What is the combined oral contraceptive pill?
The combined oral contraceptive pill, usually simply called ‘the pill’, is a contraceptive pill taken by mouth which contains two hormones, oestrogen and a progestogen.
How does it work?
The pill works by preventing ovulation, which means it stops a woman’s ovaries from releasing an egg each month, which in turn means that fertilization cannot occur and a pregnancy cannot begin.
How effective is it?
The pill is approximately 91% effective.
How is it taken?
The pill is taken by mouth every day. Most pill types come in a box of 3 to 4 sachets which each contain a month’s supply of pills. The pill sachet contains active pills (pills containing the hormones) and inactive or sugar pills (which help you to keep the habit of taking the pill every day).
Who can take the pill?
- The pill is suitable for most women.
- There are some women for whom it is NOT suitable, these include the following:
- Women who have had a deep venous thrombosis (blood clot), stroke or heart attackWomen who have severe liver problems
- Women who get a migraine with aura (is visual or other disturbances starting just before the migraine)
- Women who have breast cancer
The pill may also be unsuitable for:
- Women who have high blood pressure, diabetes, gallbladder disease, active liver disease, kidney disease, some blood problems, or you are on some other medications which may interact with the pill
- Women who have had cancer of the breast or cervix
- Women who are over 35 and smoke
- Women who have unexplained bleeding from the vagina
Advantages of the pill?
- It is very effective with correct use
- It is readily accessible
- It is easily reversible
- It gives you a predictable bleeding pattern and allows you to skip periods if you want
- It can be useful in controlling heavy or painful periods and managing Premenstrual Syndrome
- It can improve acne
Disadvantages of the pill?
- It must be taken every day
- It is less effective if not used perfectly (for example if pills are missed)
- Some types can be expensive
- Effectiveness may be reduced by vomiting or diarrhoea
The pill and your health
Serious health problems caused by the pill are very rare — the most significant of these is blood clotting. Symptoms of this are severe sudden chest pain, severe pain or swelling in one leg, sudden blurred vision or loss of sight, slurring of speech or sudden severe headache. If you have any of these symptoms contact your doctor immediately.
Your risk of developing a blood clot is increased when you are not mobile for an extended period of time e.g. sitting in a car or airplane on a long trip, or if you are planning to have surgery. Please talk to your doctor if you are planning any of these.
As well as being a contraceptive, the pill has other health benefits. When on the pill you are less likely to develop a serious pelvic infection, cancer of the ovary, cancer of the endometrium (lining of the womb), cancer of the bowel, anaemia, non-cancerous breast lumps, and cysts of the ovary.
When you are taking the pill, periods are generally less painful, the bleeding is usually lighter and more regular, and there is often less premenstrual tension. Acne may also improve.
The pill and your health
Most women feel fine on the pill, but it is common to have some minor side effects initially. You might get some bleeding in between periods, sore breasts and mild nausea (feeling sick) for the first couple of months. These side effects usually settle by themselves.
Some women report weight changes, reduced desire for sex, and mood changes, however, there is no scientific evidence to show that the pill causes these effects; other aspects of life may be contributing factors.
Very rarely the oestrogen in the pill can cause patchy brown discoloration of the skin on the face called melasma. This is more noticeable if you spend a lot of time in the sun. Melasma is not dangerous, so keep taking the pill but talk to your doctor when you have a chance.
Types of pills available There are some differences between the types of pills available and it may take a few trials to find the one most suitable one for you. Don’t be afraid to discuss your options with your doctor.
Starting the pill
As long as you are absolutely certain that you are not pregnant, you can start the pill at any time of your menstrual cycle.
If you start with a hormone pill on Day 1 to Day 5 of your cycle (Day 1 if your first day of bleeding), you are immediately protected from pregnancy.
If you start at any other days of your menstrual cycle, you will need to use additional contraception, such as condoms, or abstain from intercourse, until you have taken 7 of the active hormone pills.
What to do if you miss a pill
- If you have missed a single dose (less than 48 hours since your last pill)
Take the missed pill even if it means taking two pills in one day, and continue with your pills as usual. The pill will continue to work.
• If you have missed a dose for more than 48 hours
Take the most recently missed pill even if it means taking two pills in one day, and use condoms for seven days.
If you have had less than 7 active pills, you may need emergency contraception if you have had sex.
If you have less than 7 active pills left in your pack continue on to the next packet of pills and skip the sugar pills.