Combined Contraceptive Pill

The combined contraceptive pill is a type of hormonal contraception that is taken every day to prevent pregnancy. It can also be used to help the symptoms of heavy or painful periods and acne. Combined contraceptives do not prevent you from catching or transmitting sexually transmitted infections (STIs). This means you will need to use other contraceptive methods, like condoms, to help protect yourself and your partner from infection.

Unlike the mini pill, which only contains progesterone, the combined pill contains both oestrogen and progesterone.

The combined pill is 99% effective in preventing pregnancy when taken correctly. In reality, this drops to 91% if women forget to take the pill at the correct time, or take other medication that interacts with it, or suffer from illness such as diarrhoea and vomiting (being sick).

The main difference between the combined and mini pill is in the hormones they contain. The combined pill contains two hormones (oestrogen and progesterone) but the mini pill only has progesterone. The difference in hormones affects which pill is most suitable for you to take and what potential side effects you may get.

There are also differences in how you take each pill:

• You take most combined pills for 21 days and then take a 7 day break where you have a withdrawal bleed (similar to your period). The mini pill is taken back to back with no 7 day break and it can make your periods irregular, or change in other ways.
• With some mini pills, the window for taking the pill may be shorter. So, depending on which pill you choose, you may have to be more accurate with the time of day you take it.

Due to the oestrogen it contains, the combined pill can improve acne and make periods more regular, lighter and less painful.

The combined pill and the mini pill are just as effective in preventing pregnancy if taken properly, so you will be protected no matter which type of pill you take.

Is the mini pill safer to take than the combined pill?

For specific health conditions, the mini pill is safer to take than the combined pill if you have:

• a history of blood clots or high blood pressure
• recently given birth or are breast-feeding a baby less than 6 weeks old
• a high BMI
• breast cancer
• disease of the gallbladder or liver
• diabetes
• migraines (especially those with aura)

The mini pill is also safer if you are a smoker, especially if you are over 35. The combined pill has a higher risk of blood clots so it is essential you talk to your doctor about any health conditions you may have.

What are the benefits of the combined pill?

• Protects you from pregnancy in a way that does not interrupt sex.
• Longer timeframe to remember to take it, compared to some mini pills
• Makes your periods more regular, lighter and less painful.
• Can reduce the symptoms of PMS (premenstrual syndrome).
• Can reduce flare-ups of acne.
• Reduces your relative risk of cancer of the ovaries, womb and colon.

What are the risks of the combined pill?

• Can lead to side effects, especially in the first 3 months while your body adjusts to the hormones. Common side effects are spotting or breakthrough bleeding, feeling sick, headaches, breast tenderness and mood swings.
• Does not protect you from STIs (sexually transmitted infections).
• Can lead to higher blood pressure.
• Increases your risk of developing blood clots and certain cancers, such as breast cancer and cervical cancer, compared with women who are not taking the combined pill.

What is the risk of developing a blood clot?

The oestrogen in the combined pill can cause your blood to clot more easily. This can increase your risk of deep vein thrombosis (a clot in your leg), pulmonary embolism (a clot in your lung), stroke and heart attack. The risk of developing a blood clot when taking the combined pill is very low, at around 0.06% per year (depending on the hormones in the pill), but is higher than women who do not take any oral contraceptive (0.02%). The risk also may be significantly higher in some women, depending on other medical risk factors

Because of this increased risk, the combined pill is not recommended to women with a history of blood clots. However, the overall risk of blood clots is so low that it should not put you off taking the pill if you have had a risk assessment by your doctor, as it is still safe for most women. Indeed, the risk of developing a blood clot would be higher when pregnant than when on the pill.

What is the risk of developing cancer?

Taking the combined pill has been shown in research to slightly increase the risk of developing breast and cervical cancer. The risk goes up the longer you are on the pill and is increased if you have a family history of breast cancer or you are overweight. It goes back to normal 10 years after you stop taking the pill.

If you’re not sure if the combined pill is right for you, talk to one of our doctors via your patient account. They can recommend and prescribe the best pill for you.

All combined contraceptives work in the same way to prevent pregnancy through a regular dose of oestrogen and progesterone. The dose of the two hormones can vary, and there are different types of artificial (man made) oestrogen and progesterone. There are also different manufacturers and different brand names.

Most combined pills packs contain 21 active pills which you take over a 28 day cycle. Some brands give you 21 pills and then you take a break for 7 days without taking a pill. Other brands give you seven dummy pills so you can take a pill every day. An example of this type of pill is Microgynon 30 ED, where the ED means every day.

Standard dose or monophasic pills

These combined pills have the same amount of hormones in each pill within the packet. Monophasic pills are all the same colour.

The following monophasic pills are available:

Cycling dose or multiphasic pills

Multiphasic pills have different amounts of hormones in different pills depending on the week of your cycle. This is to try and copy the body’s natural hormonal cycle. These pills use different colours to show when in your cycle you should take each one. You have to take the pills in the specific order to get the correct dose at the right time.

Doctors recommend you start with a monophasic pill as they are easier to use. Multiphasic pills can help with side effects but cannot be taken back to back to delay your period and can be more complicated to use.

The following multiphasic pills are available:

Low dose pills

Some combined pills contain a lower dose of oestrogen. This can lower the likelihood and severity of side effects for women who find that a higher dose of oestrogen is unsuitable for them.

