Combined oral contraceptives
What Are Combined Oral Contraceptives?
- Pills that contain low doses of 2 hormones—a progestin and an estrogen—like the natural hormones progesterone and estrogen in a woman’s body.
- Combined oral contraceptives (COCs) are also called “the Pill,” low-dose combined pills, OCPs, and OCs.
- Work primarily by preventing the release of eggs from the ovaries (ovulation).
Effectiveness depends on the user: Risk of pregnancy is greatest when a woman starts a new pill pack 3 or more days late, or misses 3 or more pills near the beginning or end of a pill pack.
- As commonly used, about 8 pregnancies yy per 100 women using COCs over the first year. This means that 92 of every 100 women using COCs will not become pregnant.
- When no pill-taking mistakes are made, less than 1 pregnancy per 100 women using COCs over the first year (3 per 1,000 women).
Return of fertility after COCs are stopped: No delay
Protection against sexually transmitted infections (STIs): None
Side Effects
Some users report the following:
- Changes in bleeding patterns including:
– Lighter bleeding and fewer days of bleeding
– Irregular bleeding
– Infrequent bleeding
– No monthly bleeding
- Headaches
- Dizziness
- Nausea
- Breast tenderness
- Weight change
- Mood changes
- Acne (can improve or worsen, but usually improves)
Other possible physical changes:
- Blood pressure increases a few points (mm Hg). When increase is due to COCs, blood pressure declines quickly after use of COCs stops.
Health Benefits
Help protect against:
- Risks of pregnancy
- Cancer of the lining of the uterus (endometrial cancer)
- Cancer of the ovary
- Symptomatic pelvic inflammatory disease
May help protect against:
- Ovarian cysts
- Iron-deficiency anemia
Reduce:
- Menstrual cramps
- Menstrual bleeding problems
- Ovulation pain
- Excess hair on face or body
- Symptoms of polycystic ovarian syndrome (irregular bleeding, acne, excess hair on face or body)
- Symptoms of endometriosis (pelvic pain, irregular bleeding)
Known Health Risks
Very rare:
- Blood clot in deep veins of legs or lungs (deep vein thrombosis or pulmonary embolism)
Extremely rare:
- Stroke
- Heart attack
Safe and Suitable for Nearly All Women
Nearly all women can use COCs safely and effectively, including women who:
- Au născut sau nu au născut
- Have or have not had children
- Are not married
- Are of any age, including adolescents and women over 40 years old
- Have just had an abortion or miscarriage
- Smoke cigarettes—if under 35 years old
- Have anemia now or had in the past
- Have varicose veins
- Are infected with HIV, whether or not on antiretroviral therapy, unless that therapy includes ritonavir
Women can begin using COCs:
- Without a pelvic examination
- Without any blood tests or other routine laboratory tests
- Without cervical cancer screening
- Without a breast examination
- Even when a woman is not having monthly bleeding at the time, if it is reasonably certain she is not pregnant
Combined oral contraceptives:
- Do not build up in a woman’s body. Women do not need a “rest” from taking COCs.
- Must be taken every day, whether or not a woman has sex that day.
- Do not make women infertile.
- Do not cause birth defects or multiple births.
- Do not change women’s sexual behavior.
- Do not collect in the stomach. Instead, the pill dissolves each day.
- Do not disrupt an existing pregnancy.
- Missed pills
- Irregular bleeding (bleeding at unexpected times that bothers the client)
- No monthly bleeding
- Ordinary headaches (nonmigrainous)
- Nausea or dizziness
- Breast tenderness
- Weight change
- Mood changes or changes in sex drive
- Acne
New Problems That May Require Switching Methods
- Unexplained vaginal bleeding (that suggests a medical condition not related to the method) or heavy or prolonged bleeding
- Starting treatment with anticonvulsants, rifampicin, rifabutin, or ritonavir
- Migraine headaches
- Circumstances that will keep her from walking for one week or more
- Certain serious health conditions (suspected heart or serious liver disease, high blood pressure, blood clots in deep veins of legs or lungs, stroke, breast cancer, damage to arteries, vision, kidneys, or nervous system caused by diabetes, or gall bladder disease).
- Suspected pregnancy
Contact your doctor if you have any of the problems listed above.
It is easy to forget a pill or to be late in taking it. COC users should know what to do if they forget to take pills. If a woman misses one or more pills, she should follow the instructions below.
