What are examples of monophasic Oral Contraceptive Pills (OCPs)?

Monophasic Oral Contraceptive Pills

Monophasic oral contraceptive pills (OCPs) contain the same dose of estrogen and progestin in each active tablet, making them the preferred initial choice for most patients due to their consistent hormone delivery and well-established efficacy profiles. 1

Examples of Monophasic OCPs

• Fixed-dose monophasic regimens contain the same dose of estrogen and progestin in each active tablet, typically with 21-24 hormone pills and 4-7 placebo pills in a 28-day pack 1

• Many providers recommend starting with a monophasic OCP containing 30-35 μg of ethinyl estradiol and a progestin such as:

  • Levonorgestrel (e.g., Alesse with 100 μg levonorgestrel/20 μg ethinyl estradiol) 1, 2
  • Norgestimate (contains 0.25 mg norgestimate and 0.035 mg ethinyl estradiol) 3

• Other monophasic OCPs include those containing:

  • Desogestrel (e.g., Marvelon with 150 μg desogestrel/30 μg ethinyl estradiol) 4
  • Gestodene (e.g., 75 μg gestodene/20 μg ethinyl estradiol) 5

Monophasic vs. Other OCP Formulations

• Monophasic OCPs deliver consistent hormone levels throughout the active pill cycle 1

• In contrast, multiphasic OCPs (biphasic and triphasic) contain varying doses of hormones throughout the cycle to mimic natural hormonal fluctuations 1

• Despite theoretical advantages of multiphasic formulations, evidence suggests no significant differences in bleeding patterns between biphasic and monophasic preparations 6

• Since extensive evidence supports monophasic pills and no clear rationale exists for biphasic pills, monophasic formulations are generally preferred 6

Clinical Considerations

• Many experts recommend starting adolescents on a monophasic pill with monthly bleeding and then changing regimens as needed to address adverse effects or patient preference 1

• Monophasic OCPs can be used in standard 28-day cycles (21-24 active pills followed by 4-7 placebo days) or in extended/continuous regimens 1

• Extended or continuous cycles may be particularly appropriate for patients with conditions like anemia, severe dysmenorrhea, endometriosis, or abnormal uterine bleeding 1

• The most common adverse effect of extended-cycle regimens is unscheduled bleeding 1

Safety Considerations

• Modern monophasic OCPs typically contain ≤50 μg of ethinyl estradiol combined with second, third, or fourth generation progestins 1

• Lower-dose formulations were developed to reduce cardiovascular risks associated with earlier higher-dose pills 1

• Blood pressure should be assessed before initiating any OCP, as estrogen-containing contraceptives can increase blood pressure in some users 1, 7

• Patients with conditions associated with cardiovascular risk should not use combined OCPs (monophasic or multiphasic) 7

• The baseline risk of venous thromboembolism in adolescents is approximately 1 per 10,000 woman-years, with combined OCPs increasing this risk three to fourfold 1