What are the common brand names of Combined Oral Contraceptives (COCs) to prescribe to a 36-year-old female with no known medical contraindications?

Common Brand Names for Combined Oral Contraceptives

For a 36-year-old woman with no contraindications, prescribe a low-dose monophasic COC containing 30-35 μg ethinyl estradiol combined with either levonorgestrel or norgestimate, with common brand names including Levora, Nordette, or Ortho-Cyclen. 1

First-Line Formulation Recommendations

The American Academy of Pediatrics specifically recommends low-dose formulations (30-35 μg ethinyl estradiol) with levonorgestrel or norgestimate as first-line options. 2, 3 These progestins have well-established safety profiles with lower androgenic effects compared to older formulations. 1

Common Brand Names by Progestin Type:

Levonorgestrel-containing COCs (30-35 μg ethinyl estradiol):

• Levora (0.15 mg levonorgestrel/30 μg EE)
• Nordette (0.15 mg levonorgestrel/30 μg EE)
• Portia (0.15 mg levonorgestrel/30 μg EE)
• Seasonale (extended cycle formulation)

4, 5

Norgestimate-containing COCs (35 μg ethinyl estradiol):

• Ortho-Cyclen (0.25 mg norgestimate/35 μg EE)
• Sprintec (0.25 mg norgestimate/35 μg EE)
• MonoNessa (0.25 mg norgestimate/35 μg EE)

1, 4

Alternative Formulations

Drospirenone-containing COCs are FDA-approved for contraception, PMDD treatment, and moderate acne in women who desire oral contraception. 6 Common brand names include:

• Yaz (3 mg drospirenone/20 μg EE - 24/4 regimen)
• Yasmin (3 mg drospirenone/30 μg EE)

However, these are considered second-line due to potentially higher VTE risk compared to levonorgestrel-containing formulations. 1

Key Prescribing Considerations

Initiation protocol: The American College of Obstetricians and Gynecologists recommends same-day "quick start" initiation requiring only blood pressure measurement before prescribing. 1 If started >5 days after menses began, use backup contraception for 7 days. 1

At age 36, smoking status is critical: While smoking is not yet an absolute contraindication at this age, it becomes Category 3-4 (unacceptable health risk) at age ≥35 years with any smoking. 1 Screen carefully for cardiovascular risk factors.

Drug interaction screening is essential: Verify the patient is not taking rifampin/rifabutin, enzyme-inducing anticonvulsants, or St. John's wort, which reduce COC effectiveness. 1 Broad-spectrum antibiotics do NOT reduce effectiveness. 3, 1

Non-Contraceptive Benefits to Discuss

COCs provide significant protection against endometrial and ovarian cancers with use >3 years, along with decreased menstrual cramping, reduced blood loss, and improvement in acne. 1 These benefits may influence formulation selection based on patient priorities.

Common Pitfalls to Avoid

Emphasize consistent timing: Pills must be taken at the same time daily to maintain effectiveness and minimize breakthrough bleeding. 1 Provide clear instructions for missed pills at the time of prescribing.

Address weight concerns proactively: Weight gain is not consistently associated with COC use in most formulations. 1 Bleeding irregularities typically improve over time and do not indicate medical problems. 2