Currently available combined oral contraception

Figures & data

Figure 1. Testosterone.

Reproduced from [101].

Figure 2. Norethindrone.

Reproduced from [101].

Figure 3. Norgestrel.

Reproduced from [101].

Figure 4. Spironolactone and drospirenone.

Reproduced from [101].

Figure 5. Estradiol and ethinyl estradiol.

Reproduced from [101].

Figure 6. Mestranol.

Reproduced from [101].

Table 1. Hormone-withdrawal symptoms in oral contraceptive users.

Symptom	21 days active (%)	7 days hormone-free (%)	p-value
Pelvic pain	21	70	<0.001
Headache	53	70	<0.001
Breast tenderness	19	58	<0.001
Bloating/swelling	16	38	<0.001
Use of pain medication	43	69	<0.001

Data taken from [47].

Table 2. Risk of deep venous thrombosis when using contraception or in pregnancy.

Population	Risk of deep venous thrombosis (per 10,000)
Nonpregnant women using no hormones	1
Oral contraceptive (containing ethinyl estradiol 20–35 µg) users	3–4
Contraceptive patch users	3–6
Women with Factor V Leiden mutation using no hormones	6.5
Pregnant women	7

Table 3. WHO medical eligibility criteria for contraceptive use (4th edition, 2008 update).

Category	Description of medical condition
1	A condition for which there is no restriction for the use of the contraceptive method
2	A condition where the advantages of using the method generally outweigh the theoretical or proven risks
3	A condition where the theoretical or proven risks usually outweigh the advantages of using the method
4	A condition which represents an unacceptable health risk if the contraceptive method is used

Data taken from [66].

Table 4. 2008 WHO/CDC safety classification for combined oral contraceptives.

Medical condition	WHO/CDC category: COC use
Warning primarily based on concern regarding hypercoagulable state
History of DVT/PE	4
Acute DVT/PE	4
DVT/PE on established anticoagulant therapy	4
Major surgery with prolonged immobilization	4
SLE with positive or unknown antiphospholipid antibodies	4
Smoker ≥15 cigarettes per day and age ≥35 years	4
Hypertension systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg	4
Vascular disease	4
Current and history of ischemic heart disease	4
Stroke or history of stroke	4
Complicated valvular heart disease (including pulmonary hypertension, risk of atrial fibrillation and history of subacute bacterial endocarditis)	4
Peripartum cardiomyopathy <6 months	4
Moderately or severely impaired cardiac function (New York Heart Association class III or IV)	4
Migraine with aura at any age	4
Migraine without aura age ≥35 years old	4
Diabetes with nephropathy, retinopathy or neuropathy	4
Diabetes of >20 years duration or with vascular disease	4
Complicated solid organ transplantation (graft failure, rejection, cardiac allograft vasculopathy)	4
Multiple risk factors for arterial cardiovascular disease (older age, smoking, diabetes, hypertension)	3/4
Breastfeeding less than 1 month postpartum	3
Postpartum less than 21 days	4
Postpartum 21–42 days	3
Smoker (<15 cigarettes per day) and ≥35 years old	3
Adequately controlled hypertension	3
Hypertension systolic blood pressure 140–159 mmHg or diastolic blood pressure 90–99 mmHg	3
Peripartum cardiomyopathy ≥6 months	3
Warning based on concern for metabolism of oral estrogen via liver or gut
Acute or flare viral hepatitis	4
Severe decompensated liver cirrhosis	4
Hepatocellular adenoma or adenocarcinoma	4
Rifampin or rifabutin therapy	3
Lamotrigine therapy	3
Anticonvulsant therapy	3
Ritonavir-boosted protease inhibitors	3
Bariatric surgery with malabsorptive procedures	3
Warning based on concern for estrogen potentiating estrogen-sensitive tumors
Current breast cancer	4
History of breast cancer with no evidence of disease for 5 years	3

COC: Combined oral contraceptive; DVT: Deep venous thrombosis; PE: Pulmonary embolism; SLE: Systemic lupus erythematosus.

Data taken from [66].

Table 5. Currently available combined oral contraceptive pills.

