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Combined pill

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The combined pill is usually just called the pill. It contains two hormones – estrogen and progestogen. These are similar to the natural hormones women produce in their ovaries. There are a number of different combined pills.

The advice contained here includes the latest information  available for women who have missed a pill.

How effective is the pill?

How does the pill work?

Where can I get the pill?

Can anyone use the pill?

What are the advantages of the pill?

What are the disadvantages of the pill?

Will I put on weight if I take the pill?

Are there any risks?

Are all combined pills the same?

How do I start the first pack of pills?

When can I start the pill after having a baby, miscarriage or an abortion?

How do I take the pill?

How important is it that I take the pill at the same time?

Am I protected from pregnancy during the seven day break or the placebo week?

What should I do if I forget to take a pill or start my packet late?

What should I do if I am sick or have diarrhoea?

If I take other medicines will it affect my pill?

What if I want to change to a different pill?

I'm bleeding on days when I'm taking the pill – what should I do?

I didn't bleed in my pill free week – am I pregnant?

Can I miss out a withdrawal bleed?

What should I do if I want to stop taking the pill or try to get pregnant?

Should I give my body a break from the pill every few years or so?

How often do I need to see a doctor or nurse?

Emergency contraception

Sexually transmitted infections

Where can I get more information and advice?

How effective is the pill?

How effective any contraceptive is depends on how old you are, how often you have sex and whether you follow the instructions.

If 100 sexually active women don’t use any contraception, 80 to 90 will become pregnant in a year.

If the pill is taken according to instructions it is over 99 per cent effective. This means that less than 1 woman in 100 will get pregnant in a year.

If the pill is not taken according to instructions, more women will become pregnant.

How does the pill work?

The main way the pill works is to stop the ovaries from releasing an egg each month (ovulation). It also:

  • thickens the mucus from your cervix. This makes it difficult for sperm to move through it and reach an egg
  • makes the lining of your womb thinner so it is less likely to accept a fertilised egg.

Where can I get the pill?

You can go to a family planning clinic, your GP or practice nurse. If you prefer not to go to your own general practice, or they don’t provide contraceptive services, they will give you information about another practice or clinic. All treatment is confidential and free.

See Where do I go for help? for details of how to contact your national fpa helpline, general practice or family planning clinic.

Can anyone use the pill?

Not everyone can use the combined pill so your doctor or nurse will need to ask you about your own and your family’s medical history. Do mention any illness or operations you have had. Some of the conditions which may mean you should not use the combined pill are:

  • you think you might already be pregnant
  • you smoke and are 35 or older
  • you take certain medicines

You have now or have had in the past:

  • thrombosis (blood clots) in any vein or artery
  • a heart abnormality or circulatory disease, including raised blood pressure
  • very severe migraines or migraines with aura
  • breast cancer
  • active disease of the liver or gall bladder
  • diabetes with complications.

If you cannot use the combined pill you may be able to use the progestogen-only pill, or another progestogen-only method of contraception.

If you are healthy, don’t smoke and there are no medical reasons for you not to take the pill, you can take it until your menopause. At the age of 50, if you are still having periods, you may be advised to change your method.

What are the advantages of the pill?

Some of the advantages of the pill are it:

  • doesn’t interrupt sex
  • usually makes your bleeds regular, lighter and less painful
  • may help with pre-menstrual symptoms
  • reduces the risk of cancer of the ovary, womb and colon
  • may protect against pelvic inflammatory disease
  • may reduce the risk of fibroids, ovarian cysts and breast disease that is not cancer.

What are the disadvantages of the pill?

  • There are some serious side-effects.
  • You may get temporary side-effects at first including headaches, nausea, breast tenderness and mood changes. If these do not stop within a few months, changing type of pill may help.
  • The pill may increase your blood pressure.
  • The pill does not protect you against sexually transmitted infections, so you may need to use condoms as well.
  • Breakthrough bleeding (unexpected bleeding on pill taking days) and spotting is common in the first few months of pill use.

