From the Guidelines
To initiate treatment with a Combined Oral Contraceptive (COC) in a healthy 18-year-old female, start by prescribing a low-dose COC containing 30 to 35 μg of ethinyl estradiol and a progestin such as levonorgestrel or norgestimate, and advise the patient to take one pill daily, with the option to start on the same day as the visit ("quick start") and use a backup method for at least the first 7 days 1. When selecting a COC, consider a monophasic pill with a low dose of ethinyl estradiol, as these are often recommended for adolescents 1. Some examples of COCs that may be suitable for an 18-year-old female include those containing 30 to 35 μg of ethinyl estradiol and a progestin such as levonorgestrel or norgestimate. Key points to discuss with the patient include:
- The importance of taking one pill daily at approximately the same time
- The need to use a backup method, such as condoms, for at least the first 7 days after starting the COC
- The potential for common side effects, such as irregular bleeding, headache, and nausea, which often resolve on their own
- The importance of consistent daily use to ensure effectiveness
- Instructions for what to do if a pill is missed, including taking the missed pill as soon as possible and using a backup method for the next 7 days 1. It is also important to counsel the patient on the potential risks and benefits of COC use, including the increased risk of blood clots and the potential benefits of reduced risk of certain cancers and improved menstrual regulation 1. Additionally, the patient should be informed that COCs do not protect against sexually transmitted infections (STIs) and that a condom should be used at all times for STI protection 1.
From the Research
Initiating Treatment with a Combined Oral Contraceptive (COC)
To initiate treatment with a Combined Oral Contraceptive (COC) in a healthy 18-year-old female, consider the following steps:
- Choose a low-dose COC with the least side-effects, as the overriding principle of prescribing 2
- Select a regimen that provides effective prevention of pregnancy, such as a 20-mcg EE, 91-day extended-regimen OC 3 or a 21/7-active COC regimen with continuous low-dose ethinyl estradiol 4
- Consider an extended-cycle regimen, which may result in a lower number of bleeding days and a favorable bleeding pattern compared to a conventional-cycle regimen 5
- Spend time teaching the patient how to manage their pill-taking and be responsible for their medication and prevention follow-up 2
Key Considerations
- The patient's age and health status should be taken into account when selecting a COC regimen, as the studies included women aged 18-40 years 3, 4
- The efficacy and safety of the chosen regimen should be evaluated, with consideration of the Pearl Index and life-table approach 3, 4
- The patient should be informed about potential adverse events and bleeding patterns associated with the chosen regimen 3, 4, 5
Available Regimens
- 91-day extended-regimen OC consisting of 84 days of ethinyl estradiol (EE) 20 mcg/levonorgestrel (LNG) 100 mcg, followed by 7 days of 10 mcg EE 3
- 21/7-active COC regimen with 21 days of desogestrel (DSG)/EE followed by 7 days of EE 4
- Extended-cycle regimen with a combined oral contraceptive containing ethinylestradiol (30 μg) and levonorgestrel (150 μg) 5