The combined pill (also known as just 'the pill') is a type of contraception that prevents pregnancy by stopping sterm fertilising an egg. It contains a combination of two hormones similar to those produced naturally by the body; progestogen and oestrogen.
When used correctly, the combined pill is 99% effective at preventing pregnancy.
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.
The hormones in the combined pill prevent pregnancy by:
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.
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, Rigevidon, Brevinor and Cilest.
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.
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.
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.
The pill can become less effective at preventing pregnancy if:
The chance of getting pregnant depends on when the pills are missed and how many pills are missed.
If you have missed one pill, or if you have started the new pack one day late:
If you have missed two or more pills or if you have started the new pack two or more days late:
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.
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 people it can take a few months for their periods to return to normal.
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.
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.
It is not harmful to continue to take your next pack of pills without a 7 day break, or miss out inactive (dummy) pills with EveryDay combined pills.
The Faculty of Sexual and Reproductive Healthcare has issued guidance supporting taking the combined pill without a monthly 7 days break:
(It is noted, that these ways of taking the pill are ‘off licence’ use - this does not mean it is unsafe, but that taking the pill in this way is not within the UK product license.)
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.
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 people 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 people find that their weight changes due to fluid retention or an increase in appetite, but this should settle over time.
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.
Most people 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 people who:
It may also be unsuitable if you:
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.
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.
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.
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 people who have regular periods will find that their normal cycle will return within six months. Some people 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.
See a doctor immediately if you have any of the following:
It may reduce menopausal symptoms in some people, but is not recommended for people 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.