Will I put on weight if I take the pill?

Research has not shown evidence of weight gain in women using the combined pill.

Some women may find that their weight changes throughout their cycle due to retention of fluid.

Are there any risks?

The pill can have some serious side-effects, but these are not common. For most women the benefits of the pill outweigh the possible risks. All risks and benefits should be discussed with your doctor or nurse.

  • A very small number of women may develop a blood clot which can block a vein (venous thrombosis) or an artery (arterial thrombosis or heart attack or stroke). If you have ever had a thrombosis, you should not use the pill. Some types of pill appear to be associated with a slightly higher risk of venous thrombosis.
  • The risk of venous thrombosis is greatest during the first year that you take the pill and if any of the following apply to you: you are very overweight, are immobile for a long period of time or use a wheelchair, have severe varicose veins or a member of your immediate family had a venous thrombosis before they were 45.
  • The risk of arterial thrombosis is greatest if any of the following apply to you: you smoke, are diabetic, have high blood pressure, are very overweight, have migraine with aura, or a member of your immediate family had a heart attack or stroke before they were 45.
  • Research into the risk of breast cancer and hormonal contraception is complex and contradictory. Current research suggests that users of all hormonal contraception appear to have a small increase in risk of being diagnosed with breast cancer compared to non-users of hormonal contraception. Further research is ongoing.
  • Research suggests that there is a small increase in risk of developing cervical cancer if the pill is used continuously for more than five years.
  • Some research suggests a link between using the combined pill and developing a very rare liver cancer.

See a doctor straightaway if you have any of the following:

  • pain in the chest, including any sharp pain which is worse when you breathe in
  • breathlessness
  • you cough up blood
  • painful swelling in your leg(s)
  • weakness, numbness, or bad “pins and needles” of an arm or leg
  • severe stomach pains
  • a bad fainting attack or you collapse
  • unusual headaches or migraines that are worse than usual
  • sudden problems with your speech or eyesight
  • jaundice (yellowing skin or yellowing eyes).

If you need to go into hospital for an operation or you have an accident which affects the movement of your legs, you should tell the doctor that you are taking the combined pill. The doctor will decide if you need to stop taking the pill or need other treatment to reduce the risk of developing a blood clot.

Are all combined pills the same?

No, there are three main types of pills and many different brands. It is important to know which type of pill you are taking, as they are taken differently.

Monophasic 21 day pills – This is the most common type of pill. Each pill has the same amount of hormone in it. You take one a day for 21 days then no pills for the next seven days.

Phasic 21 day pills – These pills contain different amounts of hormone so you must take them in the right order. There are two or three sections of different coloured pills in the pack. You take one pill a day for 21 days then no pills for the next seven days.

EveryDay (ED) pills – There are 21 active pills and seven inactive pills which don’t contain any hormones (placebos). These look different to the active pills. You take one pill a day for 28 days with no break between packets. There are different types of ED pills. Whichever type you take, you must take EveryDay pills in the right order.

How do I start the first pack of pills?

These instructions apply to all types of combined pill. You can start the pill anytime in your menstrual cycle if you are sure you are not pregnant.

If you start the pill on the first day of your period you will be protected from pregnancy immediately.

You can also start the pill up to, and including, the fifth day of your period and you will be protected from pregnancy immediately.

However, if you have a short menstrual cycle with your period coming every 23 days or less, starting the pill as late as the fifth day of your cycle may not provide you with immediate contraceptive protection. This is because you may release an egg (ovulate) early in your menstrual cycle. You may wish to talk to your doctor or nurse about this and whether you need to use an additional contraceptive method for the first seven days.

If you start the pill at any other time in your menstrual cycle you will need to use another contraceptive method, such as condoms, for the first seven days of pill taking.

When can I start the pill after having a baby, miscarriage or an abortion?

You can start taking the pill three weeks (21 days) after you gave birth. Starting on day 21 you will be protected against pregnancy straight away. If you start later than day 21, you will need to use an extra method of contraception for seven days.

