Combined Oral Contraceptive Pills ( OCP )

Common Brands in Nepal : Sunaulo Gulab, Ovral L, Nilocon White

Standard Composition:  Levonorgestrel 0.15 mg/ Ethinyl Estradiol 0.03 mg . One cycle contains 21 hormonal tablets and 7 Iron tablets

First discuss with the female about its benefits including non contraceptive benefits like improvement in menorrhagia, dysmenorrhea, anemia, pre-menstrual syndrome, acne, hirsutism. 

Also talk about possible risks like Hypertension, Venous Thromoboembolic conditions, MI

- Confirm the female is not pregnant

- Obtain Blood Pressure

- Review Past Medical History for Contraindications- Uncontrolled HTN, History of VTE, advanced DM, Migraine with aura, Known ASCVD, Cirrhosis

- Obtain smoking history ( Not given in smokers more than 35 years of age )

Initiation Plan: 

- Quick start: Take 1st Pill as soon as prescription filled, need backup contraception for 7 days

- 1st day start: Take 1st Pill on 1st day of period, backup contraception not needed

- Sunday start: Take 1st Pill on Sunday after period begins, need backup for 7 days

 

When to Use Backup contraception:

- Missed pills more than or equals to 2 pills ( backup for 7 days )

- When there is use of medication which decrease efficacy of OCP like anticonvulsants, griseofulvin,  Rifampin

  

Note:

- Counsel Patients about side effects which typically resolve within 2-3 months. They include headache, nausea, mastalgia, (hirsutism, acne, weight gain- may need to switch to 3rd/4th generation progesterone with less androgenic effect ) , breakthrough bleeding, amenorrhea  

- Followup the female at 3 months to check BP, evaluate for tolerance and side effects. If pregnancy occurs while on OCP, discontinue upon diagnosis and reassure the patient there is no harm to the fetus due to OCP at time of conception.