About Oral Contraceptive Pills (OCPs)
According to Australian guidelines (e.g., RACGP, NPS MedicineWise), a low-dose monophasic pill is the recommended first-line choice. Monophasic pills deliver a constant dose of estrogen and progestogen in each active pill, which simplifies use, especially for continuous regimens. Multiphasic pills have varying hormone doses and may be considered if a patient experiences persistent breakthrough bleeding on a monophasic pill, though evidence for their superiority is limited.
- COCPs containing levonorgestrel or norethisterone have the lowest risk of VTE and are recommended as first-line options.
- Consider progestogens like drospirenone or dienogest for patients with androgen-related side effects (e.g., acne) or fluid retention, after counselling on the slightly higher VTE risk.
- Continuous or tailored use (omitting hormone-free intervals) can be offered to reduce withdrawal symptoms like headaches or heavy bleeding.
- Regular, lighter, less painful periods
- Improved acne and hirsutism
- Manages PMS/PMDD symptoms
- Reduced risk of ovarian, uterine, bowel cancer
- Manages endometriosis and PCOS
- Nausea, breast tenderness (improves)
- Bloating, mood changes
- Breakthrough bleeding/spotting
- Serious Risk: Increased VTE risk
Mechanism: Traditional POPs (levonorgestrel, norethisterone) primarily work by thickening cervical mucus. The newer drospirenone POP (Slinda) reliably inhibits ovulation and has a longer 24-hour missed pill window.
- Suitable for women who cannot take estrogen.
- Can be used while breastfeeding.
- Critical: Must be taken at the same time each day (3-hour window for traditional POPs, 24-hour for Slinda).
- Changes to bleeding patterns are very common and normal.
The two main ways to start the contraceptive pill are the Quick Start method versus the First-Day Start method. The Quick Start method is now widely preferred in Australia for its practicality.
| Feature | Quick Start Method | First-Day Start Method |
|---|---|---|
| When to start? | The day the patient gets the prescription. | The first day of the next menstrual period. |
| Immediate Protection? | No. | Yes (if started within first 5 days). |
| Backup Method? | Yes, for the first 7 days. | No, if started on Day 1. |
| Main Advantage | Simple, improves adherence. | No need for backup contraception. |
| Main Disadvantage | Requires 7 days of backup contraception. | Can lead to forgetting to start ("pill escape"). |
Sunday Start Method
A variation where the first pill is taken on the first Sunday after a period begins. The main goal is to avoid weekend bleeding. Requires backup contraception for the first 7 days.
This is a general guide. Always refer to the specific product information for the pill being prescribed.
Combined Oral Contraceptive Pill (COCP)
If >24 hours late: Take last missed pill ASAP. Continue pack as normal. EC not usually needed for one missed pill. If >1 missed, use backup contraception.
Progestogen-Only Pill (POP)
Traditional POPs: If >3 hours late, take ASAP, use backup contraception for 48 hours.
Slinda (Drospirenone POP): If >24 hours late, take ASAP, use backup contraception for 7 days.