If you are breastfeeding a baby under six months old, taking the combined pill may reduce your flow of milk. It is usually recommended that you use a different method of contraception.

You can start taking the combined pill immediately after a miscarriage or abortion, if you were pregnant for less than 24 weeks. You will be protected from pregnancy straight away.

How do I take the pill?

21 day pills – Take your first pill from the bubble marked with the correct day of the week or the first pill of the first colour (phasic pills).Try to take it at the same time each day and take a pill every day until the pack is finished (21 days).

You then stop taking pills for seven days. During this week you get a withdrawal bleed (period).

Start your next pack on the eighth day (the same day of the week as you took your first pill). Do this whether or not you are still bleeding.

EveryDay (ED) pills – Take the first pill from the section of the packet marked “start”. This will be an active pill. Take a pill every day until the pack is finished (28 days). You must take the pills in the correct order and try to take them at the same time each day. Taking the pills in the wrong order could mean that you are not protected against pregnancy.

During the seven days that you take the placebo pills you will get a withdrawal bleed (period). When you finish a pack you should start another pack the next day whether or not you are still bleeding.

ED pills come with sticky strips of paper with the days of the week marked on them. These help you keep track of your pill taking. Instructions in the packet will tell you how to use them.

The way ED pills are packaged recently changed. If you are given an older style packet your doctor or nurse will tell you how to take them and when you will be protected against pregnancy.

How important is it that I take the pill at the same time?

It is very important that you take a pill each day as instructed. When taking your first pill, choose a convenient time for you. This can be any time of the day. Taking the pill at the same time each day will help you remember to take it regularly. You should not take your pill more than 24 hours later than your chosen time. If you do, you must treat this day as if you have missed a pill. The important thing is not to stop taking your pill.

Am I protected from pregnancy during the seven-day break or the placebo week?

Yes. You are protected if:

  • you have taken all the pills correctly
  • you start the next packet on time
  • nothing else has happened that might make the pill less effective.

What should I do if I forget to take a pill or start my packet late?

Missing pills or starting the packet late may make your pill less effective. The chance of pregnancy after missing pills depends on when pills are missed and how many pills are missed.

Missing one pill anywhere in your pack or starting the new pack one day late is not a problem. Depending on which type of pill you take, missing more than one or starting the packet more than one day late may affect your contraceptive cover. See How many pills have you missed ?.

It is more risky to start a packet late or miss the first pill(s) of the next pack. This is because during the seven day break or placebo week your ovaries are not getting any effects from the pill. If you make the break or placebo week longer your ovaries might release an egg.

If you are not sure what to do continue to take your pill and use additional contraception, such as a condom, and seek advice.

What should I do if I am sick or have diarrhoea?

If you vomit within two hours of taking a pill, it will not have been absorbed by your body. Take another pill as soon as you feel well enough. As long as you are not sick again your contraception will not be affected. Take your next pill at the normal time. If you continue to be sick, seek advice.

If you have very severe diarrhoea for more than 24 hours , this may make your pill less effective. Keep taking your pill at the normal time, but treat each day that you have severe diarrhoea as if you had forgotten to take a pill and follow the missed pill instructions. See How many pills have you missed?.

If I take other medicines will it affect my pill?

There are a few medicines that make the pill less effective. Your doctor, nurse, dentist or pharmacist can advise you. Follow the instructions below if you are taking a medicine that affects the pill.

Common antibiotics – Continue taking your pill as usual and use an extra method of contraception, such as condoms, while taking the antibiotics and for seven days afterwards. If you get to the end of your packet or the end of the active pills in ED pills while you are taking the antibiotics or still need to use additional contraception, then start a new packet straight away. Do not have your usual seven day break or take your placebo tablets. You may or may not bleed, this is normal. You will be protected against pregnancy.

If you are given antibiotics in the first week of your pill packet and you have had sex recently you should seek advice as you may also need emergency contraception.

