Providing information

All patients should receive the product in its original packaging with the PIL. The patient should also be provided with written information or links to trusted online resources to help them use the COC safely and effectively. 

Dosing

• Monophasic COCs are usually taken continuously for 21 days followed by a seven-day hormone free interval (this regimen is usually referred to as “standard use”), but the latter can be truncated to four days (known as “shortened hormone-free interval”), and active pills taken for three cycles before a four- or seven-day interval is observed (“extended use” or “tri-cycling”). 

Unbroken use of active pills is also possible (“continuous use”), with some patients opting to take a four-day break if they experience breakthrough bleeding that lasts three to four days (“flexible extended use”).

In all cases, active pills should be taken at the same time each day, starting on day 15 of the menstrual cycle with no need for additional precautions.

• Monophasic, phasic (where packs contain different coloured pills which contain a different amount of hormone) and everyday pills (packs contain 21 active and seven dummy pills) should be taken at the same time every day, starting as detailed for monophasic pills, although there are some exceptions so individual SPCs should be checked.

Note that some of the above comprises off-label use but is within FSRH guidance so is allowed. 

Duration 

Up to 12 months can be supplied at a time in appropriately labelled original packs. The individual’s regimen may differ from the standard dosing on the product packaging so this would need explaining to avoid confusion. 

Repeat supplies are allowed as long as the individual continues to meet the inclusion criteria.

Adverse effects

The most commonly reported side-effects of COCs are nausea, breast tenderness, headache and migraine, menstrual disturbances, mood changes including depression, fluid retention, libido changes and skin changes including acne. However, every product is different – as is every patient – so attention should be drawn to the information provided by the manufacturer. 

Serious reactions include venous and arterial thromboembolic events, stroke and hypertension.
A patient should be advised to stop taking the COC and seek urgent medical help if they experience calf swelling, heat or pain in the calf, shortness of breath, chest pain or coughing up blood (haemoptysis). 

Users should be advised to reduce periods of immobility, for example after surgery and when travelling and encouraged to seek advice if they experience their first ever migraine or develop aura with an existing migraine condition.

Adverse effects should be recorded and reported using the Yellow Card scheme.