Recommendations

1. Monophasic OCs containing the second generation progestin, norethindrone (Ortho-Novum 1/35) are recommended when starting a patient on OCs for the first time. This progestin has very low androgenicity when compared to other second generation progestins, and also compares favorably to the third generation progestins in androgenicity.

2. The pill should be started on the first day of the period to provide the maximum contraceptive effect in the first cycle. However, most women start their pill on the first Sunday after the period starts. Some form of back-up contraception is needed for the first month if one chooses the Sunday start, because the full contraceptive effect might not be provided in the first pill pack.

Factors to Consider in Starting or Switching Oral Contraceptive Pills

Objective

Action

Products that achieve the objective

To minimize high risk of thrombosis

Select a product with a lower dosage of estrogen.

Alesse, Aviane, Loestrin 1/20, Levlite, Mircette

To minimize nausea, breast tenderness or vascular headaches

Select a product with a lower dosage of estrogen.

Alesse, Aviane, Levlite, Loestrin 1/20, Mircette

To minimize spotting or breakthrough bleeding

Select a product with a higher dosage of estrogen or a progestin with greater potency.

Lo/Ovral, Nordette, Ortho-Cept, Ortho-Cyclen, Ortho Tri-Cyclen

To minimize androgenic effects

Select a product containing a low-dose norethindrone or ethynodiol diacetate.

Brevicon, Demulen 1/35, Modicon, Ovcon 35

To avoid dyslipidemia

Select a product containing a low-dose norethindrone or ethynodiol diacetate.

Brevicon, Demulen 1/35, Modicon, Ovcon 35

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