oral contraceptive (OC)

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Introduction

Two types are available:

Indications

# may be less effective in overweight women (BMI > 27)[17]

# LoSeasonique effective in obese women as well as women with normal BMI[30]

Contraindications

* increased risk for stroke[4]

Caution:

Advantages

* reduced risk of epithelial ovarian cancer with oral contraceptives, esp those containing high-dose progestins (RR=0.72)[44] {protective effect of progestins}[10]

* reduced risk of endometrial cancer (RR=0.68)[37][44]

Dosage

  • therapy is best begun with onset of menses
    • OCs NOT fully effective for 1st week or more[15]
  • Sunday-start packaging
    • begin 1st pill on Sunday following onset of menses
    • if menses begins on Sunday, start 1st pill on that day
    • 1 tablet daily
    • last 7 days of 28 day package are inert tablets
  • MISSED dosages
    • 1 missed tablet:
      • take one as soon as you remember, or
      • take two the next day
    • 2 missed tablets:
      • take 2 tablets as soon as remembered & continue with the next daily dose at the scheduled time
      • take 2 tablets/day for the next 2 days
      • use additional contraceptive methods for 7 days
    • 3 missed tablets:
      • start a new package on day 1 of the cycle after the last pill was taken, or
      • start 7 days after the last pill was taken
      • use additional contraceptive methods for the remainder of the cycle
  • tricycle regimen
    • three 21 day packs (monophasic) consecutively
    • wait one week, then restart another cycle
    • reduces number of periods
  • discontinuation of oral contraceptive
    • amenorrhea can last up to 3 months
    • longer duration should be investigated
  • do NOT insert vaginally*[8]

* Cosmopolitan magazine 2001 or 2002 site 2 studies of vaginally inserted BCP; these studies used higher dose pills than those in common use

Pharmacokinetics

Monitor

Adverse effects

* levonorgestrel with 20 ug estrogen associated with lower risk for pulmonary embolism, stroke, or MI, relative to 7 other combinations[39]

