COC (starting routines)

This section of the system summarises the starting routines when starting a preparation of the combined oral contraceptive pill (COC) (combined hormonal contraception (CHC)) in different situations.

General principles:

CHC (Combined hormonal contraception) containing ethinylestradiol (EE) can be started by medically eligible women up to and including Day 5 of a natural menstrual cycle without the need for additional
contraceptive protection

• if it is reasonably certain that the woman is not pregnant, COCs can be initiated on any day of the menstrual cycle, not just the first day. Additional contraceptive precautions are required for the first 7 days if the pills are started after Day 5 of the cycle

CHC containing EE can be quick started by medically eligible women at any other time (with advice to use additional contraceptive precaution for 7 days) if:

• it is reasonably certain that the woman is not pregnant, OR,
• a high sensitivity urine pregnancy test is negative (even if there is a risk of pregnancy from unprotected sexual intercourse [UPSI] in the last 21 days). A follow up high sensitivity urine pregnancy test is required 21 days after the last UPSI

COC containing <= 30 μg EE in combination with levonorgestrel or norethisterone is a reasonable first-line choice of CHC to minimise cardiovascular risk

Patient advice:

• Starting the pill
  • You can start the pill any time in your menstrual cycle if you are sure you are not pregnant
    
    
  • If you start the pill on the first day of your period you will be protected from pregnancy immediately
    
    
  • You can also start the pill up to, and including, the fifth day of your period and you will be protected from pregnancy immediately
    
    
  • If you start the pill at any other time in your menstrual cycle you will need to use additional contraception, such as condoms, for the first 7 days of pill taking.

Reference:

• FSRH (July 2019). Combined Hormonal Contraception
• Faculty of Sexual & Reproductive Healthcare Clinical Guidance. Missed Pill Recommendations.Clinical Effectiveness Unit; May 2011.