Oral (Contraception, Hormonal)

Monophasic preparations

Triphasic preparations

Contraindications and guidance to starting the hormonal oral pill

Medicine interactions

Referral

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Z30.0/Z30.4

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

Monophasic preparations

• Progestin only pills, e.g.:
  • Levonorgestrel, oral, 30 mcg daily

LoE:IIIa¹⁸

• 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

LoE:IIIa¹⁹

Triphasic preparations

• 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

LoE:IIIa²⁰

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 Missed pills (Contraception, hormonal). Recommend condom use.

Contraindications and guidance to starting the hormonal oral pill

	Progestin only	Combined estrogen/progestin
Contra-indications	- 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/ genital tract - Known or suspected pregnancy LoE:IVb21	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 - May be started 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 at any other time, it needs to be taken for at least 7 days before contraceptive efficacy is established. The use of condoms is recommended during these 7 days

Medicine interactions

Click on table to enlarge

Lamotrigine

• Lowering of contraceptive effect not expected
• Oral contraceptives may reduce lamotrigine concentration, increasing the risk of seizures. Change to IUCD or progesterone only methods (i.e levonorgestrel implant, etonogestrel implant, or LNG-IUD), if lamotrigine is going to be used long term

LoE:IVb²²

Breastfeeding

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

REFERRAL

Abnormal vaginal bleeding for > 3 months.

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_ April 2025

Chapter 7: Family Planning_ 7.2 Contraception, hormonal_7.2.4 Oral