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Combined Oral Contraceptives :

Introduction to Combined Oral Contraceptives 
Women who use oral contraceptives swallow a pill each day to prevent pregnancy. Combined oral contraceptives contain two hormones similar to the natural hormones in a woman’s body---an estrogen and a progestin. Also called combined pills, COC’s, OC’s, the pill and birth control pills.

How do they work?
-Stop ovulation (release of eggs from ovaries)
-Also thicken cervical mucus, making it difficult for sperm to pass through.
-They do not work by disrupting existing pregnancy.

How effective?
Effectively as commonly used – 6 to 8 pregnancies per 100 women in first
year of use (1 in every 17 to 1 in every 12).
Very effective when used correctly and consistently – 0.1 pregnancies per
100 women in first year of use (1 in every 1,000).

Advantages
-
Very effective when used correctly
- No need to do anything at time of sexual intercourse
- Increased sexual enjoyment because no need to worry about pregnancy
- Monthly periods are regular; lighter monthly bleeding and fewer days of
bleeding; milder and fewer menstrual cramps
- Can be used at any age from adolescence to menopause 
- Fertility returns soon after stopping
- Can be used as an emergency contraceptive after unprotected sex
- Can prevent or decrease iron deficiency, anemia

Helps prevent: 
-Ectopic pregnancies
-Endometrial cancer
-Ovarian cancer
-Ovarian cysts
-Pelvic inflammatory disease
-Benign breast disease

Disadvantages
-
Nausea (most common in first three months)
- Spotting or bleeding between menstrual periods, especially if woman forgets to     take her pills or takes them late (most common in first three months) 
- Breast tenderness
- Slight weight gain
- Not recommended for breast feeding women because they effect quality and  quantity of milk
- Very rarely can cause stroke, blood clots in deep veins of the legs, or heart attack. Those at highest risk are women with high blood pressure and women who are aged 35 or old and at the same time smoke more than 20 cigarettes per day
- Do not protect against sexually transmitted diseases (STDs) 
- Starting Low-Dose Combined Oral Contraceptives

When to start?
-
The first day of the menstrual bleeding is best
- Any of the first 7 days after her menstrual bleeding has already stopped, some programs advise avoiding sex or using condoms or spermicide for seven days
- After she stops breast feeding or 6 months after child birth—whichever comes first 
- 3 to 6 weeks after childbirth. No need to wait for menstrual periods to return to be certain that she is not pregnant

Some important points for the user to remember
-
Pills can be very effective if taken regularly every day
- Safe-Serious problems are very rare
- Please come back or see another health care provider at once if you have severe , constant pain in the chest, leg, or belly, or very bad headaches, if you see flashing lights or zigzag lines, or if your skin or eyes become unusually yellow (jaundice)
- Pills do not prevent sexually transmitted diseases (STDs) including HIV/ AIDS. If you think you might get an STD, use condoms regularly along with your pills

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