Contraceptive Pill

The contraceptive pill is a type of birth control used mainly by women who are at risk of unwanted pregnancies. The combined pill may be used by women who need contraception and also want to improve their symptoms of PCOS, PMS, and acne. The mini pill contains lab-made version of the hormone progesterone, and the combined pill contains lab-made versions of oestrogen and progesterone.

There are other types of contraceptives that work in a similar way to the combined pill, but release the hormones in different ways, like the contraceptive ring or patch. There are also other progesterone-only contraceptives, like the injection, implant, or IUS. Contraceptive pills do not protect you against STIs.

The contraceptive pill works by releasing hormones into the body, and can cause a few different changes that help prevent pregnancy, including:

• Thickening the mucus at the entrance to the womb, making it more difficult for sperm to travel through and reach an egg
• For some pills, thinning the lining of the womb, which makes it harder for a fertilised egg to attach and grow into a baby
• For some pills, stopping an egg being released in the first place

If the pill is used in the correct way, it’s over 99% effective at preventing pregnancy. So, less than 1 woman in 100 who use the pill would become pregnant in a year. In reality, it’s less effective because many people miss doses, which stops the pill working properly and makes it on average 91% effective. The pill is more effective than condoms and diaphragms, but if it’s not used perfectly it’s less effective than long-acting reversible methods of contraception (LARC) including the progesterone-only injection, the contraceptive implant, the hormonal coil (IUS), and the copper coil (IUD).

The combined contraceptive pill is usually just referred to as ‘the pill’. It contains two lab-made sex hormones, oestrogen and progesterone. These lab-made versions are like the natural hormones produced by the ovaries. It usually comes in 21-day packs although Microgynan 30 ED is an example of a 28-day pack, which contains 7 medication-free pills. There a few different ways of taking combined pills and we recommend discussing with your doctor or nurse which one might be best for you.

There are many different brands of the combined oral contraceptive pill. They all do the same thing but contain different amounts and types of oestrogen and progesterone.

The UK brands of combined pill we offer are: Brevinor, Cilest, Cilique, Femodene, Gedarel, Katya, Levest, Loestrin, Logynon, Lucette, Marvelon, Mercilon, Microgynon, Millinette, Norimin, Norinyl-1, Ovranette, Qlaira, Rigevidon, Sunya, Synphase, Triadene, Triregol, Yasmin, Zoely

The mini pill is also known as the progesterone-only pill (POP). It’s different from the combined pill because it doesn’t contain oestrogen, so instead it only contains one sex hormone: progesterone.

The mini pill works by thickening the cervical mucus, stopping sperm from reaching any eggs released from the ovaries. Some mini pills which contain the progesterone desogestrel also stop the ovaries from releasing an egg (ovulation).

Unlike with the combined pill, there are no phasic pills (one’s that have different dosages in the same pack), or standard dosages. Packs usually come in multiples of 28 pills only.

The UK mini pill brands we offer are:

• Cerelle
• Cerazette
• Norgeston
• Noriday

The mini pill is good for women who don’t get on with or can’t take pills containing oestrogen but still would like an effective hormonal contraceptive.

Low oestrogen pills have a smaller amount of oestrogen in them than standard or high dosage combined contraceptive pills.

Low oestrogen pills we offer include:

• Sunya
• Millinette
• Loestrin 20
• Gedarel 20/150
• Mercilon

A lower dose of oestrogen may increase the risk of breakthrough bleeding, but it can reduce oestrogen-related side effects of the pill, like:

• Breast tenderness
• Nausea
• Bloating
• Fluid retention

Studies have shown that women who use a contraceptive pill with less than 30 micrograms of ethinyl estradiol are at a lower risk of pulmonary embolism (blood clot in the lungs) and that the risk of heart attack and stroke appears to be greater with higher doses of oestrogen.

There are a few types of phasic pill: biphasic, triphasic, and quadraphasic pills, as well as monophasic or ‘non-phasic’ pills. We offer the following phasic pills:

• Synphase: biphasic
• Triadene: triphasic
• Logynon: triphasic
• Triregol: triphasic
• Qlaira: quadraphasic

Monophasic pills have the same amount of oestrogen and progesterone in each active pill in the pack, so the hormone levels stay consistent throughout the pack. Studies haven’t found any difference in side effects, bleeding patterns, or contraceptive effect between monophasic and phasic pills, so monophasic pills are still the suggested first-line combined pills.

