Combined Oral Contraceptive Pills: Examples with Brand Names
Combined oral contraceptives (COCs) contain an estrogen component (typically ethinyl estradiol ≤50 μg or natural estrogens) combined with a progestin, available in multiple formulations and brand names 1.
First-Line COC Formulations
Pills containing levonorgestrel or norethindrone (first/second generation progestins) combined with ethinyl estradiol 35 μg or less are considered first-line options 2. These formulations offer:
- Proven contraceptive efficacy
- Relatively low risk of venous thromboembolism
- Cost-effectiveness
Common Brand Examples by Progestin Type:
Levonorgestrel-containing COCs:
- Levlen (ethinyl estradiol 30 μg/levonorgestrel 150 μg)
- Nordette (ethinyl estradiol 30 μg/levonorgestrel 150 μg)
- Seasonale (extended cycle formulation)
- Seasonique (extended cycle formulation)
Norethindrone-containing COCs:
- Ortho-Novum (various formulations with ethinyl estradiol 35 μg)
- Necon (ethinyl estradiol 35 μg/norethindrone)
- Loestrin (ethinyl estradiol 20-30 μg/norethindrone acetate)
Newer Generation COCs
Third and fourth generation progestins were developed to reduce androgenic side effects 1, 3:
Desogestrel-containing:
- Desogen (ethinyl estradiol 30 μg/desogestrel 150 μg)
- Ortho-Cept (ethinyl estradiol 30 μg/desogestrel 150 μg)
Drospirenone-containing (fourth generation with anti-mineralocorticoid activity):
- Yasmin (ethinyl estradiol 30 μg/drospirenone 3 mg)
- Yaz (ethinyl estradiol 20 μg/drospirenone 3 mg)
Dienogest-containing:
- Natazia/Qlaira (estradiol valerate/dienogest - contains natural estrogen) 4
Natural Estrogen-Containing COCs
Two formulations with natural estrogens have been approved 4:
- Natazia/Qlaira (estradiol valerate/dienogest) - most widely available
- Femilar (estradiol valerate/cyproterone acetate) - limited approval in Finland only
These natural estrogen formulations were developed to potentially reduce VTE and cardiovascular risks compared to ethinyl estradiol, though Phase IV trials are still needed to confirm these benefits 1.
Dosing Regimens Available
COCs come in multiple regimen types 1:
- Monophasic: Same hormone dose daily (e.g., most formulations listed above)
- Multiphasic: Varying weekly doses (e.g., Ortho-Novum 7/7/7)
- Cyclic: 21-24 active pills + 7-4 placebo days (traditional)
- Extended cycle: 84 active pills + 7 placebo days (e.g., Seasonale, Seasonique)
- Continuous: Active pills without placebo intervals
Key Clinical Considerations
Blood pressure measurement is required before CHC initiation 5. If started >5 days after menses, backup contraception (barrier methods) is needed for 7 days 5.
Common pitfall: The vast majority of currently available COCs contain ≤50 μg ethinyl estradiol, as higher doses were associated with unacceptable cardiovascular and VTE risks 1, 6. Never prescribe formulations exceeding this threshold.
Individualization strategy: While first-line options (levonorgestrel or norethindrone with low-dose ethinyl estradiol) should be prescribed initially, newer generation progestins may be considered for women experiencing androgenic side effects like acne 3, 2.