The
Combined Pill
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 do 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?
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% 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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?.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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