Riscul unei sarcini nedorite va creste în dependență de cîte pastile ați uitat să luați.
1. Take a missed hormonal pill as soon as possible.
2. Missed 1 or 2 pills:
– Take a hormonal pill as soon as possible.
– Use a backup method for the next 7 days
– Also, if you had sex in the past 5 days, can consider Emergency Contraceptive Pills.
1. Should a woman take a “rest” from COCs after taking them for a time?
No. There is no evidence that taking a “rest” is helpful. In fact, taking a “rest” from COCs can lead to unintended pregnancy. COCs can safely be used for many years without having to stop taking them periodically.
2. If a woman has been taking COCs for a long time, will she still be protected from pregnancy after she stops taking COCs?
No. A woman is protected only as long as she takes her pills regularly.
3. How long does it take to become pregnant after stopping COCs?
Women who stop using COCs can become pregnant as quickly as women who stop nonhormonal methods. COCs do not delay the return of a woman’s fertility after she stops taking them. The bleeding pattern a woman had before she used COCs generally returns after she stops taking them. Some women may have to wait a few months before their usual bleeding pattern returns.
4. Do COCs cause abortion?
No. Research on COCs finds that they do not disrupt an existing pregnancy. They should not be used to try to cause an abortion. They will not do so.
5. Do COCs cause birth defects? Will the fetus be harmed if a woman accidentally takes COCs while she is pregnant?
No. Good evidence shows that COCs will not cause birth defects and will not otherwise harm the fetus if a woman becomes pregnant while taking COCs or accidentally starts to take COCs when she is already pregnant.
6. Do COCs cause women to gain or lose a lot of weight?
No. Most women do not gain or lose weight due to COCs. Weight changes naturally as life circumstances change and as people age. Because these changes in weight are so common, many women think that COCs cause these gains or losses in weight. Studies find, however, that, on average, COCs do not affect weight. A few women experience sudden changes in weight when using COCs. These changes reverse after they stop taking COCs. It is not known why these women respond to COCs in this way.
7. Do COCs change women’s mood or sex drive?
Generally, no. Some women using COCs report these complaints. The great majority of COC users do not report any such changes, however, and some report that both mood and sex drive improve. It is difficult to tell whether such changes are due to the COCs or to other reasons. Providers can help a client with these problems . There is no evidence that COCs affect women’s sexual behavior.
8. What can a provider say to a client asking about COCs and breast cancer?
The provider can point out that both COC users and women who do not use COCs can have breast cancer. In scientific studies breast cancer was slightly more common among women using COCs and those who had used COCs in the past 10 years than among other women. Scientists do not know whether or not COCs actually caused the slight increase in breast cancers. It is possible that the cancers were already there before COC use but were found sooner in COC users .
9. Can COCs be used as a pregnancy test?
No. A woman may experience some vaginal bleeding (a “withdrawal bleed”) as a result of taking several COCs or one full cycle of COCs, but studies suggest that this practice does not accurately identify who is or is not pregnant. Thus, giving a woman COCs to see if she has bleeding later is not recommended as a way to tell if she is pregnant. COCs should not be given to women as a pregnancy test of sorts because they do not produce accurate results.
10. Must a woman have a pelvic examination before she can start COCs or at follow-up visits?
No. Instead, asking the right questions usually can help to make reasonably certain that a woman is not pregnant. No condition that could be detected by a pelvic examination rules out COC use.
11. Can women with varicose veins use COCs?
Yes. COCs are safe for women with varicose veins. Varicose veins are enlarged blood vessels close to the surface of the skin. They are not dangerous. They are not blood clots, nor are these veins the deep veins in the legs where a blood clot can be dangerous (deep vein thrombosis). A woman who has or has had deep vein thrombosis should not use COCs.
12. Can a woman safely take COCs throughout her life?
Yes. There is no minimum or maximum age for COC use. COCs can be an appropriate method for most women from onset of monthly bleeding (menarche) to menopause.
13. Can women who smoke use COCs safely?
Women younger than age 35 who smoke can use low-dose COCs. Women age 35 and older who smoke should choose a method without estrogen or, if they smoke fewer than 15 cigarettes a day, monthly injectables. Older women who smoke can take the progestin-only pill if they prefer pills. All women who smoke should be urged to stop smoking.