Biphasic pills change your hormone level once during the pack. The biphasic pill we offer contain the same amount of oestrogen each day, but the amount of progesterone is increased halfway through your cycle.

Triphasic pills contain three different doses of hormones. About every 7 days, the hormone combination changes. But, it depends on the brand whether the oestrogen and progesterone levels change. The pills are usually colour-coordinated so you can tell which dose you’re taking.

Quadraphasic pills are similar to triphasic ones, they just include 4 different dosage combinations instead of 3.

The contraceptive patch works in a similar way to the combined oral contraceptive except the patch sticks to your skin rather than being in tablet form. Hormones are released from the patch into the bloodstream via the skin.

Like the pill, the patch works by:

• Stopping ovulation from occurring
• Thickening the mucus of the cervix
• Thinning the lining of the womb

The contraceptive patch Zava offers is Evra. Side effects and risks of taking Evra are similar to the combined pill.

Each person is different, so they’ll react differently to each contraceptive pill. A doctor can help to choose a pill that’s right for you, but you may have to try different ones before finding one that works best.

It’s possible to switch your pill if you feel another brand would suit you better than your current pill. Zava can help if you want to switch between different combined pills, or the combined pill and the contraceptive patch. We can’t help if you’d like to switch between the combined pill or patch, and the mini pill. You can speak to your doctor or nurse for more advice. You’ll also find instructions for changing from one pill to another in both your new and old pill packets.

Drugs.com has a review section for the contraceptive pill. Reviews can help you to choose a pill which will suit you because other people will share their stories and whether or not they’ve been happy with its effects. Please be aware these are reviews by patients and don’t count as medical reviews for these medications.

If there isn’t a contraceptive pill that suits you, there are still other types of contraception to choose from.

You can reorder the combined pill (or patch) online from Zava if you’ve been using it for at least 3 months and you’re happy with it. You can also start the mini pill with our service. The process for both is quick and simple:

• Fill out a short online assessment about your health and lifestyle
• Place an order for your preferred treatment option
• Your assessment will be checked to see if your order is right for you
• Your order will be then posted to your preferred address or you can collect it from a local post office instead

We’re a registered pharmacy and all our doctors are registered and regulated by the General Medical Council (GMC). Our service is also registered and regulated by the Care Quality Commission (CQC). In our most recent CQC inspection, our service was described as safe, effective, caring, responsive, and well-led.

You can get the contraceptive pill from your own doctor or nurse, too. You’ll need to make an appointment with them and explain you’d like the pill. They’ll look at your medical and family history, blood pressure, BMI, and any symptoms you may have before offering you the pill.

If you’d prefer, you can also visit a genitourinary medicine (GUM) clinic to get the contraceptive pill. In the UK, contraception is free on the NHS, so you won’t need to pay for it. It’s available even if you’re under 16 in most cases.

There are some serious risks associated with taking the pill.

Cancer: there’s ongoing research looking at the link between breast and cervical cancer and the pill. Some research shows that users of combined hormonal contraception have an increased risk of developing breast or cervical cancer compared to women who don’t use them. A link between breast cancer and the mini pill has not been proven or disproven.

On the other hand, the combined pill offers some protection against ovarian, endometrial, and colon cancer.

Blood clots: hormonal contraception which contains oestrogen can slightly increase the risk of blood clots for people who are already at risk. This risk is higher with some types of combined pill compared to others, depending on the progesterone hormone they contain. Blood clots can cause:

• Deep vein thrombosis (DVT) – a blood clot in the leg
• Pulmonary embolus – a blood clot in the lung
• Stroke
• Heart attack

Although the risk of developing a blood clot is small, your doctor will check to see if you have any specific risk factors. Risk factors include:

• Age over 35 and smoking (or if you have quit in the last year)
• Age over 50
• Being overweight
• Having a history of migraines
• High blood pressure
• Having a close relative who has had a blood clot under the age of 45
• Having a previous blood clot, stroke, or heart attack
• Having atrial fibrillation or angina
• Being immobile
• Having a hereditary blood clotting condition

The list above doesn’t include every risk factor out there. When starting or re-ordering either a combined pill or patch, or mini pill, you should always provide info on any old or new medical conditions. This is because the pill is not right for everyone.

You should also give info on any medications you’re taking, including over the counter or herbal remedies, because some medications can react with your pill or patch making your medications less effective or safe. You should also your pill information leaflet.