What is an example of a combined oral contraceptive pill (COC) available in Australia for a woman of reproductive age?

Example of Combined Oral Contraceptive Pills Available in Australia

In Australia, first-line combined oral contraceptive pills contain ethinyl estradiol 30-35 μg combined with levonorgestrel or norethisterone, with specific examples including Microgynon 30 (30 μg ethinyl estradiol + 150 μg levonorgestrel) or Nordette (30 μg ethinyl estradiol + 150 μg levonorgestrel). 1, 2

First-Line Formulations

• Pills containing levonorgestrel or norethisterone in combination with ethinyl estradiol 35 μg or less are considered first-line options in Australia. 2

• These formulations are effective when taken correctly, have a relatively low risk of venous thromboembolism compared to newer progestins, and are listed on the Pharmaceutical Benefits Scheme. 2

• Second-generation progestins like levonorgestrel demonstrate a safer coagulation profile and lower thrombotic risk compared to third and fourth-generation progestins. 1

Specific Product Examples

• Microgynon 30 contains 30 μg ethinyl estradiol and 150 μg levonorgestrel in a monophasic formulation, providing consistent hormone doses throughout the cycle. 3

• Levlen ED and Nordette are other commonly available brands containing the same hormone combination (30 μg ethinyl estradiol + 150 μg levonorgestrel). 4, 2

• Pills containing 30-35 μg of ethinyl estradiol with norgestimate are also appropriate first-line options. 1

Dosing Considerations

• The lowest effective dose of estrogen and progestogen should be prescribed to minimize adverse effects while maintaining contraceptive efficacy. 2

• Formulations containing 35 μg or more of ethinyl estradiol show statistically higher odds ratios for venous thromboembolism than lower doses. 1

• The typical Pearl index for these formulations ranges from 0.88 to 1 per 100 woman-years, indicating high contraceptive efficacy. 4

Administration Options

• Standard pill packs include 28 pills total, with 21 hormone pills and 7 placebo pills taken in monthly cycles. 1

• Some women may prefer extended pill regimens with fewer or no inactive pills, which can be useful for conditions exacerbated cyclically. 1, 2

• Pills can be started on the same day as the visit ("quick start") in healthy, non-pregnant individuals, with backup contraception used for the first 7 days. 1

Common Pitfall to Avoid

• Do not prescribe third-generation progestins (desogestrel, norgestimate) or fourth-generation progestins (drospirenone) as first-line options, as they carry higher venous thromboembolism risk compared to levonorgestrel. 1, 2