Examples of Combined Hormonal Contraceptives (CHCs)
Combined hormonal contraceptives (CHCs) include combined oral contraceptives (COCs), the combined hormonal patch, and the combined vaginal ring. 1
Combined Oral Contraceptives (COCs)
- COCs typically contain both estrogen (usually ethinyl estradiol) and a progestin component 2, 1
- Most currently available COCs contain ≤50 μg of ethinyl estradiol combined with a second, third, or fourth-generation progestin 3
- Newer COCs may contain natural estrogens such as estradiol valerate (a prodrug of estradiol) or estetrol (a fetal estrogen) instead of synthetic ethinyl estradiol 3, 4
COC Formulations and Dosing Regimens
- Monophasic dosing: same dose of hormones in each pill 3
- Multiphasic dosing: varying weekly hormone doses to mimic the menstrual cycle 3
- Cyclic formulations: active hormone pills for 21-24 days followed by placebo pills for 7-4 days 3
- Extended cyclic formulations: active hormone pills for 84 days followed by placebo pills for 7 days 3
- Continuous formulations: active hormone pills taken continuously 3
Examples of COCs by Progestin Generation
- First-generation progestins: norethindrone 3, 5
- Second-generation progestins: levonorgestrel 3, 5
- Third-generation progestins: desogestrel, gestodene, norgestimate 3, 6
- Fourth-generation progestins: drospirenone, dienogest 3, 7
Specific COC Example
- Yaz: contains drospirenone (3 mg), a fourth-generation synthetic progestin, combined with ethinyl estradiol (0.02 mg) in a 24/4 day regimen 7, 8
- Drospirenone possesses both antimineralocorticoid and antiandrogenic properties similar to natural progesterone 7
Combined Hormonal Patch
- Transdermal contraceptive patch releases 150 μg of norelgestromin and 20 μg ethinyl estradiol daily 2, 1
- Provides comparable safety and pharmacokinetic profiles to COCs with similar hormone formulations 1
Combined Vaginal Ring
- Vaginal contraceptive ring releases 120 μg etonogestrel and 15 μg ethinyl estradiol daily 2, 1
- Provides comparable safety and pharmacokinetic profiles to COCs with similar hormone formulations 1
- May be preferred by some women, particularly those experiencing CHC-related female sexual dysfunction 9
Clinical Considerations
- CHCs can be initiated at any time if it is reasonably certain that the woman is not pregnant 2
- If CHCs are started >5 days since menstrual bleeding started, additional contraceptive protection is needed for the next 7 days 2, 10
- Blood pressure measurement is recommended before initiation of CHCs 2, 10
- CHCs do not protect against sexually transmitted infections (STIs) or human immunodeficiency virus (HIV) 1
- Approximately 9 out of 100 women become pregnant in the first year of use with typical use of CHCs 2