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Abstract ombined oral contraceptive is one of the most commonly prescribed birth control methods, used by millions of women in many countries (Nisenbaum et al., 2014). Combined oral contraceptive (COC) is a popular and effective method for contraception. Since the dose of estrogen or the type of progestin component in COCs are associated with adverse events, especially venous thromboembolism (Pazol et al., 2018) There are many different formulations or brands, but the average pack is designed to be taken over a 28-day period, or cycle. For the first 21 days of the cycle, users take a daily pill that contains hormones (estrogen and progestogen). The last 7 days of the cycle are hormone free days. Some packets only contain 21 pills and users are then advised to take no pills for the following week. Other packets contain 7 additional placebo pills, or biologically inactive pills (Evans and Sutton, 2015). A woman on the pill will have a withdrawal bleed sometime during her placebo pill or no pill days, and is still protected from pregnancy during this time. Then after 28 days depending on which type a person is using, users start a new pack and a new cycle (Evans and Sutton, 2015). Contraceptive efficacy may be impaired by: missing more than one active pill in a packet, delay in starting the next packet of active pills (i.e., extending the pill-free, inactive or placebo pill period beyond 7 days), intestinal malabsorption of active pills due to vomiting or diarrhea, drug interactions with active pills that decrease contraceptive estrogen or progestogen levels. (Akintomide et al., 2018). |