EML

Z30.0/Z30.4

Dual contraception with barrier methods, are recommended to reduce the risk of STIs, including HIV.

Progestins and estrogen, fixed combinations, e.g.:
Ethinylestradiol/ levonorgestrel, oral, 30 mcg/150 mcg:
- 21 tablets ethinylestradiol/levonorgestrel, 30 mcg/150 mcg and
- 7 tablets placebo.

Progestins and estrogen, sequential preparations, e.g.:
Ethinylestradiol/levonorgestrel, oral:
- 6 tablets ethinylestradiol/levonorgestrel,30 mcg/50 mcg
- 5 tablets ethinylestradiol/levonorgestrel, 40 mcg/75 mcg and
- 10 tablets ethinylestradiol/levonorgestrel,30 mcg/125 mcg and
- 7 tablets placebo.

LoEIII [18]

Counselling:

Hormonal oral pills must be taken at the same time every day without interruption.
Taking the hormonal oral pill with food or at bedtime may alleviate nausea.
If the woman is not using dual contraception with barrier methods and vomits within 2 hours, or has severe diarrhoea within 12 hours of taking the hormonal oral pill, repeat the dose as soon as possible. Recommend condom use.
Women who have persistent vomiting or severe diarrhoea resulting in two or more missed pills must follow instructions for missed pills. See Recommend the use of condoms.

	Progestin only	Combined estrogen/progestin
Contraindications	Progestin only preparations are contraindicated in certain conditions. (Consult the package insert in this regard). Contraindications include: » Abnormal uterine bleeding of unknown cause. » Myocardial infarction/ stroke » Liver disease. » Cancer of the breast or genital tract » Known or suspected pregnancy. LoEIII[19]	Combination preparations contraindicated in certain conditions. (Consult the package insert in this regard). Contraindications include: » Women >35 years of age who smoke ≥ 15 cigarettes a day or have risk factors for cardiovascular disease: - heart disease - liver disease - thromboembolism - certain cancers
When to start the pill	» Exclude pregnancy. » Start anytime within the menstrual cycle, but it is advisable to start during menses. » If the first pill is given between days 1 and 5 of the menstrual cycle the contraceptive effect is achieved immediately. » If the pill is started in at any other time, it needs to be taken for at least 7 days before it protects against pregnancy.	» Start anytime within the menstrual cycle, but it is advisable to start during menses. » If the first pill is given between days 1 and 5 of the menstrual cycle the contraceptive effect is achieved immediately. » Dual contraception use is recommended irrespective of when the pill is started in the menstrual cycle.

Enzyme-inducing medicines interacting with oral contraceptives		Recommendation
Therapeutic class	Examples
Anti-tuberculosis	Rifampicin	Use copper IUCD or alternatively use dual contraception e.g. condoms in combination with COCs.
Anti-epileptics	Phenobarbital	Use IUCD or alternatively use dual contraception e.g. condoms in combination with COCs.
	Phenytoin	Use IUCD or alternatively use dual contraception e.g. condoms in combination with COCs.
	Carbamazepine	Use IUCD or alternatively use dual contraception e.g. condoms in combination with COCs.
Antiretrovirals	Nevirapine	Use IUCD or alternatively use dual contraception e.g. condoms in combination with COCs.
	Lopinavir/ritonavir	Use IUCD or alternatively use dual contraception e.g. condoms in combination with COCs.
	Efavirenz	Use IUCD or alternatively use dual contraception e.g. condoms in combination with COCs.

Non-liver enzyme inducing medicines

Lamotrigine:

Lowering of contraceptive effect not expected.
Oral contraceptives may reduce lamotrigine concentration by 50%, increasing the risk of seizures. Consider alternative dual contraception method.

Breastfeeding

Women who are intending to breastfeed should delay initiation of COCs until cessation of breastfeeding or at 6 months postpartum, whichever occurs earlier.

Abnormal vaginal bleeding for > 3 months.

Oral