Contraceptive Pill

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The combined contraceptive pill or ‘the pill’ is a type of medication that prevents against pregnancy. It can be used to treat heavy periods, painful periods, PMS or premenstrual syndrome, and endometriosis. It can also improve acne. A woman gets pregnant when a man’s sperm meets one of her eggs. To prevent pregnancy, the pill keeps the sperm and egg apart, by stopping ovulation, by making it harder for sperm to get to an egg and by making it harder for a fertilised egg to implant in the lining of the womb. The combined pill contains synthetic versions of the female sex hormones oestrogen and progesterone. To take it, you swallow one tablet at roughly the same time each day with a glass of water.

There are many different types of contraceptive pill but, used correctly, all types are over 99% effective at protecting against pregnancy.
Cilest, Marvelon, Yasmin and Microgynon are all just over 99% effective when taken correctly. This means that they prevent 99 in 100 possible pregnancies.

3.5 million women in the UK are on the pill (that’s about one in every three women of reproductive age).  Whereas in France for instance, 55.5% of women using a contraceptive are on the pill (Source : Baromètre santé 2010).

The pill is not without disadvantages, but most women find that the benefits outweigh the risks. It is quite common for there to be some temporary side effects of the contraceptive pill, which include mood swings, tender or sore breasts, headaches, breakthrough bleeding and spotting, and nausea. These side effects normally go away after a few months. If they don’t pass, you could try a different pill instead.

The contraceptive pill can raise your blood pressure. It has also been linked to an increased risk of getting breast cancer and thrombosis (blood clots). Blood clots are very rare, but your doctor will discuss risk factors with you to decide which pill is most suitable for you. If you have two or more of the following risk factors, you shouldn’t take the pill:

• If you are aged 35 years or older
• If you smoke or have quit smoking in the past year
• If you are overweight and your Body Mass Index exceeds 30
• If you have high blood pressure
• If you have had a blood clot or a stroke in the past
• If you have a close relative who has had a blood clot before they were 45 years old

Research is ongoing, but suggests that the pill is also linked to an increased risk of cancer. Women who use any type of hormonal contraception are more likely to get breast cancer than women who do not use hormonal contraception. Ten years after you stop taking the contraceptive pill though, your risk of getting breast cancer returns to normal. There is some evidence to suggest there might be a link between the pill and the risk of getting cervical cancer and a rare type of liver cancer too. But then again, there is evidence to suggest that the pill can protect against colon cancer, ovarian cancer and endometrial cancer (cancer of lining of the womb). It also reduces your risk of getting non-cancerous breast disease, fibroids and ovarian cysts.

To take it, you swallow one tablet at roughly the same time each day with water. Some pills come in packs of 21 tablets. With these you take a pill a day for 21 days, then you have a seven day break. 

Other pills come in packs of 28 tablets. With these you take a pill everyday and don’t take a break, but the last seven tablets are placebos (pills that don’t have any medicine in them).

To use your contraceptive patch:

• If you’re starting contraception (not switching) then apply the patch on the first day of your next period
• If you’re switching from the pill: for the combined pill, use your first patch the day after your last ‘active’ pill (the one with hormones in) and you’ll be protected right away. For the mini pill you can start the patch right after, the day after you’ve last taken a pill, but you will need extra contraceptive protection for 7 days afterwards
• Once you have applied your first patch, you should leave it on for exactly 7 days
• On the 8th day, change the patch for a new one
• Do the same for week 2 and 3
• At the end of week 3 remove the patch and do not wear a patch for seven days
• During your patch-free week, you should have a withdrawal bleed, like a period
• After 7 patch-free days, put on a new patch and start the 4-week cycle again
• You should begin your new cycle even if you are still bleeding

Tips for using the patch:

• You can stick the patch on most areas of the body providing it is clean, dry, and not very hairy
• It’s a good idea to change the position of the patch each time you change
• Avoid applying it to sore or irritated skin
• Avoid applying it to your breasts
• Avoid applying it anywhere where it may get rubbed off by tight fitting clothing

Yes. Your doctor can provide this, as can our doctors online.

Every woman reacts differently to each pill. Your doctor will assist you in choosing a suitable pill. It is not uncommon for women to have to try more than one pill before they find one which works well for them. Some pills are more frequently prescribed than others, for example Yasmin, Microgynon and Cilest. Yasmin is the most popular pill world-wide and  is favoured by women who are worried about putting on weight, because it prevents water retention.

Most contraceptive pills, like Cilest and Marvelon, offer immediate protection against pregnancy if you start taking them on the first day of your period. If you start taking one of these pills later than the first day of your period then you will need to use a barrier type of contraception (e.g. condoms) for seven days.  Another example is Microgynon, which is also available in packets of 28 tablets: 21 contain the active ingredients, the other 7 are placebo tablets so that you don’t break the habit of taking your pill each day.

