Technical Update on COCs, POPs and ECP

The effectiveness of COCs depends on daily intake, and they are available in the public sector as free and ASHA supply, with the brand name Mala-N. Each hormonal tablet in a COC strip contains Levonorgestrel (0.15mg) and Ethinyl estradiol (30 micrograms). COCs have several non-contraceptive benefits, including protection against endometrial and ovarian cancer, iron deficiency anemia, polycystic ovarian syndrome, endometriosis, and a decreased risk of ectopic pregnancy. The effectiveness of COCs depends on regular and correct use, and they can be started at any time if it is reasonably certain that the woman is not pregnant. A pregnancy checklist should be used to confirm non-pregnancy status. COCs work primarily by preventing the release of eggs from the ovaries (ovulation) by suppressing FSH and LH. Women with menstrual cycles can start COCs within 5 days of menstrual bleeding without needing a back-up method, but if started after 5 days, a back-up method is required for the first 7 days. Breastfeeding women more than 6 months after giving birth can start COCs in the absence of menstrual bleeding after ruling out pregnancy, and a back-up method is needed for 7 days. Women not breastfeeding can start COCs at different times depending on their postpartum status. Those less than 4 weeks after giving birth can start COCs anytime on days 21-28 after childbirth without a back-up method, while those more than 4 weeks after giving birth can start COCs anytime when reasonably certain that they are not pregnant, with a back-up method required for the first 7 days. After miscarriage or abortion, COCs can be started within 7 days without a back-up method, but beyond 7 days, a back-up method is required for the first 7 days. To use COC pills effectively, it is recommended to link pill intake to a daily activity to help remember to take the pill daily and reduce some side effects. When finishing one pack, the first pill from the next pack should be taken on the very next day. Bleeding occurs when a woman is on iron tablets, but pills should be continued, irrespective of bleeding.