The following low dose pills are available:

The combined pill works by releasing and regulating artificial (man made) versions of the hormones oestrogen and progesterone into your body. This prevents pregnancy by:

• stopping ovulation so your ovaries do not release an egg each month.
• increasing the thickness of the fluid around the neck of the womb so it is harder for sperm to reach an egg
• reducing the thickness of the lining of the womb so it is more difficult for any egg that does become fertilised to implant itself.

How long does the combined pill take to work?

How quickly the combined pill protects you from pregnancy depends on when in your cycle you start taking it.

For most pills:

Days 1 to 5 of your period: you will be protected straight away

Day 6 and beyond: you will not be protected for 7 days so you must use additional protection for a week

If your menstrual cycle is shorter than 23 days the window at the start of your period will be shorter. Talk to your doctor to be clear on when you will be protected from pregnancy before you start taking the combined pill.

How effective is the combined pill?

All combination pills are over 99% effective at preventing pregnancy when taken correctly. Factors such as forgetting to take pills, other medication you are taking and being sick (vomiting) or having diarrhoea reduces this to 91% in reality.

The combined pill is effective at preventing pregnancy but it does not protect you from sexually transmitted infections (STIs). You need to use a condom to prevent STIs.

The combined pill comes in strips of either 21 or 28 tablets. Each tablet is marked with the day of the week it should be taken on.

1. Take your pill marked for the correct day of the week, for multiphasic pills this will be the first pill of the first colour
2. Swallow one tablet whole with water at the same time every day
3. At the end of 21 day strip you take a 7 day break
4. If you are taking the 28 day strip you take the dummy tablets (which look different) for the last 7 days
5. During this 7 day period you will have a ‘withdrawal bleed’ which is similar to your period
6. Start your new strip after 7 days on the same day each time

You are protected from pregnancy both when you are taking the pills and during your 7 day break

Can I take the combined pill back to back?

Yes, if you are taking a monophasic or low dose 21 day combined pill you can take back to back and delay your period.

Talk to your doctor if you plan to do this for more than 2 months in a row to discuss the benefits and possible side effects.

This depends on how many pills you have missed.

If you have missed 1 pill or start your new strip a day late, take the missed pill as soon as you remember, even if this means taking two pills at once. Check your pill leaflet, for most pills if you have just missed one, you will still be protected from pregnancy and should continue taking the strip as normal. If your strip ends within 6 days of you missing a pill then do not take the 7 day break and start your new strip right away.

If you are sick (vomit) within 3 to 4 hours of taking your pill or have diarrhoea, your body may not have fully absorbed the hormones so you should act as though you have missed a pill. In the case of ongoing vomiting and diarrhoea, you should get medical advice to be clear on whether you need to use additional protection.

If you have missed two or more pills you should take the last pill you missed as soon as you remember, even if this means taking two pills at once. Leave any earlier pills that you missed. You should use extra contraception for the next 7 days as you may not be protected from pregnancy. If you have had unprotected sex since you missed your pill you may need to use emergency contraception.

Many women who take the combined pill will not get any side effects. However, some women will get side effects that can vary in symptoms and severity.

Side effects are more common in the first 3 months of taking the pill as your body gets used to the hormonal changes. Your side effects should reduce over time. If they do not reduce or they impact your life negatively, talk to your doctor, who can recommend trying a different pill. You can message your SuperDrug Online Doctor through your patient account.

Common side effects reported by women include headache, feeling sick or having stomach pain, tender breasts and mood changes.

In rare cases taking the combined pill can lead to a blood clot. Signs of a blood clot include stabbing chest pain, coughing up blood, shortness of breath, immediate loss of vision, unexplained swelling or tenderness in one or both legs. In these cases, you should stop taking it immediately and seek urgent medical help.

Will the combined pill affect my weight?

While women report weight gain as a side effect of taking the combined pill, the research into this shows there is no evidence that the pill causes changes in weight. Oestrogen can increase your appetite and fluid retention when you first start taking it, but this usually settles down after 3 months.

You can find more information on our page on weight gain and the contraceptive pill.

How does the combined pill affect my skin?

If you suffer from hormonal acne, the combined pill can help your skin. This is because it helps to balance and regulate your hormone levels, preventing flare-ups. The regular dose of oestrogen also can reduce sebum production, the oily substance that protects the skin that can cause acne by clogging up your pores.

How will the combined pill affect my periods?

The regulated dose of hormones in the combined pill can make periods lighter and less painful. For this reason, the combined pill can be prescribed to help with heavy or painful periods.

How will the combined pill affect my mood?

Taking the contraceptive pill changes your hormonal balance. This can impact your mental health positively, negatively or not at all. Mood changes are more common in the first 3 months of taking the pill as your body adjusts to the hormonal changes. If you think the combined pill you are taking is affecting your mood, talk to your doctor about trying a different one.

Will the combined pill affect my sex drive?

Some studies suggest that higher levels of oestrogen may have a positive effect on your libido. On the other hand, the pill regulates hormones and this can reduce the hormonal spikes which create periods of high sex drive. If this happens to you it is worth waiting to see if this side effect disappears after 3 months. If it doesn’t, talk to your doctor about your options.

Can the combined pill affect my fertility?

There is no evidence that taking the combined pill affects fertility after you stop taking it. It is possible to get pregnant as soon as you stop taking the pill, but it may take a few weeks for your periods to return to their normal cycle.