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Quick Reference Guide for Clinicians
Choosing a Birth Control Method

(Updated June 2014)

Combined Oral Contraceptive Pills


  • Most of the currently available COC formulations contain 20 to 35 mcg of ethinyl estradiol plus one of eight progestins.


  • All COCs require a prescription.
  • Providers may want to select initially a formulation with a midlevel dose of estrogen and then adjust later if the woman experiences unwelcome side effects. Combined oral contraceptives
  • The Pocket Guide to Managing Contraception is a good resource for up-to-date listings of the many currently available COCs. (The book can be purchased online for $10 or downloaded in pdf format for free).
  • COC pill packs generally contain 28 pills (either 21 or 24 active-hormone pills and the remainder placebo) and require users to take a pill daily.


  • This method is very effective, with a failure rate of 0.3 percent with perfect use and 9 percent with typical use.19
  • However, a high number of unintended pregnancies are due to COC misuse or discontinuation.
  • By the third month of use, the typical user misses three or more pills each cycle.
  • Consistent and correct use tends to decline rather than improve over time.20
  • Weight does not appear to affect the effectiveness of COCs. A study of almost 60,000 COC users in Europe found that body mass index (BMI) and weight had little, if any, relationship to effectiveness.21

Risks, Side Effects, and Contraindications

As described in previous section for all combined hormonal contraception.


As described in previous section for all combined hormonal contraception.


As described in previous section for all combined hormonal contraception, plus:

  • Adherence: user must remember to take pill daily (for most pill packs)

Counseling Messages

  • Adherence is an important factor for success with this method. (Providing a prescription that lasts at least a year and can be filled 3 months at a time can help support consistent use.)
  • Patients who use COCs should obtain emergency contraception (EC) in advance. (Note that patients who are less than 17 years old will need a prescription for EC.)
  • Non-hormonal back-up contraception is needed for the first 7 days if COCs are started any day other than day 1 of the menstrual cycle.
  • This method does not protect against STIs.