Take it for advantages

1. COMBINED ORAL CONTRACEPTIVES
(COCs)
29th September 2022
Dr. Ali M. Ibrahim

2. WHAT ARE THEY?
• Combined Oral Contraceptives are pills that
contain low doses of synthetic oestrogen and
progestins similar to the natural hormones in a
woman’s body.
• Combined orals contraceptives (COCs) are also
called “the pill”

3. HOW DO THEY WORK?
• Prevention of ovulation.
• Thickening of cervical mucus.
• Thinning of the endometrial lining.

4. ADVANTAGES (BENEFITS)
Contraceptive Benefits:
• Highly effective
• Effective immediately –when started
within 7 days of menses
• Easy to use
• Can be provided by a non-clinical service
providers
• Pelvic examination is not essential to
initiate use

5. KNOWN HEALTH BENEFITS
Help protect against :
• Risk of Pregnancy
• Endometrial cancer
• Cancer of the ovary
• Symptomatic pelvic inflammatory disease
May protect against
• Ovarian cysts
• Iron –deficiency anemia

6. CONT’’
COCs reduce:
• Menstrual cramps
• Menstrual bleeding problems
• Ovulation pains
• Excess hair on the face or body
• Symptoms of polycystic ovarian syndrome

7. SIDE EFFECTS
Minor side effects:
• Nausea
• Spotting or bleeding in between periods
• Mild headache
• Breast tenderness
• Slight weight gain.
• Mood changes or changes in sex drive.

8. CONT’’
Major Side effects
They are rare, though possible
• DVT/pulmonary embolism
• Myocardial infarction
• Stroke
• Heart attack

9. CONT’’
Effectiveness may be lowered by:
• Anti -TB drugs
• Anti- epileptic
• Anti- retroviral drugs
• Gastroenteristis, vomiting and diarrhoea
NB: COCs offer no protection against
STI/HBV/HIV/AIDS- ensure dual
protection

10. WHO CAN USE COCS?
Nearly all women can use COCs safely and
effectively including women who:
• Have or have not had children
• Are not married
• Are of RH age
• Have just had an abortion or miscarriage
• Are smoker <35yrs
• Have anemia
• Have varicose veins
• Are HIV+
• Breasting feeding women after 6 months

11. SITUATIONS TO USE WITH CARE
• Women over 40 years
• Women with unexplained vaginal bleeding
• Women with migraine
• Women gallbladder disease
• Women with breast lumps
• Women with sickle cell disease
• Diabetes

12. WHO SHOULD NOT USE
• Breastfeeding mothers <6 months postpartum
• Women with history of blooding clotting disorders
• Women with ischaemic heart disease or complicated
valvular heart disease
• Women with active liver disease
• Women with hypertension( BP-140-159/90-99 or equal
to r more than 160/100
• Women with diabetes complicated by heart disease

13. CONT”
• Women who are smokers and are 35 yrs or older
• Women with history or current breast cancer
• Women with gall bladder disease
• Women receiving treatment with drugs that affect liver
enzymes:
Rifampcin (TB), phenytoin ,carbamazepine,
barbiturates, primidone, topiramate and
oxcarbazipine (epilepsy) and certain ARVs
(HIV) e.g. Nevirapine, Ritonavir,Nelfinavir, Lopinavir
(with Ritonavir (Kaletra)

14. WHEN TO START COCS
• Having menstrual period or switching from a non
hormonal method
• Switching from a hormonal method
• Breastfeeding above six months
• After abortion or miscarriage
• After taking emergency contraceptive pills
• Any time of the menstrual cycle when your are
reasonably sure that the client is not pregnant

15. EXPLAINING HOW TO USE COCS
• Give pills: as many as possible- a years supply
• Explain pill pack: show on the pack where to begin
• Give key instruction: take one pill each day –same until
pack is empty
• Explain starting next pack: explain when to begin next
the next pack-28 or 21-pill pack
• Provide backup and explain use: some times she many
need a backup; explain e.g. in missed pills

16. WARNING SIGNS
A: Abdominal pain (severe)
C: Chest Pain (severe), cough, with shortness of
breath
H: Headaches (severe), dizziness, weakness,
numbness
E: Eye problems (vision loss or blurring), speech
problems
S: Severe leg pain (calf or thigh)
If any of the above signs are noticed, STOP COC
and report to health facility immediately.

17. KEY POINTS FOR PROVIDERS AND CLIENTS
• Take one pill every day
• Bleeding changes are common but not
harmful
• Take any missed pills as soon as possible
• Can be given to women at any time to
start later

18. Thank You.