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Combined hormonal contraception (CHC): COC, patch, ring

A Canadian clinical summary of combined hormonal contraception (chc): coc, patch, ring, with source-attributed priorities and explicit jurisdiction boundaries.

JurisdictionCanada
Source check2026-08-20
Clinical reviewiatroX editorial team 路 Clinical editorial review 路 reviewed 2026-08-20 路 due 2027-08-20
AudienceHealthcare professionals practising in Canada
This is an iatroX educational summary of named Canada sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. The evidence source is pan-Canadian, but formularies, funded access, referral routes, public-health directions and service availability remain provincial or territorial.

Source and scope

This summary is bounded to the recommendations, population and decisions covered by Guideline No. 329: Canadian Contraception Consensus, Combined Hormonal Contraception. Apply it with the current provincial or territorial pathway where implementation differs.
sources for this section:SOGC 329

Source-attributed clinical priorities

  • Assess pregnancy possibility, blood pressure, migraine aura, thrombosis and cardiovascular risk, smoking, medicines and postpartum status.
  • Choose pill, patch or ring through effectiveness, preference, adherence and contraindications and explain expected bleeding changes.
  • Give method-specific missed-dose, backup and emergency-contraception advice using current Canadian guidance.
  • Measure blood pressure and assess estrogen contraindications before prescribing a combined method.
sources for this section:SOGC 329

Practical assessment and management workflow

1
Review pregnancy, migraine aura, smoking, thrombosis, hypertension, cardiovascular disease, liver disease and interacting medicines.
2
Discuss pill, patch and ring effectiveness, adherence, bleeding, noncontraceptive benefits and STI protection.
3
Select an eligible formulation and explain initiation, missed doses and expected early bleeding.
4
Review new risk factors, blood pressure, adherence and troublesome symptoms.
sources for this section:SOGC 329

Safety, red flags and urgent escalation

  • Stop and assess new focal neurology, chest pain, major dyspnea or unilateral leg swelling urgently.
  • Do not use estrogen-containing contraception with migraine with aura or major thrombotic contraindication.
  • Enzyme inducers can reduce effectiveness and require an alternative plan.
sources for this section:SOGC 329

Confirm the local pathway before acting

The evidence source is pan-Canadian, but formularies, funded access, referral routes, public-health directions and service availability remain provincial or territorial.
sources for this section:SOGC 329

Source and implementation boundary

Read this educational summary with the linked source, current Canadian product information where medicines are involved, and the applicable provincial or territorial pathway. Local formularies, reporting duties, referral routes and service availability can differ.
sources for this section:SOGC 329

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. Society of Obstetricians and Gynaecologists of CanadaGuideline No. 329: Canadian Contraception Consensus, Combined Hormonal Contraceptionaccessed 2026-08-20
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