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 the 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 93% effective.
HOW IS IT TAKEN?
The pill is taken by mouth every day. Most pill types come in a box of three to four sachets with each sachet containing a month’s supply of pills. Each pill sachet contains hormone pills that you usually take for three weeks, and inactive or sugar pills (which help you to keep the habit of taking the pill every day) that you take before starting the active pills again. You can also take the hormone pills for longer than three weeks so that you skip periods. If you think you would like to do this discuss it with your doctor.
WHO CAN TAKE THE PILL?
The pill is suitable for most contraceptive users.
There are some medical conditions that make the pill unsuitable; these include the following:
- A history of deep venous thrombosis (blood clot), stroke or heart attack.
- Severe liver problems.
- Migraine with aura (visual or other disturbances starting just before the migraine).
- Breast cancer.
- Some autoimmune conditions that increase the risk of blood clots.
The pill may also be unsuitable:
- If you have high blood pressure, diabetes, gall bladder disease, active liver disease, kidney disease, some blood problems, or you are on some other medications which may interact with the pill.
- If you have a history of breast cancer or cervical cancer.
- If you are over 35 and smoke.
- If you have unexplained bleeding from the vagina.
- If any of these conditions apply to you, let your doctor help you decide if the pill is suitable for you.
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 pill 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.
Most people 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 people 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 a patchy brown discolouration of the skin on the face called melasma. This is more noticeable if you spend a lot of time in the sun. If melasma does occur it usually does so in the first few months after starting the pill. If you notice this discolouration starting to appear on your face see your doctor.
TYPES OF PILLS AVAILABLE
There are quite a few different types of the pill available. There are some differences between them and it may take a few trials to find the one most suitable for you. Don’t be afraid to discuss the different options with your doctor.
PROGESTOGEN ONLY PILL (SLINDA®)
Slinda® is a new progestogen only pill. Unlike the combination oral contraceptive pills, it does not contain any oestrogen. However, it works in a similar way by preventing ovulation. It is quite different to the mini pill which works by thickening mucus in the cervix. Slinda® is approximately 93% effective.
Advantages: Slinda® is very effective with correct use; easy to get with a script from your doctor; easily reversable; can reduce menstrual bleeding over time; and can be used by people who cannot take pills that contain oestrogen.
Disadvantages: Slinda® needs to be be taken every day; may be less effective if not used properly; may cause light irregular bleeding(spotting); and is more expensive than some of the combined oral contraceptive pills.
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 on any other day 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 hormone pills.
WHAT TO DO IF YOU MISS A PILL
Is it more than 24 hours since the pill should have been taken? (This means more than 48 hours since you last took a pill.)