If you are taking a common antibiotic for more than two weeks (eg for treatment of acne), you will need to follow different instructions. Your doctor or nurse can advise you.

Some other medicines – These include some medicines used to treat epilepsy, HIV and TB, and the complementary medicine, St John’s Wort. These types of drugs are called enzyme inducers. If you take these medicines, talk to your doctor or nurse. It is often advised that you use a different method of contraception instead of the combined pill.

What if I want to change to a different pill?

It is easy to change from one pill to another. Talk to your doctor or nurse as you may need to miss out the break or placebo week or use additional contraception for a short time.

I'm bleeding on days when I'm taking the pill – what should I do?

Bleeding is very common when you first start taking the pill and is not usually anything to worry about. It may take up to three months to settle down. It is very important to keep taking the pills to the end of the packet, even if the bleeding is as heavy as your ‘period’.

Bleeding may also be caused by missing pills or by a sexually transmitted infection.

I didn't bleed in my pill free week – am I pregnant?

You don’t have proper periods when you are on the pill. What you have is called a ‘withdrawal bleed’. This bleeding (which doesn’t always happen) is caused by you not taking hormones in the pill free week.

If you took all your pills correctly and you didn’t have an upset stomach or take any other medicines which might have affected the pill, then it is very unlikely you are pregnant. So start your next packet at the right time. If you are worried ask your doctor or nurse for advice, or do a pregnancy test. Always do this if you miss more than one bleed. If you do become pregnant, there is no evidence to show that taking the combined pill harms the baby.

Can I miss out a withdrawal bleed?

Yes. This is not harmful to do. If you are taking a monophasic pill you should start another packet straight away and miss out the pill free break. With EveryDay pills, miss out the placebo tablets. If you are taking a phasic pill, ask your doctor, nurse or fpa helpline which pills to take.

Sometimes you do still get some bleeding. This is nothing to worry about. If you have taken your pills correctly, you will still be protected against pregnancy.

What should I do if I want to stop taking the pill or try to get pregnant?

Ideally, it is easier to stop taking the pill at the end of the packet. If you don’t want to wait until the end of the packet seek advice because you can risk becoming pregnant if you have had sex recently. If you do not want to become pregnant you should use another method of contraception from the day that you take your last active pill. Don’t worry if your normal periods don’t start immediately. For some women it can take a few months.

If you want to try for a baby it helps to wait for one natural period before trying to get pregnant. This means the pregnancy can be dated more accurately and you can start pre-pregnancy care such as taking folic acid and stopping smoking. You can ask your doctor or nurse for advice. Don’t worry if you do get pregnant sooner, it will not harm the baby.

Should I give my body a break from the pill every few years or so?

No, you don’t need to take a break because the hormones do not build up. There are no known benefits to your health or fertility from taking a break.

How often do I need to see a doctor or nurse?

When you first start the pill you will usually be given three months’ supply to see how it suits you. After that you should go back to the doctor or nurse regularly to get new supplies and to have your blood pressure checked. If there are no problems, you can be given up to a year’s supply of the pill.

You do not need to have a vaginal examination or cervical smear test when you are first prescribed the pill.

Emergency contraception

If you have had sex without using contraception or think your method might have failed there are two emergency methods you can use.

  • The emergency hormonal pill – must be taken up to three days (72 hours) after sex. It is more effective, the earlier it is taken after sex.
  • An IUD – must be fitted up to five days after sex, or up to five days after the earliest time you could have released an egg (ovulation).

Ask your doctor or nurse about getting emergency pills in advance, just in case you need them.

Sexually transmitted infections

Most methods of contraception do not protect you from sexually transmitted infections.

Male and female condoms, when used correctly and consistently, can help protect against sexually transmitted infections. Diaphragms and caps may also protect against some sexually transmitted infections. If you can, avoid using condoms containing Nonoxinol 9 (spermicidally lubricated), as this does not protect against HIV and may even increase the risk of infection.

Where can I get more information and advice?

Find out where to get more information and advice.



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