14. What if a client wants to use COCs but it is not reasonably certain that she is not pregnant after using the pregnancy checklist?
If pregnancy tests are not available, a woman can be given COCs to take home with instructions to begin their use within 5 days after the start of her next monthly bleeding. She should use a backup method until then.
15. Can COCs be used as emergency contraceptive pills (ECPs) after unprotected sex?
Yes. As soon as possible, but no more than 5 days after unprotected sex, a woman can take COCs as ECPs. Progestin-only pills, however, are more effective and cause fewer side effects such as nausea and stomach upset.
16. What are the differences among monophasic, biphasic, and triphasic pills?
Monophasic pills provide the same amount of estrogen and progestin in every hormonal pill. Biphasic and triphasic pills change the amount of estrogen and progestin at different points of the pill-taking cycle. For biphasic pills, the first 10 pills have one dosage, and then the next 11 pills have another level of estrogen and progestin. For triphasic pills, the first 7 or so pills have one dosage, the next 7 pills have another dosage, and the last 7 hormonal pills have yet another dosage. All prevent pregnancy in the same way. Differences in side effects, effectiveness, and continuation appear to be slight.
17. Is it important for a woman to take her COCs at the same time each day?
Yes, for 2 reasons. Some side effects may be reduced by taking the pill at the same time each day. Also, taking a pill at the same time each day can help women remember to take their pills more consistently. Linking pill taking with a daily activity also helps women remember to take their pills.
For a family planning consultation:
- Ask your family doctor at your health care facility in your area of residence (see here). WARNING: if you belong to one of the socially vulnerable groups (see here) you can benefit from free contraceptives!
- Ask Youth Friendly Health Centers
- Call the RHTC Hotline (free and confidential call) – 0800-088-08
- Call RHTC – 022355072 / 060903782 / 078306973
- Write to RHTC e-mail – cidsr2012@gmail.com
Progestin-Only Pills
What Are Progestin-Only Pills?
- Pills that contain very low doses of a progestin like the natural hormone progesterone in a woman’s body.
- Do not contain estrogen, and so can be used throughout breastfeeding and by women who cannot use methods with estrogen.
- Progestin-only pills (POPs) are also called “minipills” and progestin-only oral contraceptives.
- Work primarily by:
– Thickening cervical mucus (this blocks sperm from meeting an egg)
– Disrupting the menstrual cycle, including preventing the release of eggs from the ovaries (ovulation).
Effectiveness depends on the user: For women who have monthly bleeding, risk of pregnancy is greatest if pills are taken late or missed completely
Breastfeeding women:
- As commonly used, about 1 pregnancy per 100 women using POPs over the first year. This means that 99 of every 100 women will not become pregnant.
- When pills are taken every day, less than 1 pregnancy per 100 women using POPs over the first year (3 per 1,000 women).
Less effective for women not breastfeeding:
- As commonly used, about 3 to 10 pregnancies per 100 women using POPs over the first year. This means that 90 to 97 of every 100 women will not become pregnant.
- When pills are taken every day at the same time, less than 1 pregnancy per 100 women using POPs over the first year (9 per 1,000 women).
Return of fertility after POPs are stopped: No delay
Protection against sexually transmitted infections (STIs): None
Side Effects
Some users report the following:
- Changes in bleeding patterns including:
– For breastfeeding women, longer delay in return of monthly bleeding after childbirth (lengthened postpartum amenorrhea)
– Frequent bleeding
– Irregular bleeding
– Infrequent bleeding
– Prolonged bleeding
– No monthly bleeding
Breastfeeding also affects a woman’s bleeding patterns.
- Headaches
- Dizziness
- Mood changes
- Breast tenderness
- Abdominal pain
- Nausea
Other possible physical changes:
- For women not breastfeeding, enlarged ovarian follicles.
Known Health Benefits: Help protect against – Risks of pregnancy
Known Health Risks: None.
