How to choose the right COC

How to choose the right COC


More than 50 years have passed since the introduction of the first combined oral contraceptives (COCs) . Since then, the drugs have improved: dosages have been reduced, which has improved safety; also, new active substances have been developed that give COC additional non – contraceptive properties. This has led to the fact that more and more women choose this method of preventing unwanted pregnancy. However, there are a lot of drugs on the market , and it is easy to get confused in them, so it is important for a doctor to form his own algorithm for selecting COCs in each specific case.

It is not always easy to navigate the active ingredients , and this can lead to difficulties in the selection of COCs. In fact, everything is not so difficult, because it is important to remember a few main points. First of all, it must be said that the composition of COCs includes two hormonal components: estrogenic and gestagenic.

The estrogenic component in most COCs is ethinyl estradiol. This substance is one of the most studied components of COCs, provides optimal control of the cycle, and also complements the ovulation-inhibiting effect of the progestogen component.

Gestagens suppress ovulation by blocking the hypothalamic-pituitary axis, thicken the mucus produced in the lumen of the cervical canal (this is how the contraceptive effect is supplemented and inflammatory diseases of the pelvic organs are prevented ), and also lead to reversible thinning of the mucous membrane of the uterine cavity and reduce peristalsis fallopian tubes. Moreover, each of the gestagens, as mentioned above, has other additional beneficial effects.

All this in a complex provides a reliable contraceptive effect of COCs, exceeding 99%.

Gestagens are divided into generations, depending on their properties. The third generation includes desogestrel, norgestimate, gestodene. The fourth is drospirenone. It was singled out into a separate group not only because it was synthesized recently, but also because of its special properties. It promotes a mild diuretic effect, that is, it prevents the retention of excess fluid in the body. It also helps to reduce the increased appetite inherent in some women in the second phase of the cycle, and prevents the development of fat cells. Thus, drospirenone does not allow an increase in body weight, the occurrence of edema , etc. In addition to all this, drospirenone has antiandrogenic properties, which is expressed in a cosmetic effect (reducing the number of acne elements , oily skin and hair, etc.).

Among doctors, there is sometimes an opinion that if one COC does not fit, then another one with a different composition will not work either. In fact, this is not the case. Due to the different action of gestagens, the doctor has the opportunity to individualize the selection of COCs, and change the “unsuitable” drug to COCs with other properties, if necessary.

What you need to focus on when choosing a COC


The age of the woman. It is believed that at a younger and later reproductive age (up to 20-25 years old and after 40 years), micro-dosage preparations are more suitable. In active reproductive age (25-40 years), low-dose COCs (30-35 g ethinylestradiol) can be the first choice of contraceptive . The preparations with the content of etinilesradiola 20 micrograms or less can often be accompanied by spotting and breakthrough bleeding.
The needs of a woman. It is important to understand that the properties of drospirenone cover most of a woman’s needs in contraception, as well as in its “additional” properties. This is the control of body weight, and the above cosmetic effect and other properties.
Thus, the drug of first choice for contraception in patients of active reproductive age (25-40 years) can be COCs with a dosage of ethinyl estradiol at 30 g and drospirenone at a dose of 3 mg. This COC will provide a reliable contraceptive effect, good cycle control and the above additional properties.

An example of such a combination would be the low-dose COC Delsia. Indications for its reception – a protection against unwanted pregnancy. The drug may be the choice for contraception in women 25-40 years old, that is, in an active reproductive age.

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