Combined Oral Contraceptive Pills (COCP)

COCP is one of the effective contraceptive methods and contains a combination of two hormones: oestrogen and progestogen. It is easy to use and has a very low failure rate (0.1-1 pregnancies in 100 women for one year.) Combined oral contraception is commonly used by young, healthy women and is independent of sexual intercourse.


Most COCPs contain 21 pills with hormones; one pill to be taken daily from the first day of menstrual cycle, followed by a seven day pill-free interval. Some everyday (ED) preparations include seven placebo pills which are taken daily instead of having a pill-free interval. COCPs should be taken regularly at roughly the same time each day.

How do COCPs act?

Both oestrogen and progestogen inhibit the release of FSH and LH. This process prevents development of eggs in the ovary and therefore, ovulation. Hormones of the COCPs also prevent the development of the endometrium and make it hostile to an implanting embryo. They alter the secretions of the cervix too and prevent sperm moving into the uterus.

Adverse effects of COCP

Most of the women can tolerate COCP well but some women will have few side effects.

• Venous thromboembolism (VTE) - 15 to 30 per 100,000 women will have VTE.

• Slightly increased risk of myocardial infarction and ischaemic stroke - Cigarette smoking will increase the risk further. If you smoke, you should stop smoking or stop COCP at the age of 35 years.

• Hypertension - One per cent of women will become hypertensive, and they should stop taking COCP.

• Slightly Increased risk of breast cancer - It is not of great significance to young women. However, it is significant for a woman in her forties but ten years after stopping COCP; the risk of breast cancer will become normal.

• Drug interaction - Some anti-epileptic drugs may reduce the efficacy of COCPs. If you are taking anti-epileptic drugs, you may need to take COCPs with higher oestrogen concentration. Some antibiotics reduce intestinal absorption of COCPs. Therefore, you should use additional contraceptive methods during antibiotic treatment and for one week thereafter.

• Nausea and vomiting

• Dyspepsia

• Gall-stones

• Weight gain

• Cholestatic jaundice

• Headache

• Loss of libido

• Depression

• Cystitis

• Vaginal discharge

• Irregular bleeding

• Growth of fibroids

• Breast pain

• Muscle cramps

• Pigmentation of the face

You cannot take COCP, if you have had at least one of the following conditions.

• Ischaemic heart disease
• Stroke
• Significant hypertension
• Any significant risk factors for ischaemic heart disease
• Acute liver disease
• Severe liver disease
• Arterial or venous thrombosis
• Risk for thrombosis
• Oestrogen dependent cancers such as breast cancer
• Focal migraine

You can take COCP under medical supervision, if you have had one of the following conditions.

• Long-term immobilisation
• Generalised migraine
• Fewer severe risk factors for ischaemic heart disease such as diabetes, heavy cigarette smoking, and obesity.
• Irregular vaginal bleeding (until a cause has been identified)

Your doctor will ask to stop COCP at least two months before any leg or pelvic operation.

Health benefits of COCPs

• You will have Light, regular, pain-free periods.
• COCP can be used to manage heavy or painful periods.
• They will improve premenstrual syndrome (PMS.)
• COCPs can lower the risk of pelvic inflammatory disease.
• COCPs reduce the risk of ovarian and endometrial cancers.
• They can be used as a treatment for pimples (acne.)

Related Links:

What is birth control?
Have you missed your combined oral contraceptive pill?
Combined hormonal patches
Progestogen-only contraceptive methods
Progestogen-only pill (Mini-pill/POP)
Progestogen injections
Subdermal Implants