Combined Oral Contraceptive Pills (COCs) are small pills, which contain two synthetic hormones, estrogen and progestin, which are very similar to the hormones that are naturally present in the woman¡¯s body. COCs are available in packets of 28 pills. Twenty-one white pills are hormone pills, which are to be taken once daily from the first day of the menstrual period and the remaining seven are brown iron pills, which are to be taken once the brown pills are finished. Once the packet is finished, the next packet should be started the very next day


· Very effective when used correctly (efficacy is as high as 99.9%);
· Decreased menstrual cramps;
· Regular menstrual periods most months;
· Decreased benign breast diseases (fibrocystic changes)
· Decreased problems with ovarian cysts;
· Decreased risk of cancer of the ovaries and ovarian cysts;
· Decreased risk of cancer of endometrium (lining of uterus);
· Decreased risk of ectopic pregnancy; and
· Improvement of acne (in some women).


COCs are desired among women who:

· Desire a highly effective method of contraception (99.9% effective when used correctly);
· Has anemia from heavy menstrual bleeding;
· no medical supervision required;
· Has severe menstrual cramping;
· Complains of menstrual cycle symptoms like premenstrual weight gain, anxiety, depression, mid cycle ovarian pain;
· Long history of irregular menstrual cycle;
· Has a history of ectopic pregnancy;
· Has had benign ovarian cysts; and
· Strong family history of ovarian cancer.


Combined Oral Contraceptives are absolutely contra-indicated in the following situations.

1. Pregnancy;
2. Pregnancy;
3. Breastfeeding to a child less than 6 weeks of age;
4. Unexplained vaginal bleeding;
5. Jaundice / Hepatitis;
6. Smoker and age 35 years or older;
7. Women with diabetic history of more than 20 years;
8. Migraine;
9. Hypertension;
10. Breast cancer;
11. Liver tumors;
12. Epilepsy; and;
13. Tuberculosis.

Sides effects & management Sides effects Management Amenorrhea

Assess how you have been taking your pills; Have you missed any pill; Check for pregnancy; If not pregnant then continue taking COCs Bleeding / Spotting

If the you have recently begun using COCs, then do not worry; otherwise check for gynecological conditions; The spotting / bleeding settles by fourth month of start of COCs



If BP is more than 160/100 then, discontinue, otherwise slight raise in BP settles in 1-3 months

Nausea / Dizziness / Nervousness Find out if pills are taken in morning or on an empty stomach. Take pill with evening meal or just before bed time; Check for pregnancy; If no cause found, this situation will decrease over the first 3 months of COC use.

Breast fullness or tenderness

Check for pregnancy; Check breasts for Lumps / Cysts; Discharge; Discuss with your service provider if you feel uncomfortable with breast fullness or tenderness.

Chest Pain (especially if it occurs with exercise) Check for possible cardiovascular disease and check for blood pressure and heart for irregular beats (arrhythmias) with your service provider Depression May be related to progestin in COCs. If your depression has worsened while using COCs, choose another method. Headache If headaches are mild, take analgesics (paracetamol / aspirin). Consult your service provider to re-evaluate after 1 month if mild headache persists; If headaches have changed since starting COCs (i.e., associated with numbness, tingling, or loss of speech, blurred vision), stop COCs and choose another method.


Acute jaundice occurring after starting COC use begins is not method related. Check for Hepatitis, Gall Bladder Disease & benign or malignant tumors. If jaundice is due to hepatitis, gall bladder disease or liver tumors, stop COC and choose another method. Danger sign

If the following signs appear, this should be taken as an emergency situation and the woman taking oral contraceptives should be taken to a hospital immediately.

· Severe lower abdominal pain
· Severe headache
· Loss of or blurred vision
· Severe chest pain, shortness of breath
· Severe leg (calf or thigh) pain
· Slurred speech

Where to get services

Oral pills is available in all program and non program outlets, the oral pills is also available in all medical stores.