Initiation: Combined oral contraceptive pills are to be taken daily at approximately the same time each day. Avoid taking them greater than 24 hours apart as this could affect efficacy.
First-day start: Pills are started on the first day of menses, and this is considered the best strategy as it attains contraceptive efficacy faster than other methods.
Quick start: Pills are started on any day medicine is given to women. When patients initiate this method, they are not protected from pregnancy in the first seven days, and an additional form of birth control is recommended.
Missed doses: If a patient misses a tablet, take the missed tablet as soon as they remember and the next tablet at the usual time (taking two pills in 1 day). If the patient misses two tablets in a row in the first or second week, take two tablets the day the patient remembers and two pills the next day, then resume 1 per day. Use additional forms of contraception until the patient begins a new cycle.[10] Check the package insert for accurate information on managing if it occurs.
Emergency Contraception: It is recommended in the first week of the cycle if unprotected intercourse occurs and if two or more COC pills are missed (exception ulipristal acetate).
Most side effects of OCP’s are mild and disappear with continued use or switching to another pill formulation. The most common adverse effect of combined oral contraceptive pills is breakthrough bleeding. Women will also complain of nausea, headaches, abdominal cramping, breast tenderness, and increased vaginal discharge or decreased libido.