Safe and Suitable for Nearly All Women
Nearly all women can use POPs safely and effectively, including women who:
- Are breastfeeding (starting as soon as 6 weeks after childbirth)
- Have or have not had children
- Are not married
- Are of any age, including adolescents and women over 40 years old
- Have just had an abortion, miscarriage, or ectopic pregnancy
- Smoke cigarettes, regardless of woman’s age or number of cigarettes smoked
- Have anemia now or had in the past
- Have varicose veins
- Are infected with HIV, whether or not on antiretroviral therapy, unless that therapy includes ritonavir
Women can begin using POPs:
- Without a pelvic examination
- Without any blood tests or other routine laboratory tests
- Without cervical cancer screening
- Without a breast examination
- Even when a woman is not having monthly bleeding at the time, if it is reasonably certain she is not pregnant
Progestin-only pills:
- Do not cause a breastfeeding woman’s milk to dry up.
- Must be taken every day, whether or not a woman has sex that day.
- Do not make women infertile.
- Do not cause diarrhea in breastfeeding babies.
- Reduce the risk of ectopic pregnancy.
Problems Reported as Side Effects or Problems With Use:
- No monthly bleeding.
- Irregular bleeding (bleeding at unexpected times that bothers the client).
- Heavy or prolonged bleeding (twice as much as usual or longer than 8 days).
- Missed pills.
- Ordinary headaches (nonmigrainous).
- Mood changes or changes in sex drive.
- Breast tenderness.
- Severe pain in lower abdomen.
- Nausea or dizziness.
New Problems That May Require Switching Methods
- Unexplained vaginal bleeding (that suggests a medical condition not related to the method)
- Starting treatment with anticonvulsants, rifampicin, rifabutin, or ritonavir
- Migraine headaches
- Certain serious health conditions (suspected blood clots in deep veins of legs or lungs, liver disease, or breast cancer).
- Heart disease due to blocked or narrowed arteries (ischemic heart disease) or stroke
- Suspected pregnancy
Contact your doctor if you have any of the problems listed above.
1. Can a woman who is breastfeeding safely use POPs?
Yes. This is a good choice for a breastfeeding mother who wants to use pills. POPs are safe for both the mother and the baby, starting as early as 6 weeks after giving birth. They do not affect milk production.
2. What should a woman do when she stops breastfeeding her baby? Can she continue taking POPs?
A woman who is satisfied with using POPs can continue using them when she has stopped breastfeeding. She is less protected from pregnancy than when breastfeeding, however. She can switch to another method if she wishes.
3. Do POPs cause birth defects? Will the fetus be harmed if a woman accidentally takes POPs while she is pregnant?
No. Good evidence shows that POPs will not cause birth defects and will not otherwise harm the fetus if a woman becomes pregnant while taking POPs or accidentally takes POPs when she is already pregnant.
4. How long does it take to become pregnant after stopping POPs?
Women who stop using POPs can become pregnant as quickly as women who stop nonhormonal methods. POPs do not delay the return of a woman’s fertility after she stops taking them. The bleeding pattern a woman had before she used POPs generally returns after she stops taking them. Some women may have to wait a few months before their usual bleeding pattern returns.
5. If a woman does not have monthly bleeding while taking POPs, does this mean that she is pregnant?
Probably not, especially if she is breastfeeding. If she has been taking her pills every day, she is probably not pregnant and can keep taking her pills. If she is still worried after being reassured, she can be offered a pregnancy test, if available, or referred for one. If not having monthly bleeding bothers her, switching to another method may help—but not to a progestin-only injectable.
6. Must the POP be taken every day?
Yes. All of the pills in the POP package contain the hormone that prevents pregnancy. If a woman does not take a pill every day— especially a woman who is not breastfeeding—she could become pregnant. (In contrast, the last 7 pills in a 28-pill pack of combined oral contraceptives are not active. They contain no hormones.)
7. Is it important for a woman to take her POPs at the same time each day?
Yes, for 2 reasons. POPs contain very little hormone, and taking a pill more than 3 hours late (more than 12 hours late with POPs containing desogestrel 75 mg) could reduce their effectiveness for women who are not breastfeeding. (Breastfeeding women have the additional protection from pregnancy that breastfeeding provides, so taking pills late is not as risky.) Also, taking a pill at the same time each day can help women remember to take their pills more consistently. Linking pill taking with a daily activity also helps women remember to take their pills.
8. Do POPs cause cancer?
No. Few large studies exist on POPs and cancer, but smaller studies of POPs are reassuring. Larger studies of implants have not shown any increased risk of cancer. Implants contain hormones similar to those used in POPs, and, during the first few years of implant use, at about twice the dosage.
