Feature Article

Combined OCPs: how to choose the right one

Terri Foran



With so many combined oral contraceptive pills available, each patient must be assessed individually to choose the right one. Noncontraceptive effects and side effect profiles must be considered when making this choice.

Key Points

  • The progestogen component is responsible for the primary contraceptive effect in a contraceptive preparation.
  • The oestrogen component of the combined oral contraceptive pill (COCP) is associated with the more serious side effects of venous thromboembolism and cardiovascular and cerebrovascular events; however, it is responsible for the noncontraceptive benefits of the COCP, such as improvements in acne, hirsutism and cycle control.
  • The qualities of a COCP are governed by the dose of the compounds it contains and the interactions between them.
  • When starting a COCP, a woman should generally be commenced on a preparation containing either levonorgestrel or norethisterone; however, if the initial choice does not suit the patient or noncontraceptive benefits drive the decision, a preparation containing one of the newer progestogens could be considered.

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