The choices Combined pill

Combined pill

What is it?

‘The Pill' or combined pill contains the hormones estrogen and progestogen. Most come in 21-pill or 28-pill packs. With the 21-pill pack, a pill is taken for 21 days followed by a seven day break, during which you're likely to have a bleed similar to a natural period. The 28-pill pack, called every day pills (ED), contains 21 tablets that contain hormones plus seven tablets some of which may contain no hormones. These extra pills act as a reminder to take your pill every day.

‘The Pill' needs to be taken at a regular time on each day for it to be effective. Different types of pills contain differing amounts and types of hormones.

It can be started up to and including the fifth day of your period, protecting immediately against pregnancy. However, this may not be the case if you have short cycles so always discuss your starting regime with your doctor or nurse. If started on any other day, another method of contraception must also be used for seven days.

How does it work?

The two hormones in the combined pill, estrogen and progestogen, have a similar effect to the hormones found in your own body, taken daily they:

• Stop your ovaries releasing an egg
• Thicken the mucus of the cervix to act as a barrier to sperm
• Stop the egg settling by keeping the lining of the womb thin

How effective is it?

The Pill is more than 99% effective when used correctly. However this depends on women taking tablets exactly as required. In practice, many women are unable to do this.

What are the benefits?

• Does not interrupt sex
• Lighter, less painful, regular bleeds
• Easily reversible if you want to get pregnant
• Protects against cancer of the ovary, colon and womb
• Can help to reduce premenstrual tension (PMT)
• Can reduce the risk of fibroids and ovarian cysts
• May help with acne

Who may not be able to / may not want to use it?

Women who:

• Are over 35 years old and smoke or have stopped smoking less than a year ago
• Are overweight (BMI of 30 kg/m or over)
• Suffer from migraines with aura
• Have had blood clots in any vein or artery
• Have had circulatory disease or a heart abnormality
• Have diabetes complications or have had diabetes for over 20 years
• Have breast cancer or have had it within the last five years
• Have active liver or gall bladder disease
• Take certain medicines that interfere with the effectiveness of ‘the Pill'
• Are allergic to estrogen
• Don't want to take a pill every day
• Might be pregnant

Possible side-effects?

Not all women will experience side-effects

• Temporary increase in the chance of breast tenderness, headaches, nausea and mood changes
• Breakthrough bleeding
• May increase blood pressure
• Very small increased risk of blood clots
• Very small increased risk of breast cancer/cervical cancer

What if:

I miss a pill?

Missed pills or starting a packet late make ‘the Pill' less effective. The chance of getting pregnant after missing a pill depends on how many you missed and when you missed them. If you miss one pill in your pack or you start the pack one day late, it is not usually a problem. Missing more than one pill or starting a pack more than one day late may affect your contraceptive cover. It is more risky to start ‘the Pill' packet late than to miss more than one pill. This is because during the seven day break your ovaries are not getting the effect from ‘the Pill', so your ovaries might release an egg. If you are not sure what to do, continue to take your Pill, use a barrier method of contraception, and seek advice.

I want to become pregnant?

If you decide to try for a baby, it is best if you stop taking ‘the Pill' at the end of the packet. It can help to wait for one natural period before trying to get pregnant. Waiting means you can start pre-pregnancy care, such as taking folic acid and stopping smoking. It also allows the pregnancy to be dated more accurately.

This method does not protect you against sexually transmitted infections, so you may need to use a condom as well.

Remember: Contact your doctor or nurse if you have any concerns or are worried / unsure about anything to do with your contraception.