have been exposed to HIV infection or any other sexually transmitted infections
  • If you have just delivered a baby and you are not breastfeeding, you may begin taking the pill after the third postpartum week, or at any time you and your doctor or health care provider believe you are not pregnant.
  • If you have just had an abortion, you may begin taking the pill on the same day as the abortion or at any time you and your health care provider believe you are not pregnant.
  • If you are ill and have severe vomiting or diarrhea, your pills may not work effectively. Use another contraceptive method or do not have sexual intercourse until you are well and have taken the pills for seven days in a row without severe vomiting or diarrhea.

What to do if you miss taking a pill:

  • If you miss taking a pill on one day, take it as soon as you remember. Take the next pill at the regular time, even if this means you take two pills in one day.
  • If you miss taking a pill on two or more days in a row, take a pill as soon as you remember. Take a pill each day until you finish the pack and wait to have sexual intercourse, or use another contraceptive method (such as condoms), until you have taken one pill each day for seven days in a row. This will give the pills time to protect you fully against pregnancy.
  • If you continually forget to take pills or if you interrupt pill-taking often, talk with your health care provider about using another method of family planning.

Changes in menstrual periods and other side effects

If you have any of the following side effects and they bother you, talk to your health care provider. Most side effects go away after the first few months of using COCs.

  • Your period will usually come while you are taking the fourth week of pills. If you do not have a period, continue to take your pills, but if you have symptoms of pregnancy, contact a health care provider for advice.
  • When you begin to take the pills, you may have some spotting between your menstrual periods. This is not your menstrual period. You should continue taking the pill each day.
  • You may have some nausea, dizziness, or headaches because your body is adjusting to the pill. These discomforts usually disappear after one or two packets of pills. Try taking the pill at bedtime or with food.
  • Your weight may slightly increase.
  • You may develop acne or dark-colored areas on your face.

Warning signs

Return to your health facility or go to a hospital at once if you have any of the warning signs listed here. Be sure to tell the health care provider that you are taking contraceptive pills.

  • Your skin or the whites of your eyes look yellow (jaundice)
  • You have severe pain in your belly
  • You have severe chest pain, cough, or shortness of breath
  • You have severe headache, dizziness, weakness, or numbness
  • New vision problems (vision loss or blurring) have developed
  • You are having speech problems
  • You have severe pain in your leg (calf or thigh)

What are the advantages and disadvantages of COCs?

Advantages:

  • You can discontinue COCs on your own at any time.
  • COCs are not linked to sexual intercourse.
  • Your menstrual periods may be more regular with less bleeding.
  • COCs may protect against some forms of cancer.

Disadvantages:

  • COCs do not provide protection against HIV infection and other sexually transmitted infections.
  • The pills may cause spotting between periods.
  • COCs are not usually recommended for women who are breastfeeding.
  • You may experience mild side effects, such as nausea, at the beginning.
  • You must remember to take a pill every day.

Are COCs the right method for me?

There are a number of factors that you should consider before deciding whether COCs are right for you. These questions can help you determine whether COCs might be an effective contraceptive method for you.


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