A GP guide to oral contraceptives

An update for GPs, including non-contraceptive indications, managing risks and side effects, newer agents and options for women across the reproductive lifespan

Need to know:

  • Oral contraceptives have high efficacy when taken correctly and consistently (99.5% for perfect use, 93% for typical use).
  • Combined oral contraceptives (COCPs) containing 30mcg ethinylestradiol, or less with levonorgestrel, are considered first-line due to their well-established safety profile (and PBS listing).
  • COCPs can have additional non-contraceptive benefits for acne, heavy menstrual bleeding and premenstrual dysphoric disorder. There is generally limited evidence demonstrating superiority of one COCP type over another.
  • Extended use of COCPs allows users to avoid withdrawal bleeding, and potentially increases effectiveness and non-contraceptive benefits.
  • There is limited evidence guiding choice of progestogen-only pills (POPs). Traditional low-dose POPs have a three-hour missed pill window that typically limits their use.
  • A new 4mg drospirenone POP has recently become available that