Drug interactions

Mechanism of action

Notes

More general terms

More specific terms

References

  1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999.
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 242-43
  4. Jump up to: 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17. American College of Physicians, Philadelphia 1998, 2012, 2015
  5. Jump up to: 5.0 5.1 Prescriber's Letter 7(7):39 2000
  6. Prescriber's Letter 7(9):52 2000
  7. Jump up to: 7.0 7.1 Journal Watch 21(11):85, 2001 Stewart FH et al Clinical breast and pelvic examination requirements for hormonal contraception: Current practice vs evidence. JAMA 285:2232, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11325325
  8. Jump up to: 8.0 8.1 Prescriber's Letter 9(2):9 2002
  9. Jump up to: 9.0 9.1 9.2 9.3 Journal Watch 22(3):21-22, 2002 Tanis BC et al Oral contraceptives and the risk of myocardial infarction. N Engl J Med 345:1787, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11752354
  10. Jump up to: 10.0 10.1 Journal Watch 22(5):39, 2002 Schildkraut JM et al Impact of progestin and estrogen potency in oral contraceptives on ovarian cancer risk. J Natl Cancer Inst 94:32, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11773280
  11. Jump up to: 11.0 11.1 Journal Watch 22(9):74, 2002 Munoz N et al Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet 359:1093, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11943256
    Moreno V et al Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet 359:1085, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11943255
  12. Jump up to: 12.0 12.1 Journal Watch 22(15):120-21, 2002 MarchBanks PA et al Oral contraceptives and the risk of breast cancer. N Engl J Med 346:2025, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12087137
    Davidson NE & Helzlsouer KJ Good news about oral contraceptives. N Engl J Med 346:2078, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12087145
  13. Jump up to: 13.0 13.1 Prescriber's Letter 9(7):39 2002
  14. Jump up to: 14.0 14.1 Prescriber's Letter 11(2):8 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200203&pb=PRL (subscription needed) http://www.prescribersletter.com
  15. Jump up to: 15.0 15.1 Prescriber's Letter 11(4):21 2004
  16. Hormonal Contraception Prescriber's Letter 10(10):57 2003 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=191010&pb=PRL (subscription needed) http://www.prescribersletter.com
  17. Jump up to: 17.0 17.1 Prescriber's Letter 12(2): 2005 Efficacy of Oral Contraceptives in Overweight Women Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210212&pb=PRL (subscription needed) http://www.prescribersletter.com
    Journal Watch 25(4):34-35, 2005 Holt VL, Scholes D, Wicklund KG, Cushing-Haugen KL, Daling JR. Body mass index, weight, and oral contraceptive failure risk. Obstet Gynecol. 2005 Jan;105(1):46-52. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15625141
  18. Jump up to: 18.0 18.1 Prescriber's Letter 12(9): 2005 Ortho Evra and the Risk of Thromboembolism Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210902&pb=PRL (subscription needed) http://www.prescribersletter.com
  19. Jump up to: 19.0 19.1 19.2 19.3 19.4 Prescriber's Letter 12(9): 2005 Oral Contraceptive (OC) Drug Interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210903&pb=PRL (subscription needed) http://www.prescribersletter.com
  20. Prescriber's Letter 14(3): 2007 Concerns About the Newer Oral Contraceptives Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230303&pb=PRL (subscription needed) http://www.prescribersletter.com
  21. Prescriber's Letter 14(12): 2007 Hormonal contraception Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=231207&pb=PRL (subscription needed) http://www.prescribersletter.com
  22. Prescriber's Letter 15(5): 2008 Hormonal Contraception in Older Women Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240508&pb=PRL (subscription needed) http://www.prescribersletter.com
  23. Jump up to: 23.0 23.1 Townsend MK et al Oral contraceptive use and incident urinary incontinence in premenopausal women. J Urol 2009 May; 181:2170. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19296979
    Jackson SL and Fihn SD Exogenous estrogen and urinary incontinence. J Urol 2009 May; 181:1989. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19286197
  24. Prescriber's Letter 16(8): 2009 PATIENT HANDOUT: What I Need to Know About Missing Birth Control Doses CHART: Missed Doses of Hormonal Contraceptives COMMENTARY: Missed Doses of Hormonal Contraception GUIDELINES: Missed Hormonal Contraceptives: New Recommendations Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250811&pb=PRL
  25. Jump up to: 25.0 25.1 Stringer EM et al HIV disease progression by hormonal contraceptive method: Secondary analysis of a randomized trial. AIDS 2009 Jul 17; 23:1377. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19448528
  26. Jump up to: 26.0 26.1 Hannaford PC et al. Mortality among contraceptive pill users: Cohort evidence from Royal College of General Practitioners' Oral Contraception Study. BMJ 2010 Mar 11; 340:c927. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20223876 <Internet> http://dx.doi.org/10.1136/bmj.c927
  27. Prescriber's Letter 17(12): 2010 CHART: Hormonal Contraception CHART: Comparison of Oral Contraceptives Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=261207&pb=PRL (subscription needed) http://www.prescribersletter.com
  28. Jump up to: 28.0 28.1 Jick SS and Hernandez RK Risk of non-fatal venous thromboembolism in women using oral contraceptives containing drospirenone compared with women using oral contraceptives containing levonorgestrel: case- control study using United States claims data BMJ 2011; 342:d2151 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21511805 <Internet> http://www.bmj.com/content/342/bmj.d2151
    Parkin L et al Risk of venous thromboembolism in users of oral contraceptives containing drospirenone or levonorgestrel: nested case-control study based on UK General Practice Research Database BMJ 2011; 342:d2139 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21511804 <Internet> http://www.bmj.com/content/342/bmj.d2139
    Dunn N The risk of deep venous thrombosis with oral contraceptives containing drospirenone BMJ 2011; 342:d2519 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21511807 <Internet> http://www.bmj.com/content/342/bmj.d2519.extract
