The oral contraceptive pill (OCP) is the most commonly used form of reversible contraception. The two types of OCPs are combination oral contraceptives (COCs), which contain estrogen and progesterone, and progestin-only pills (POPs). Both have failure rates of approximately 7.2% to 9% with typical use, and are safe for most patients. Because estrogen-containing contraceptives can increase the risk of venous thromboembolism, patients with conditions associated with a risk of cardiovascular events should not use COCs. Blood pressure level should be assessed before initiation of oral contraceptives. Noncontraceptive benefits of oral contraceptives include reduced risk of ovarian and endometrial cancers, more favorable bleeding patterns, and improvement in menstruation-related symptoms such as acne, migraine headaches, and premenstrual dysphoric disorder. OCPs can be initiated any time the physician can be reasonably certain that the patient is not pregnant. Extended cycle regimens may be preferred by some patients. After assessing need, physicians should present all methods that can be used safely using a tiered effectiveness approach. High-quality contraceptive counseling includes working collaboratively with patients to find the most effective and acceptable method for them and helping to identify factors that may assist in or hinder their ability to use the method correctly over time.
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