Combined pill

Combined pill

Benefits

  • Usually makes periods regular, lighter and less painful
  • May help with premenstrual symptoms
  • Reduces the risk of cancer of the ovary, uterus and colon
  • Improves acne in some women
  • You are protected from pregnancy straight away if you start taking the combined pill in the first five days of your period
  • When you stop using the pill your fertility will return to normal.

The combined pill (also known as ‘the pill’), is a small round tablet that releases artificial versions of the oestrogen and progesterone hormones. It has to be taken daily. Almost half of all women using contraception take oral contraceptive pills as their primary method of contraception. The combined pill is most popular amongst women aged between 16 and 24.

Combined pill effectiveness
Combined pill lasts for
Combined pill period cycle
Combined pill side effects

*for typical use (effectiveness for perfect use 99%)

How it works

How to use it

Combined pill how

There are different types of combined pill, which use different brand names. The most common are 21 day pills, where you take one pill every day for 21 days, then stop for 7 days (to follow your 28 day menstrual cycle). Another option is to take ‘every day’ pills – you take one pill every day with no break, but 7 of these are ‘dummy’ pills which do not contain any hormone.

Why it works

Combined pill why

The hormones in the combined pill prevent pregnancy by:

  • Thickening the mucus in the neck of the womb, so it is harder for sperm to penetrate the womb and reach an egg
  • Thinning the lining of the womb, so there is less chance of a fertilised egg implanting into the womb
  • In some women, the combined pill also stops the ovaries from releasing an egg (ovulation), but most women will continue to ovulate.
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Things to consider

The combined pill does not protect you from STIs. You should use a condom as well if you think you are at risk of an STI.

You need to remember to take your pill every day. If you find that you often forget to take your pill, there are long lasting contraception options available.

Timescale

There are three main types of combined pill. You should follow the instructions in your packet as each type will be different. If you have any questions about how to take your pill, ask your GP, practice nurse or pharmacist. It's important to take the pills as instructed, because missing pills or taking them at the same time as certain medicines may make them less effective at preventing pregnancy.

Combined pill time3

Monophasic (21-day)

This is the most common type. Each pill has the same amount of hormone in it. One pill is taken each day for 21 days and then no pills for the next 7 days.

Common brands include: Microgynon, Brevinor and Cilest.

Combined pill time3

Phasic (21-day)

Phasic pills contain two or three sections of different coloured pills in a pack. Each section contains a different amount of hormones. One pill is taken each day for 21 days and then no pills for the next 7 days. Phasic pills need to be taken in the right order.

Common brands include: Binovum and Logynon.

Combined pill time4

Every day

There are 21 active pills and 7 inactive (dummy) pills. The two types of pill look different. One pill is taken each day for 28 days with no break between packets of pills. Every day pills need to be taken in the right order.

Common brands include: Microgynon ED and Logynon ED.

The pill can become less effective at preventing pregnancy if:

  • You have vomiting and/or diarrhoea, as the pill may not absorbed into your bloodstream. Read more in our Questions section.
  • You are taking some medicines. Ask a clinician or pharmacist and read the information that comes with your medicine. Always tell your doctor that you are taking the combined pill if you are prescribed any medicines.

What if?

You miss a pill:

The chance of getting pregnant depends on when the pills are missed and how many pills are missed. Read more in our Questions section.

If you are not sure what to do, continue to take your pill and use another method of contraception, such as condoms, and seek advice from your local sexual health clinic, pharmacy or GP.

Suitability

Most women can take the combined pill, but your clinician or GP will ask about your family and medical history to determine whether or not it is the best method for you.

The combined pill is not always suitable for women who:

  • Are pregnant
  • Smoke (or stopped smoking less than a year ago) and are 35 or older
  • Are very overweight.

It may also be unsuitable if you have or have had certain health conditions.

Side effects & risks

Although serious side effects are not common, there are some risks associated with the combined pill.

Common Rare
Short term:

Can cause temporary side effects such as headaches, nausea, breast tenderness and mood swings – these often improve over time but can be persistent.

Some bleeding and spotting in the first few months.

Long term:

Some loss of libido. Changes to skin.

Can increase your blood pressure.

Small increased risk of some serious health conditions, such as thrombosis (blood clots) and breast cancer or cervical cancer. These risks reduce with time after stopping the pill.

Can cause hair loss and Chloasma (dark patches over the face).

You should discuss any concerns with your clinician or GP.

Questions?

Most women can take the combined pill, but your GP or clinician will ask about your family and medical history to determine whether or not it is the best method for you.

The combined pill is not always suitable for women who:

  • Are pregnant
  • Smoke (or stopped smoking less than a year ago) and are 35 or older
  • Are very overweight
  • Are over 50 years old.

It may also be unsuitable if you:

  • Take certain medicines (ask your GP about this)
  • Have or have had thrombosis
  • Have or have had a heart abnormality or heart disease, including high blood pressure
  • Have or have had severe migraines, especially with aura (disturbances of vision or sensation)
  • Have or have had breast cancer
  • Have or have had disease of the gallbladder or liver
  • Have or have had diabetes
  • Are immobile for a long period of time or use a wheelchair
  • Have systemic lupus erythematosus
  • Have a family history of thombosis
  • Have a family history of cardiovascular problems at a young age.