Regimen	Estrogen	Dose (µg)	Progestin	Dose (mg)	US market
21-day regimen
Monophasic	Ethinyl estradiol	20	Levonorgestrel	0.1	Aviane-28, Lessina, Lutera, Sronyx
	Ethinyl estradiol	20	Norethindrone	1	Junel 1/20, Junel 1/20 Fe, Loestrin-21 1/20, Loestin Fe 1/20, Microgestin 1/20, Microgestin Fe 1/20
	Ethinyl estradiol	30	Levonorgestrel	0.15	Levora, Nordette-28, Portia-28
	Ethinyl estradiol	30	Norgestrel	0.3	Cryselle-28, Low-Ogestrel-21, Low-Ogestrel-28, Lo/Ovral-28
	Ethinyl estradiol	30	Norethindrone acetate	1.5	Junel 1.5/30, Junel Fe 1.5/30, Loestrin 1.5/30–21, Loestrin Fe 1.5/30, Microgestin 1.5/30, Microgestin Fe 1.5/30
	Ethinyl estradiol	30	Desogestrel	0.15	Apri, Desogen, Ortho-Cept, Reclipsen, Solia
	Ethinyl estradiol	30	Drospirenone	3	Ocella, Yasmin
	Ethinyl estradiol	35	Ethynodiol diacetate	1	Kelnor, Zovia
	Ethinyl estradiol	35	Norgestimate	0.25	Ortho-Cyclen-28, MonoNessa, Previfem, Sprintec
	Ethinyl estradiol	35	Norethindrone	0.4	Ovcon-35, Balziva, Femcon Fe chewable, Zenchent
	Ethinyl estradiol	35	Norethindrone	0.5	Brevicon-28, Modicon-28, Necon 0.5/35, Nortrel 0.5/35
	Ethinyl estradiol	35	Norethindrone	1	Necon 1/35–28, Norinyl 1+35–28, Nortrel 1/35–28, Ortho-Novum 1/35–28
	Mestranol	50	Norethindrone	1	Necon 1/50, Norinyl 1+50
	Ethinyl estradiol	50	Norethindrone	1	Ovcon-50
	Ethinyl estradiol	50	Norgestrel	0.5	Ogestrel 0.5/50–28
	Ethinyl estradiol	50	Ethynodiol diacetate	1	Zovia 1/50–28
	17 β-estradiol	1.5 mg	Nomogestrol acetate	2.5	Recently approved in Europe with US FDA approval expected in early 2012
Biphasic	Ethinyl estradiol	20 × 21 days, placebo × 2, 10 × 5 days	Desogestrel	0.15	Azurette, Kariva, Mircette
	Ethinyl estradiol	35	Norethindrone	0.5 × 10 days, 1 × 11 days	Necon 10/11
Triphasic	Ethinyl estradiol	20 × 5 days, 30 × 7 days, 35 × 9 days	Norethindrone	1	Estrostep Fe, Tilia, Tilia Fe, Tri-Legest Fe
	Ethinyl estradiol	25	Norgestimate	0.18 × 7 days, 0.215 × 7 days, 0.25 × 7 days	Ortho Tri-Cyclen Lo, Tri Lo Sprintec
	Ethinyl estradiol	25	Desogestrel	0.1 × 7 days, 0.125 × 7 days, 0.15 × 7 days	Caziant, Cesia, Cyclessa, Velivet
	Ethinyl estradiol	30	Levonorgestrel	0.05 × 6 days, 0.075 × 5 days, 0.125 × 10 days	Enpresse, Trivora
	Ethinyl estradiol	35	Norgestimate	0.18 × 7 days, 0.215 × 7 days, 0.25 × 7 days	Ortho Tri-Cyclen, TriNessa, Tri-Previfem, Tri-Sprintec
	Ethinyl estradiol	35	Norethindrone	0.5 × 7 days, 1 × 9 days, 0.5 × 5 days	Aranelle, Leena, Tri-Norinyl
	Ethinyl estradiol	35	Norethindrone	0.5 × 7 days, 0.75 × 7 days, 1 × 7 days	Ortho-Novum 7/7/7, Nortrel 7/7/7, Necon 7/7/7
Quadrephasic	Estradiol valerate	3 mg × 2 days, 2 mg × 22 days, 1 mg × 2 days	Dienogest	None × 2 day, 2 × 5 days, 3 × 17 days, none × 4 days	Natazia
Extended-cycle regimen	Ethinyl estradiol	10 × 26 days	Norethindrone	1 × 24 days	Lo-Loestrin Fe
	Ethinyl estradiol	20 × 24 days	Norethindrone	1 × 24 days	Loestrin-24 Fe
	Ethinyl estradiol	20 × 24 days	Drospirenone	3 × 24 days	Beyaz, Gianvi, Yaz
Continuous-cycle regimen	Ethinyl estradiol	20 × 84 days, 10 × 7 days	Levonorgestrel	0.1 × 84 days	LoSeasonique
	Ethinyl estradiol	30 × 84 days	Levonorgestrel	0.15 × 84 days	Introvale, Jolessa, Seasonale, Quasense
	Ethinyl estradiol	30 × 84 days, 10 × 7 days	Levonorgestrel	0.15 × 84 days	Seasonique
Continuous	Ethinyl estradiol	20	Levonorgestrel	90 µg	Lybrel

Adapted from [81].

Activity Evaluation: Where 1 is strongly disagree and 5 is strongly agree

	1	2	3	4	5
1. The activity supported the learning objectives.
2. The material was organized clearly for learning to occur.
3. The content learned from this activity will impact my practice.
4. The activity was presented objectively and free of commercial bias.

NIH US National Library of Medicine http://dailymed.nlm.nih.gov/dailymed

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