9. Can POPs be used as emergency contraceptive pills (ECPs) after unprotected sex?
Yes. As soon as possible, but no more than 5 days after unprotected sex, a woman can take POPs as ECPs. Depending on the type of POP, she will have to take 40 to 50 pills. This is many pills, but it is safe because there is very little hormone in each pill.
10. Do POPs change women’s mood or sex drive?
Generally, no. Some women using POPs report these complaints. The great majority of POP users do not report any such changes, however, and some report that both mood and sex drive improve. It is difficult to tell whether such changes are due to the POPs or to other reasons. Providers can help a client with these problems. There is no evidence that POPs affect women’s sexual behavior.
11. What should be done if a POP user has an ovarian cyst?
The great majority of cysts are not true cysts but actually fluid-filled structures in the ovary (follicles) that continue to grow beyond the usual size in a normal menstrual cycle. They may cause some mild abdominal pain, but they only require treatment if they grow abnormally large, twist, or burst. These follicles usually go away without treatment .
12. Do POPs increase the risk of ectopic pregnancy?
No. On the contrary, POPs reduce the risk of ectopic pregnancy. Ectopic pregnancies are rare among POP users. The rate of ectopic pregnancy among women using POPs is 48 per 10,000 women per year. The rate of ectopic pregnancy among women in the United States using no contraceptive method is 65 per 10,000 women per year. On the uncommon occasions that POPs fail and pregnancy occurs, 5 to 10 of every 100 of these pregnancies are ectopic. Thus, the great majority of pregnancies after POPs fail are not ectopic. Still, ectopic pregnancy can be life-threatening, so a provider should be aware that ectopic pregnancy is possible if POPs fail.
For a family planning consultation:
- Ask your family doctor at your health care facility in your area of residence (see here). WARNING: if you belong to one of the socially vulnerable groups (see here) you can benefit from free contraceptives!
- Ask Youth Friendly Health Centers
- Call the RHTC Hotline (free and confidential call) – 0800-088-08
- Call RHTC – 022355072 / 060903782 / 078306973
- Write to RHTC e-mail – cidsr2012@gmail.com
Emergency Contraceptive Pills
What Are Emergency Contraceptive Pills?
- Pills that contain a progestin alone, or a progestin and an estrogen together—hormones like the natural hormones progesterone and estrogen in a woman’s body.
- Emergency contraceptive pills (ECPs) are sometimes called “morning after” pills or postcoital contraceptives.
- Work primarily by preventing or delaying the release of eggs from the ovaries (ovulation). They do not work if a woman is already pregnant.
- If 100 women each had sex once during the second or third week of the menstrual cycle without using contraception, 8 would likely become pregnant.
- If all 100 women used progestin-only ECPs, one would likely become pregnant.
- If all 100 women used estrogen and progestin ECPs, 2 would likely become pregnant.
Return of fertility after taking ECPs: No delay. A woman can become pregnant immediately after taking ECPs. Taking ECPs prevents pregnancy only from acts of sex that took place in the 5 days before. They will not protect a woman from pregnancy from acts of sex after she takes ECPs—not even on the next day. To stay protected from pregnancy, women must begin to use another contraceptive method at once.
Protection against sexually transmitted infections (STIs): None
Side Effects
Some users report the following:
- Changes in bleeding patterns including:
– Slight irregular bleeding for 1–2 days after taking ECPs
– Monthly bleeding that starts earlier or later than expected
In the week after taking ECPs:
- Nausea
- Abdominal pain
- Fatigue
- Headaches
- Breast tenderness
- Dizziness
- Vomiting
Known Health Benefits: Help protect against risks of pregnancy
Known Health Risks: None
Tests and examinations are not necessary for using ECPs. They may be appropriate for other reasons—especially if sex was forced
Toate femeile pot utiliza PCU în siguranţă şi eficient, inclusiv femeile care nu pot utiliza cu regularitate metode contraceptive hormonale. Datorită modalităţii lor de utilizare pe termen scurt, nu există nicio afecţiune medicală în care utilizarea PCU să fie lipsită de siguranţă pentru femeie.
Emergency contraceptive pills:
- Do not cause abortion.
- Do not cause birth defects if pregnancy occurs.
- Are not dangerous to a woman’s health.
- Do not promote sexual risk-taking.
- Do not make women infertile.
- Slight irregular bleeding
- Change in timing of next monthly bleeding or suspected pregnancy
Contact your doctor if you have any of the problems listed above.
