Advanced Oral Contraceptive Regimens and Their Management

The article comprehensively describes the approved contraceptive pills, dosage regimens, guidelines to manage missed pills, and emergency contraceptive pills.
Published Online: September 04, 2014
Mohd Aftab Alam, PhD; Raisuddin Ali, PhD; Fahad Ibrahim Al-Jenoobi, PhD; and Abdullah M. Al-mohizea, PhD

Contraceptive pill regimens have gone through numerous changes and modifications to improve safety, compliance, and tolerability. Several generations of progestins were introduced, and their doses were adjusted over time. Four dosing regimens (monophasic, biphasic, triphasic and quadriphasic) have been introduced. These dosing regimens provide different hormonal doses at different stages of menstrual cycle. The 28-day cyclic (21 + 7) regimens are preferred because they result in better compliance than 21-day regimens. In the present review, we comprehensively describe the development of contraceptive pills, contraceptive doses, dose regimens, cyclic regimens, extended-cycle contraceptive pills, selection criteria of contraceptives, and emergency contraceptive pills. We also provide the FDA’s guidelines for managing missed contraceptive pills to assist users in taking them safely and to avoid contraceptive failure. In conclusion, the literature suggests that the success of combined oral contraceptive pills depends on regular intake according to a prescribed routine.

Am J Pharm Benefits. 2014;6(4):e103-e114

Contraceptive pill regimens have gone through numerous changes and modifications to improve safety, compliance, and tolerability.

  •  Contraceptive pills should be taken according to a regular routine, and dose regimens should be followed strictly.
  •  Missed pills should be managed according to recommended guidelines.
  • User-friendly packaging, which can improve compliance, is preferred.
  •  Nonhormonal contraceptive backup plans should be used for prescribed days when pills are missed.

Since the 1960s, oral contraceptives have been prescribed to fertile women for preventing unwanted pregnancy. Numerous contraceptive methods and products can be used. Some of them are oral pills, intrauterine devices, transdermal patches, implants, surgical procedures, condoms, diaphragms, cervical caps, injections, vaginal rings, and vaginal spermicides.1-3 The order of efficacy of contraceptive methods is presented in the Figure.4 Large numbers of oral contraceptive products are available in the market, varying  dose strength, regimen, packaging, and hormone combinations. In the present review, we elaborate mainly on oral contraceptive pills (OCPs)—their dosage regimens, dosage strengths, compositions, and guidelines to manage missed pills—as well as emergency oral contraceptives.

Oral contraceptive pills are among the preferred contraceptive methods because they are easy to take, there is no pleasure interruption, no surgical procedure is required, there is no device- related discomfort, they can be discontinued easily if the couple is planning for pregnancy, and the method is highly effective when taken properly according to the regimen. Success of OCPs is almost 99% when taken regularly according to recommended regimens.2 Compliance is the only major issue associated with OCPs and is considered to be responsible for cases of failure. Clinicians can play an important role in improving compliance by proper counseling of consumers about side effects, dose routine, and missed pill management, and can suggest backup plans in case of missed pills.5-8 Various packaging and other methods such as wallet pill cards specifying days of the pills (Ovcon-50), colored pills (Ortho- Tri-Cyclen), shaped pills (Estrostep Fe), dial-pack dispensers (Ortho-Novum, Ortho-Cyclen), and click-case dispensers (Lybrel) have been developed to improve compliance. 

Selection of the right contraceptive method/product requires making decisions, because the choice varies from person to person.9 Several factors play important roles in the selection of contraceptives. A few of these factors are safety and side effects, health risks, simplicity of the method, user’s compliance, user’s experience, protection against sexually transmitted disease, success rate, pharmacoeconomic concerns, frequency of intercourse, lifestyle, age, product availability and access, sociocultural convictions, overthe- counter versus prescription products, cost, effects on regular periods, advice from partner, friends, or health professionals, advertising, interruption of pleasure, duration of contraception desired, duration of contraceptive effectiveness, mode of contraception (eg, reversible or irreversible), and so forth.10-14 Mishell and colleagues updated the guidelines for oral contraceptive selection and recommended oral contraceptives as a first choice unless the consumer has some contraindication or intolerable side effects, or difficulty in taking pills regularly.15

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