What are the recommended birth control pills in Alberta?

Recommended Birth Control Pills in Alberta

For women in Alberta seeking combined oral contraceptives, first-line options are pills containing levonorgestrel or norethisterone combined with ≤35 μg ethinyl estradiol, as these provide effective contraception with the lowest risk of venous thromboembolism. 1

First-Line Pill Selection

• Pills containing levonorgestrel (100 μg) with low-dose ethinyl estradiol (20 μg) are highly effective, with a Pearl index of 0.88 and cumulative pregnancy rate of 1.9% after 30 cycles 2
• The overriding principle is prescribing the lowest effective dose of estrogen and progestogen to minimize side effects while maintaining contraceptive efficacy 1, 3
• Combined oral contraceptives containing ≤35 μg ethinyl estradiol are considered first-line because they balance effectiveness with safety 1

Specific Formulations Available

Pills declared safe and effective by regulatory authorities include 4:

• Alesse, Lessina, or Levlite (containing lower doses of ethinyl estradiol)
• Aviane (5 orange pills per dose)
• Levlen or Nordette (4 light-orange pills per dose)
• Portia, Seasonale (extended cycle options)

Effectiveness Considerations

• Typical use failure rates for oral contraceptives are 4-7% per year, while perfect use results in <1% failure rate 5
• Long-acting reversible contraceptives (IUDs, implants) have <1% failure rates and should be discussed as alternatives, though pills remain the most commonly used reversible method at 21.9% of all contraception 5

Safety Profile

• Combined oral contraceptives increase venous thromboembolism risk from 2-10 events per 10,000 women-years to 7-10 events per 10,000 women-years 5
• Third-generation progestogen pills with low-dose estrogen have minimal effects on lipid and glucose metabolism 6
• Pills should not be used in women with contraindications including history of DVT/PE, uncontrolled hypertension, or within 3 weeks postpartum if breastfeeding 4

Initiation Protocol

Start pills within the first 5 days of menstrual bleeding to avoid need for backup contraception 4:

• If started within days 1-5 of menses: no backup contraception needed 4
• If started >5 days after menses began: use backup contraception for 7 days 4

Managing Common Side Effects

• Breakthrough bleeding occurs in 12.9% of cycles and spotting in 10.1%, but these typically improve with continued use 2
• Nausea and breast tenderness can be managed by adjusting estrogen dose or changing progestogen type 6
• Enhanced counseling about expected bleeding patterns reduces discontinuation rates 7

Important Contraindications

Avoid combined oral contraceptives in 4:

• Breastfeeding women <3 weeks postpartum (Category 4)
• Women 3-4 weeks postpartum who are breastfeeding (Category 3)
• History of DVT/PE without anticoagulation (Category 3-4 depending on risk factors)
• Acute DVT/PE (Category 4)