    FDA Safety Alert: Posted 05/31/2011 Birth Control Pills Containing Drospirenone: Possible Increased Risk of Blood Clots http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm257337.htm
  29. Jump up to: 29.0 29.1 Lidegaard O et al Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9 BMJ 2011; 343:d6423 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22027398 <Internet> http://www.bmj.com/content/343/bmj.d6423.full
    Hannaford PC The progestogen content of combined oral contraceptives and venous thromboembolic risk BMJ 2011; 343:d6592 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22028481 <Internet> http://www.bmj.com/content/343/bmj.d6592.extract
  30. Jump up to: 30.0 30.1 Westhoff CL et al. Body weight does not impact pregnancy rates during use of a low-dose extended-regimen 91-day oral contraceptive. Contraception 2012 Mar; 85:235. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22067763
  31. Jump up to: 31.0 31.1 Lidegaard O et al Thrombotic Stroke and Myocardial Infarction with Hormonal Contraception N Engl J Med 2012; 366:2257-2266June 14, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22693997 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1111840
    Petitti DB Hormonal Contraceptives and Arterial Thrombosis - Not Risk-free but Safe Enough N Engl J Med 2012; 366:2316-2318June 14, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22694003 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1204769
  32. Jump up to: 32.0 32.1 Mantha S et al Assessing the risk of venous thromboembolic events in women taking progestin-only contraception: a meta-analysis. BMJ 2012;345:e4944 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22872710 <Internet> http://www.bmj.com/content/345/bmj.e4944
  33. American College of Obstetricians and Gynecologists Over-the-Counter Access to Oral Contraceptives http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/Over-the-Counter_Access_to_Oral_Contraceptives
  34. Jump up to: 34.0 34.1 ACOG Committee on Practice Bulletins-Gynecology. ACOG practice bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol. 2006 Jun;107(6):1453-72. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16738183
  35. Jump up to: 35.0 35.1 Stegeman BH et al Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ 2013;347:f5298 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24030561 <Internet> http://www.bmj.com/content/347/bmj.f5298
  36. Jump up to: 36.0 36.1 Vinogradova Y et al Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ 2015;350:h2135 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26013557 <Internet> http://www.bmj.com/content/350/bmj.h2135
    Jick SS Fresh evidence confirms links between newer contraceptive pills and higher risk of venous thromboembolism. BMJ 2015;350:h2422 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26013974 <Internet> http://www.bmj.com/content/350/bmj.h2422
  37. Jump up to: 37.0 37.1 Collaborative Group on Epidemiological Studies on Endometrial Cancer. Endometrial cancer and oral contraceptives: an individual participant meta-analysis of 27,276 women with endometrial cancer from 36 epidemiological studies. The Lancet Oncology. Aug 5, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26254030 <Internet> http://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045%2815%2900212-0.pdf
  38. Jump up to: 38.0 38.1 Charlton BM et al Maternal use of oral contraceptives and risk of birth defects in Denmark: prospective, nationwide cohort study. BMJ 2016;352:h6712 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26738512 <Internet> http://www.bmj.com/content/352/bmj.h6712
  39. Jump up to: 39.0 39.1 39.2 Weill A, Dalichampt M, Raguideau F et al Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ 2016;353:i2002 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27164970 Free PMC Article <Internet> http://www.bmj.com/content/353/bmj.i2002
    Hannaford PC The vascular risks associated with combined oral contraceptives. BMJ 2016;353:i2544 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27165133 <Internet> http://www.bmj.com/content/353/bmj.i2544
  40. Jump up to: 40.0 40.1 Skovlund CW et al Association of Hormonal Contraception With Depression. JAMA Psychiatry. Published online September 28, 2016. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27680324 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2552796
  41. Jump up to: 41.0 41.1 Michels KA, Brinton LA, Pfeiffer RM, Trabert B. Modification of the associations between duration of oral contraceptive use and ovarian, endometrial, breast, and colorectal cancers. JAMA Oncol 2018 Jan 18; PMID: https://www.ncbi.nlm.nih.gov/pubmed/29346467 https://jamanetwork.com/journals/jamaoncology/article-abstract/2669779
  42. Jump up to: 42.0 42.1 Judge-Golden CP, Smith KJ, Mor MK, Borrero S Financial implications of 12-month dispensing of oral contraceptive pills in the Veterans Affairs health care system. JAMA Intern Med 2019 Jul 8; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31282923 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2737751
  43. Jump up to: 43.0 43.1 Isley M, MD, Allen RH American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice Over-the-Counter Access to Hormonal Contraception ACOG Committee Opinion Summary, Number 788. Obstetrics & Gynecology: Oct 2019 - 134(4):886-887 https://journals.lww.com/greenjournal/Fulltext/2019/10000/Over_the_Counter_Access_to_Hormonal_Contraception_.41.aspx
  44. Jump up to: 44.0 44.1 44.2 44.3 Karlsson T, Johansson T, Hoglund J, Ek WE, Johansson A. Time-dependent effects of oral contraceptive use on breast, ovarian and endometrial cancers. Cancer Res 2020 Dec 17; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/33334812 Free article. https://cancerres.aacrjournals.org/content/early/2020/12/15/0008-5472.CAN-20-2476
  45. Jump up to: 45.0 45.1 45.2 Lou N Women on the Pill Have Comforting CVD Outcomes Years Down the Line. Oral contraceptive use not tied to excess cardiovascular disease, mortality. MedPage Today August 11, 2023. https://www.medpagetoday.com/cardiology/prevention/105860
    Dou W, Huang Y, Liu X et al Associations of Oral Contraceptive Use With Cardiovascular Disease and All- Cause Death: Evidence From the UK Biobank Cohort Study. J Am Heart Assoc. 2023. August 10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37581386 PMCID: PMC10492942 Free PMC article https://www.ahajournals.org/doi/10.1161/JAHA.123.030105
  46. Jump up to: 46.0 46.1 46.2 NEJM Knowledge+

Patient information

oral contraceptive patient information