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Contraception - Management
What types of combined oral contraceptives (COCs) are available?
- Combined oral contraceptives (COCs) consist of two components and these can vary in strength between different preparations (Table 1).
- Oestrogen component: ethinylestradiol (or a prodrug of ethinylestradiol), a synthetic oestrogen.
- Progestogen component: one of the following:
- Levonorgestrel, norethisterone, norethisterone acetate (metabolized to norethisterone), or norgestimate (metabolized to levonorgestrel).
- Desogestrel or gestodene.
- Drospirenone (a derivative of spironolactone). This has anti-androgenic properties and anti-mineralocorticoid activity (unlike most other progestogens).
- COC preparations can be categorized according to:
- The dose/strength of oestrogen:
- Low-strength COCs contain 20 micrograms of ethinylestradiol.
- Standard-strength preparations contain 30–35 micrograms of ethinylestradiol in monophasic COCs and 30–40 micrograms ethinylestradiol in phased preparations.
- Higher-strength preparations with 50 or more micrograms of ethinylestradiol are no longer used.
- The progestogen component: see above.
- How the doses vary over the menstrual cycle:
- Monophasic COCs: the amount of oestrogen and progestogen in each active tablet is constant throughout the cycle.
- Phasic COCs: the amounts of oestrogen and progestogen vary over the cycle.
- Biphasic COCs: contain two different sets of tablets.
- Triphasic COCs: contain three different sets.
- The presence or absence of a pill-free interval:
- Products with 21 pills: most COCs are packaged as calendar strips of 21 active tablets. One tablet is taken daily for 3 weeks; no tablet is taken during the following 7 days.
- Every-day COCs: to aid compliance, some products are packed with 21 active tablets and 7 inert or placebo tablets; a tablet is taken every day of the 28 day cycle.
Table 1. Combined oral contraceptives (COCs) currently marketed in the UK.
Oestrogen (micrograms per day) | Progestogen (micrograms per day) | Products |
|---|
Monophasic combined oral contraceptives |
Low strength oestrogen |
Ethinylestradiol 20 | Norethisterone acetate 1000 | Loestrin 20® |
Ethinylestradiol 20 | Desestrogel 150 | Mercilon®, Gedarel® 20/150 |
Ethinylestradiol 20 | Gestodene 75 | Femodette®, Sunya®, Milinette® 20/75 |
30 micrograms oestrogen, first-line progestogen |
Ethinylestradiol 30 | Norethisterone acetate 1500 | Loestrin 30® |
Ethinylestradiol 30 | Levonorgestrel 150 | Microgynon 30®, Microgynon 30 ED®, Ovranette®, Levest®, Rigevidon® |
Ethinylestradiol 30 | Levonorgestrel 250 | Eugynon 30® |
35 micrograms oestrogen, first-line progestogen |
Ethinylestradiol 35 | Norethisterone 500 | Brevinor®, Ovysmen® |
Ethinylestradiol 35 | Norethisterone 1000 | Norimin® |
Mestranol 50* | Norethisterone 1000 | Norinyl-1® |
30–35 micrograms oestrogen, second-line progestogen |
Ethinylestradiol 30 | Desogestrel 150 | Marvelon®, Gedarel® 30/150 |
Ethinylestradiol 30 | Gestodene 75 | Femodene®, Femodene ED®, Katya®, Millinette® 30/75 |
Ethinylestradiol 35 | Norgestimate 250 | Cilest® |
Ethinylestradiol 30 | Drospirenone 3000 | Yasmin® |
Primarily therapy for acne |
Ethinylestradiol 35 | Cyproterone acetate 2000 | Generic: co-cyprindiol 2000/35 tablets. Brand names included: Acnocin®, Cicafem®, Clairette®, Dianette®, Diva® |
Biphasic combined oral contraceptives |
Ethinylestradiol 35 | Norethisterone 500 x 7, 1000 x 14 | BiNovum® |
Triphasic combined oral contraceptives |
Ethinylestradiol 35 | Norethisterone 500 x 7, 1000 x 9, 500 x 5 | Synphase® |
Ethinylestradiol 35 | Norethisterone 500 x 7, 750 x 7, 100 x 7 | Trinovum® |
Ethinylestradiol 30 x 6, 40 x 5, 30 x 10 | Levonorgestrel 50 x 6, 75 x 5, 125 x 10 | Logynon®, Logynon ED®, Triregol® |
Ethinylestradiol 30 x 6, 40 x 5, 30 x 10 | Gestodene 50 x 5, 70 x 5, 100 x 10 | Triadene® |
ED = every day. * Mestranol is converted in the liver with 70% efficiency to ethinylestradiol; i.e. 50 micrograms of mestranol is pharmacologically equivalent to 35 micrograms of ethinylestradiol. |
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