1. Do ECPs disrupt an existing pregnancy?
No. ECPs do not work if a woman is already pregnant. When taken before a woman has ovulated, ECPs prevent the release of an egg from the ovary or delay its release by 5 to 7 days. By then, any sperm in the woman’s reproductive tract will have died, since sperm can survive there for only about 5 days.
2. Do ECPs cause birth defects? Will the fetus be harmed if a woman accidentally takes ECPs while she is pregnant?
No. Good evidence shows that ECPs will not cause birth defects and will not otherwise harm the fetus if a woman is already pregnant when she takes ECPs or if ECPs fail to prevent pregnancy.
3. How long do ECPs protect a woman from pregnancy?
Women who take ECPs should understand that they could become pregnant the next time they have sex unless they begin to use another method of contraception at once. Because ECPs delay ovulation in some women, she may be most fertile soon after taking ECPs. If she wants ongoing protection from pregnancy, she must start using another contraceptive method at once.
4. What oral contraceptive pills can be used as ECPs?
Many combined (estrogen-progestin) oral contraceptives and progestinonly pills can be used as ECPs. Any pills containing the hormones used for emergency contraception—levonorgestrel, norgestrel, norethindrone, and these progestins together with estrogen (ethinyl estradiol)—can be used.
5. Is it safe to take 40 or 50 progestin-only pills as ECPs?
Yes. Progestin-only pills contain very small amounts of hormone. Thus, it is necessary to take many pills in order to receive the total ECP dose needed. In contrast, the ECP dosage with combined (estrogenprogestin) oral contraceptives is generally only 2 to 5 pills in each of 2 doses 12 hours apart. Women should not take 40 or 50 combined (estrogen-progestin) oral contraceptive pills as ECPs.
6. Are ECPs safe for women with HIV or AIDS? Can women on antiretroviral therapy safely use ECPs?
Yes. Women with HIV, AIDS, and those on antiretroviral therapy can safely use ECPs.
7. Are ECPs safe for adolescents?
Yes. A study of ECP use among girls 13 to 16 years old found it safe. Furthermore, all of the study participants were able to use ECPs correctly.
8. Can a woman who cannot use combined (estrogen-progestin) oral contraceptives or progestin-only pills as an ongoing method still safely use ECPs?
Yes. This is because ECP treatment is very brief.
9. If ECPs failed to prevent pregnancy, does a woman have a greater chance of that pregnancy being an ectopic pregnancy?
No. To date, no evidence suggests that ECPs increase the risk of ectopic pregnancy. Worldwide studies of progestin-only ECPs, including a United States Food and Drug Administration review, have not found higher rates of ectopic pregnancy after ECPs failed than are found among pregnancies generally.
10. Why give women ECPs before they need them? Won’t that discourage or otherwise affect contraceptive use?
No. Studies of women given ECPs in advance report these findings:
- Women who have ECPs on hand took them sooner after having unprotected sex than women who had to seek out ECPs. Taken sooner, the ECPs are more likely to be effective.
- Women given ECPs ahead of time were more likely to use ECPs than women who had to go to a provider to get ECPs.
- Women continued to use other contraceptive methods as they did before obtaining ECPs in advance.
11. Should women use ECPs as a regular method of contraception?
No. Nearly all other contraceptive methods are more effective in preventing pregnancy. A woman who uses ECPs regularly for contraception is more likely to have an unintended pregnancy than a woman who uses another contraceptive regularly. Still, women using other methods of contraception should know about ECPs and how to obtain them if needed—for example, if a condom breaks or a woman misses 3 or more combined oral contraceptive pills.
12. If a woman buys ECPs over the counter, can she use them correctly?
Yes. Taking ECPs is simple, and medical supervision is not needed. Studies show that young and adult women find the label and instructions easy to understand. ECPs are approved for over-thecounter sales or nonprescription use in many countries.
For a family planning consultation:
- Ask your family doctor at your health care facility in your area of residence (see here). WARNING: if you belong to one of the socially vulnerable groups (see here) you can benefit from free contraceptives!
- Ask Youth Friendly Health Centers
- Call the RHTC Hotline (free and confidential call) – 0800-088-08
- Call RHTC – 022355072 / 060903782 / 078306973
- Write to RHTC e-mail – cidsr2012@gmail.com
