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CHAPTER 1 - Combined Oral Contraceptives

Key Points for Providers and Clients
  • Take one pill every day. For greatest effectiveness a woman must take pills daily and start each new pack of pills on time.
  • Take any missed pill as soon as possible. Missing pills risks pregnancy and may make some side effects worse.
  • Bleeding changes are common but not harmful. Typically, there is irregular bleeding for the first few months and then lighter and more regular bleeding. 
  • Can be given to a woman at any time to start now or later.

What Are Combined Oral Contraceptives?

  • Pills that contain low doses of 2 hormones—a progestin and an estrogen—like the natural hormones progesterone and estrogen in a woman’s body. 
  • Combined oral contraceptives (COCs) are also called “the Pill,” low-dose combined pills, OCPs, and OCs. 
  • Work primarily by preventing the release of eggs from the ovaries (ovulation). 

How Effective?

Effectiveness depends on the user: Risk of pregnancy is greatest when a woman starts a new pill pack 3 or more days late, or misses 3 or more pills near the beginning or end of a pill pack. 

  • As commonly used, about 7 pregnancies per 100 women using COCs over the first year. This means that 93 of every 100 women using COCs will not become pregnant. 
  • When no pill-taking mistakes are made, less than 1 pregnancy per 100 women using COCs over the first year (3 per 1,000 women).

Return of fertility after COCs are stopped: No delay

Protection against sexually transmitted infections (STIs): None

Why Some Women Say They Like Combined Oral Contraceptives
  • Are controlled by the woman
  • Can be stopped at any time without a provider's help
  • Do not interfere with sex
  • Are easy to use
  • Easy to obtain, for example, in drug stores or pharmacies