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Combined Oral Contraceptives

Modern combined oral contraceptives are made from very low doses of synthetic estrogen and progestin. These combined oral contraceptives (COCs) -- often called combined pills, the Pill, and birth control pills -- are very effective in preventing pregnancy when taken consistently and correctly (at the same time every day).  Their use does not interfere with intercourse. COCs are safe for most women; only some cardiovascular conditions, severe chronic conditions, and heavy smoking in women age 35 and over preclude use of the method. Most conditions that restricted use of high-dose COCs do not apply to low-dose formulations. Some characteristics of COCs are highlighted below.


0.1% to 0.8% failure rate during the first year of typical use; 0.01% failure rate with perfect use in the first year

Age limitations         

No restrictions on use from menarche to age 40

Parity limitations

No restrictions on use

Mode of action

Primarily by inhibiting ovulation; secondary mechanisms include thickening of the cervical mucus, changing endometrium, and reducing sperm transport

Effect on STD risk

Not protective

Drug interaction

Certain antiseizure medications (barbiturates, carbamazepine, phenytoin, primidone) and antibiotics (Rifampin and Griseofulvin) may reduce the contraceptive effect of COCs

Duration of use

Most women can use COCs safely throughout their reproductive years; there is no need for periodic discontinuation

Return to fertility

Immediately or after slight delay (average 2-3 months)

Return to Contraceptive Method List

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