Combined Oral Contraceptive

• Contraception
• Cycle regulation
• Endometriosis
• Acne (some)

Suppresses ovulation (↓ LH surge), thickens cervical mucus, thins endometrium.

• Migraine with aura
• BMI ≥35 + smoker ≥35y
• <6 weeks postpartum + breastfeeding
• Current breast cancer
• Known thrombophilia

Start

Day 1 of cycle (immediate cover)

Missed pill

>24 h late → emergency rules

• AbsoluteMigraine with aura
• AbsoluteVTE history / thrombophilia
• AbsoluteActive breast cancer

• Nausea
• Breast tenderness
• Mood change
• VTE (3× baseline)
• Stroke / MI (smokers)

• • Stop ≥4 weeks before major surgery.
• • Not used in pregnancy.

• Enzyme inducers

  Avoid

  ↓ efficacy — use alternative

• Lamotrigine

  Caution

  ↓ lamotrigine levels

• 💡 Quick-start any day if pregnancy excluded.
• 💡 Restart 21 days postpartum if not breastfeeding.