Whether you are taking a combination pill or a mini-pill, all contraceptive pills need to be taken at the same time everyday. If you miss or forget to take the pill it can affect your contraceptive cover and should be avoided. Most pills can be taken with a delay of up to 12 hours, however, due to their lower hormone content some progesterone-only pills (or mini-pills) lose their contraceptive protection much quicker. Please read the patient leaflet and ensure you understand the time frame for taking your particular pill.

Whether forgetting a combination pill has affected your contraception depends on how much time has passed. If you remember to take the missed pill within 12 hours you are still protected. In this case, there is no need for the use of additional methods of contraception. Just take the pill as soon as you remember and continue your treatment at your usual time (even if this means taking two pills in a 24 hour period).

If more than 12 hours have passed since your usual time for taking your daily contraceptive, this may have affected your protection. Whether you need to take extra steps to prevent pregnancy depends on during which week in your cycle you have missed a pill. The patient leaflet of your contraceptive pill contains detailed information on how to proceed in the 1st, 2nd and 3rd week of your monthly course of tablets. Follow these instructions carefully and ask a doctor if you have any questions. If you have missed a pill in the third week you may need to skip the break during the fourth week and continue with a new pack straight away.

If you would like personalised advice on the contraceptive pill you can book a telephone consultation with one of our online doctors.

Brevinor, Cerazette, Cerelle, Cilest, Femodene, Femodene ED, Femodette, Femulen, Gedarel 20, Gedarel 30, Katya, Levest, Loestrin 20, Loestrin 30, Logynon, Logynon ED, Marvelon, Mercilon, Microgynon, Microgynon ED, Micronor, Millinette 20, Millinette 30, Norgeston, Noriday, Norimin, Norinyl-1, Ovranette, Ovysmen, Qlaira, Rigevidon, Sunya, Synphase, Triadene, TriNovum, TriRegol, Yasmin.

If you don’t have a medical reason why you shouldn’t take the pill and as long as you don’t smoke, there’s no reason why you shouldn’t take the pill until you hit the menopause. Unfortunately every woman seems to react slightly differently to each pill, so you may have to try a few until you find the one that works best for you. Some women who have had trouble with some of the other types of contraceptive pills find that the ‘premium pills’ Yasmin and Cilest work better for them.

While the combined pill normally has two types of hormones in it, the mini-pill only has one. The active ingredient in the mini-pill is progestin, a synthetic form of the hormone progesterone that appears naturally in the female body. The mini-pill is 99% effective at preventing pregnancy, as long as you take it properly. It works by preventing ovulation, stopping sperm from getting to an egg to fertilize it, and making it hard for a fertilized egg to implant in the womb.

There are several different types of contraceptive pill on the market. Many pills contain different dosages of the two hormones: estrogen and progestin. Your doctor can advise which pill is best suited to your body and the way it works. Some types of birth control pills (continuous pills) can be used to reduce the frequency of a woman's periods, for example. If you have any problems with your contraceptive pill, it is worth having a conversation with your GP. It might be that there is a different pill available that would suit you better.

Pills differ mostly according to their dosage in estrogen and progestin. Thus you can break down the different types of pills into monophasic – where a pill contains the same amount of the two hormones – and multiphasic where a pill contains different amounts of the hormones.

Biphasic pills try to recreate your body's natural hormonal cycle. This pill provides a lower amount of progestin in the first half of the cycle and increases that amount in the second, all the while keeping estrogen levels constant. The triphasic pill causes both the estrogen and progestin levels to vary in accordance with the cycle. Both biphasic and triphasic pills mirror the body's natural cycle to reduce the likelihood of side effects. There are also low-dose pills which contain less than 50mcg of estrogen for women who have stronger reactions to the common dose. However the impact of low-dose pills on regulating the effects of the menstrual cycle (e.g. bleeding) is also reduced.

Combined oral contraceptives mimic women's natural 28-day cycle, including seven days a month for menstruation. During this time, women have the choice to take either no pill or placebos (pills containing no active drug) for 7 days, in order to avoid disturbing the daily habit of taking the pill. Many women find the 28 day packs helpful for not forgetting to take the pill, but in the end you should choose the solution that is most convenient for you.

It is quite common for the pill to cause some temporary side effects, which include mood swings, tender or sore breasts, headaches, breakthrough bleeding and spotting and nausea. These side effects normally go away after the first three months. If they don’t pass, you could try a different pill instead.

The pill can raise your blood pressure. It has also been linked to an increased risk of getting breast cancer and thrombosis (blood clots). However, it reduces your risk of getting non-cancerous breast disease, fibroids and ovarian cysts.

The pill interacts with some types of medication, so if you are concerned you should speak to a doctor or read the patient information leaflet. The medications it interacts with include some types of antibiotics (including rifampicin and rifabutin - most commonly used to treat tuberculosis and meningitis); epilepsy medication, St John’s Wort and HIV medications (all of which speed up the time it takes for your liver to break down progestogen).