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Combined oral contraceptive pill (COCP)

Types of combined pill:

Most of the combined birth control pills have two main hormones i.e. estrogen and progestin. Depending upon the level of hormones stays during the first three weeks of the menstrual cycle it is categorized as monophasic or biphasic and triphasic form.

a) Monophasic
In monophasic type of pill, hormones level is same in all doses. The advantage of monophasic pill is that it helps in maintaining mood steady, which is most likely to be changed in other type of pills having various levels of hormones. Side effects like blotting and breast tenderness will be lesser in Monophasic pills, however, it may cause higher spotting. Monophasic pills may be costlier than other oral contraceptives. Women do prefer to opt for this type of pill for these reasons.

Monophasic birth control pills can be classified into following three categories according to estrogen level

- 20 mcg (low level)
- 30-35 mcg (regular level)
- 50 mcg (high level)

Seasonale is the only monophasic birth control pill approved by FDA in 2003. It is 91-day cycle medicine designed to prevent pregnancy upto 99% if taken as directed. Seasonale stops menstruation completely for the entire 91-day cycle.

Monophasic types of pills are Alesse, Apri, Aviane, Brevicon, Demulen, Desogen Genora, Jenest, Levlen, Levlite, Levora, Loestrin, Lo/Ovral, Microgestin FE, ModiCon, Nelova, Necon, Nordette, Norethin, Norinyl, Ortho-cept. Ortho-cyclen, Ortho Novum, Ovcon, Ovral, Portia, Seasonale and Zovia

b) Biphasic
Biphasic birth control pills have fixed strength of estrogen but two different strength of progestine hormones that were designed with keeping in mind the requirement of level of hormones in women's body during the menstrual cycle. Daily use of biphasic pills deliver same strength of estrogen each day, however, progestine level rises about halfway in the entire menstruation cycle. Biphasic pills change the hormones ration in two levels

- In the first half of the menstruation cycle, the hormones level will be lower helping endomentrium to be thick as it should be.
- In the second half, the hormones level will be higher enough to shred the lining in the uterus

The strength of Biphasic birth control pills will be:
- It will be same strength or same hormone ratio in first 7 to 10 days (with same color of pills)
- For next 11 to 14 days, strength will be different (with another color of pills)
- The last 7 days may not contain any active pills (placebo pills)

Biphasic pills are available in Jenest 28, Kariva, Mircette, Necon 10/11, Ortho-Novum 10/11 & Sprintec

c) Triphasic
Triphasic birth control pills are having three different levels of hormones - designed for changing hormone level in every seven days during the entire three weeks of menstrual cycle. These triphasic birth control pills are recommended for women who are very sensitive to estrogen and progestin hormones.

Depending upon which brand you use, the level of estrogen and progestin will change three times in the complete cycle time.

The strength of triphasic pills will be:

- The first three pills will have one strength (one color)
- Next 5, 7 or 9 pills have another strength (another color)
- The last 7 days may not contain any active pills or may be placebo pills (different color)

Triphasic pills are available in Estrostep-21, Necon 7/7/7, Ortho-Novum 7/7/7, Ortho Tri-Cyclen, Tri-Levlen, Tri-Norinyl, Triphasil and Trivora.

It is wrong to believe any one type of birth control pill is better than others because all of them are designed for sole purpose of avoiding unintended pregnancy and can be effective upto 99% if taken as directed. It is advisable to consult with your doctor or healthcare professional before deciding to go on contraceptive pills.

Effectiveness of Combined Birth Control Pills:

Combined oral contraceptives are very much effective upto 99.9% with very cases of birth control failure in a year. However, its effectiveness greatly depends upon the following up of instruction and taking medicines as directed. If combined birth control pills used properly as directed then its pregnancy rate is 0.3% Effectiveness or failure rates are measured for the medicines used in the first year. Decrement tables and Pearl Index are commonly used to analyze the effectiveness rates.

Failure rates could defer due to various factors like
- healthcare professional or doctor prescribed the wrong dosages
- completely wrong medicine is prescribed - patients did not start the pills within five days of start of menstrual cycle
- patients did not follow the instruction and missed pills many times in the prescribed cycle
- patients did not start the next pack of pills due on date - patients had unprotected intercourse during the missed pills period
- patients did not use birth control backup method like condoms, spermicides or diaphragm during the first 7 days when you start the first birth control pills
- drug interaction like antifungals, anticonvulsants and such other drugs may increase the metabolism of contraceptive steroids with contraceptive pills will significantly reduce the effectiveness. St. John's Wort may aggregate hepatic enzymes (cytochrome P450) and p-glycoprotein transporter affecting the effectiveness of contraceptive steroids.

Combined birth control pills:

Generic Name	Brand Name
desogestrel and ethinyl estradiol	Apri, Cyclessa, Desogen, Mircette, Ortho-Cept
drospirenone and ethinyl estradiol	Yasmin
levonorgestrel and ethinyl estradiol	Alesse, Aviane, Levlen, Levlite, Levora, Lybrel, Nordette, Tri-Levlen, Seasonale, Seasonique, Triphasil, Trivora
ethynodiol diacetate and ethinyl estradiol	Demulen, Zovia
norethindrone and ethinyl estradiol	Brevicon, Genora 0.5/35, Genora 1/35, Intercon 0.5/35, Intercon 1/35, Jenest, Modicon, Necon (0.5/35, 1/35 or 10/11), Nelova (0.5/35E, 1/35E or 10/11), Norethin 1/35E, Norinyl (1+35 or 1+50), N.E.E., Ortho-Novum, Ortho–Novum 1/35, Ortho Novum (7/7/7 or 10/11), Ovcon, Tri-Norinyl
norethindrone acetate and ethinyl estradiol	Estrostep, Loestrin
norethindrone and mestranol	Genora 1/50, Nelova 1/50M, Intercon 1/50, Necon 1/50, Norethin 1/50 M, Norinyl 1/50, Ortho–Novum 1/50
norgestimate and ethinyl estradiol	Ortho-Cyclen, Ortho Tri-Cyclen
norgestrel and ethinyl estradiol	Low-Ogestrel, Ogestrel, Ovral, Lo/Ovral

Note : Combined birth control pills are explained according to their Generic names. They may vary in doses, benefits and side effects. Please consult your doctor or healthcare professional before deciding to take any contraceptive pills.

You can also visit at combined oral contraceptive pills to review the additional list of birth control pills.

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