When you stop using the combined pill your fertility will return to normal. (Don’t worry if your periods don’t start immediately. For some women it can take a few months.)

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 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.

This depends on when in your cycle you start taking it. If you start within the first five days of your menstrual cycle then it will be effective immediately. If you start after the first five days of your cycle then the combined pill will not be effective for 7 days. If you are switching from one method of contraception to another then you should talk to your doctor or nurse about using additional contraception.

The combined pill prevents ovulation and limits the build-up of the lining of the womb (endometrium) that is usually lost with your period. This results in a shorter, lighter and often less painful bleed.

You may sometimes be provided or prescribed a different brand of pills, but the nurse or clinician will explain that the hormones and doses will be the same. The clinics are likely to stock the pill brand that was cheaper at the time.

Combined pill time1

If you have missed one pill, anywhere in the pack:

  • Take the last pill you missed now, and take the next pill at the normal time
  • Continue taking the rest of the pack as usual
  • You don’t need to use additional contraception, such as condoms
  • Take your 7 day pill-free break as normal.
Combined pill time2

If you have missed two or more pills (you are taking your pill more than 48 hours late) anywhere in the pack:

  • Take the last pill you missed now, even if it means taking two pills in one day
  • Leave any earlier missed pills
  • Continue taking the rest of the pack as usual and use an extra method of contraception for the next 7 days
  • Check how many pills you have left in your pack. If it is more than 7 pills then complete the pack as usual and take the 7 day break at the end of the packet. If you have less than 7 pills left in the pack then miss the break at the end of this packet and start the new packet immediately without the 7 day pill free interval
  • You may need emergency contraception if you have had unprotected sex since missing the pills or in the 7 days before missing the pills.

If you are not sure what to do, continue to take your pill and use another method of contraception, such as condoms, and seek advice as soon as possible.

Bleeding is common when you first start taking the combined pill. It can take up to 3 months to settle down, but it’s very important to keep taking the pills to the end of the pack, even if your bleeding is heavier than usual.

Once your body is used to the pill, your period should become regular, with bleeding during the pill-free week.

Bleeding can also be caused by not taking the pill correctly, or by a sexually transmitted infection or pregnancy. If the bleeding does not settle down or if you are concerned, speak to your GP, sexual health clinic or call NHS 111 for advice.

If you vomit within two hours of taking the combined pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

If you continue to be sick, keep using another form of contraception while you're ill and for 7 days after recovering.

Very severe diarrhoea (six to eight watery stools in 24 hours) may also mean that the pill doesn't work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for 7 days after recovering.

Speak to your GP or contraception nurse or call NHS 111 for more information, or if your sickness or diarrhoea continues.

Taking the combined pill can increase your blood pressure. There is a small increased risk of some serious health conditions, such as thrombosis (blood clots) and breast cancer or cervical cancer. These risks reduce with time after stopping the pill.

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' in 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).

Some medicines make the combined pill less effective (including those used to treat epilepsy, HIV and TB, and the herbal medicine St John’s Wort). Ask your GP, clinician or pharmacist and read the information that comes with your medicine.

Research is ongoing into the link between breast cancer and the pill. Research suggests that users of all types of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with women who do not use them. However, 10 years after you stop taking the pill, your risk of breast cancer goes back to normal.

Research has also suggested a link between the pill and the risk of developing cervical cancer and a rare form of liver cancer. However, the pill does offer some protection against developing endometrium (lining of the womb) cancer, ovarian cancer and colon cancer.

The combined pill may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease.

Research has not shown that the combined pill leads to weight gain. Some women find that their weight changes due to fluid retention or an increase in appetite, but this should settle over time.

It is not harmful to miss a period / monthly withdrawal bleed by continuing to take your pill, or missing out inactive (dummy) pills with EveryDay pills.

Get advice from your contraception clinic, doctor or pharmacist about this. You can also call NHS 111 or the Sexual Health Line on 0300 123 7123.

It may reduce menopausal symptoms in some women, but is not recommended for women over 50.

If you have just had a baby and are not breastfeeding, you can start the pill on day 21 after the birth. You will be protected against pregnancy straight away. If you start the pill later than 21 days after giving birth, you will need additional contraception (such as condoms) for the next 7 days.

If you are breastfeeding a baby less than six months old, taking the pill can reduce your flow of milk. It is recommended that you use a different method of contraception until you stop breastfeeding.

If you have had a miscarriage or abortion, you can start the pill up to five days after this and you will be protected from pregnancy straight away. If you start the pill more than five days after the miscarriage or abortion, you'll need to use additional contraception until you have taken the pill for 7 days.

The combined pill can cause temporary side effects, such as mood swings, when you start taking it. If these do not go away after a few months, speak to your GP or sexual health clinic about using a different form of contraception.

Some reports suggest that there may be a very small increased risk of breast cancer and cervical cancer, but the pill does help protect against other types of cancers such as ovarian, colon and uterine cancers.

There is no evidence to suggest the pill causes infertility. Most women, who have regular periods will find that their normal cycle will return within six months. Some women find that their usual cycles begin again very quickly after stopping, but for others it can take longer.

The benefits of long term use of the pill usually outweigh the risks.

Where can I get it?

The combined pill is available free on the NHS. You should visit your sexual health clinic or GP to discuss your suitability.

You can also order the combined pill now from SH:24 for free.