Title: Combined oral contraceptives (COCs)
Course: Adolescent and Youth Reproductive Health - Ethiopia (Full)

Combined oral contraceptives (COCs)

COCs are appropriate and safe for young people. Many young people choose a COC because this method has a low failure rate and also offers relief from dysmenorrhea (pain during menstruation). It is a straightforward method that does not interfere with sexual intercourse. This is a good method for you to recommend when it is clearly appropriate for the girl; the particular COC you would suggest will depend on what is available. Some pills are more oestrogen-dominant and others are more progestin-dominant. A COC with more progestin is helpful for girls who have painful and excessive menstrual bleeding.

Failure rates are higher for young girls than for older women. This is because young girls often fail to take pills regularly. Failure to take pills regularly is often due to lack of knowledge about pill taking. You should encourage condom use in addition to COCs for STI/HIV protection.

Will a COC protect the girl from sexually transmitted infections (including HIV)?

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No, it offers no protection against STIs.

What further advice would you give to the girl to help prevent STIs?

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That she should ensure that her partner uses a condom, or that she should use female condoms if they are available.

You can help young girls figure out where to keep pills and how to remember to take them at the same time daily by linking pill taking to a routine activity that they do on daily basis. COCs are available in 21-day or 28-day packages (Figure 8.4). Most girls do better using the 28-day pill because it is easier to remember to take a pill every day rather than stopping for 7 days. Carefully discuss with them when they should start taking the pill so that you both are clear about when she begins taking the pills. This will make it easier to determine later whether the pills are being taken correctly.

Figure 8.4 Contraceptive pills.

Do you remember when a woman should begin her daily COCs? (You have learned this in the Family Planning Module.)

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A woman can start using COCs any time she wants if it is reasonably certain she is not pregnant. One common way is to start on the first day of menstruation (the monthly period) or the first day after an abortion.

The most important issue is to make sure that young girls understand the necessity of taking pills correctly. Using the knowledge you gained in the Family Planning Module, show the girl the pill packet and explain how to take the pills. Review with her the possible side effects of COCs to make sure that she understands side effects very well and will return to you if she has any problems.