Monophasic versus multiphasic oral contraceptives
RHL practical aspects by Shah DS
FIRST CONTACT (PRIMARY CARE) LEVEL
Doctors, non-doctor clinic personnel and community health workers trained to educate and counsel clients can provide oral contraceptives (OCs), depending on local regulations and practice. OCs that contains the lowest effective doses of estrogen and progestogen should be used for all users. Based on the findings of the three reviews monophasic OCs can be provided through clinic- or community-based services (CBS), using appropriate check-list for their prescription, for example WHO's Medical eligibility criteria for contraceptive use (1). The woman (or couple) should be encouraged to ask questions to clear up any uncertainties and misunderstanding, and should be asked to repeat the basic instructions to ensure that the woman in particular understands them. The woman should be told about the importance of not forgetting to take the pill each day.
The woman should be advised to return to the clinic in three months' time for a routine follow-up. Thereafter, a routine follow-up schedule is advisable. A list of warning signs for the user to look out for can be put on a card or a leaflet and given to her. Whenever possible, it should be ensured that the supply given to the woman will allow her to always have a standby packet of pills. It might be good practice to provide the woman with a supply of condoms when she receives the initial packets of pills in case she needs to use them for additional protection.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
The secondary (referral) care level should provide health assessment facilities, including medical and relevant social history, physical examination and any necessary laboratory examinations. The woman should be advised to consult a referral hospital if pregnancy is suspected or if she experiences warning signs of complications such as severe abdominal pain, severe chest pain, severe headache, blurring or loss of vision, severe pain in calf or thigh or jaundice. Provision of OCs to women with category 3 conditions as per WHO's Medical eligibility criteria for contraceptive use (1) should be under the supervision of a properly qualified practitioner at this level of care.
AT HOME OR IN THE COMMUNITY
Considering the low couple protection rate in India, there is a need for the provision of OCs over the counter through subsidized commercial channels. Social marketing programmes should ensure adequate user information and education about the proper use of the method.
The supply system should be flexible so that women can obtain OCs easily in the desired quantities when needed. It is important to keep the number of visits to get new prescriptions to the minimum. In general, if a woman does not request otherwise, three cycles of pills should be offered at the first encounter and then up to 10 cycles at the three-month follow-up encounter, provided there are no problems.
- WHO medical eligibility criteria for contraceptive use. Third edition. World Health Organization;Geneva, 2004.
This document should be cited as: Shah DS. Monophasic versus multiphasic oral contraceptives: RHL practical aspects (last revised: 23 June 2009). The WHO Reproductive Health Library; Geneva: World Health Organization.