The contraceptive pill

The combined pill contains artificial versions of the female hormones oestrogen and progesterone, which women produce naturally. The pill stops your ovaries from releasing an egg, as well as thickening your cervical mucus to help prevent sperm from joining the egg. They also prevent the lining of your womb from thickening so a fertilised egg would not be able to implant into it.

POPs only contain progestogen, and so only thicken the mucus in the cervix to prevent sperm from reaching the egg. Some specific POPs, however, can also prevent ovulation in some women.

Monophasic 21-day pills are the most common type of combined pill. Each pill has the same amount of hormones. You take one pill each day for 21 days and then take no pills for the next seven days. Examples include Cilest, Marvelon, Yasmine and Microgynon.

Phasic 21-day pills contain two or three sections of different coloured pills per pack, with each section containing a different amount of hormones. You should take one each day for 21 days and then no pills for the next seven days. Phasic 21-day pills need to be taken in the right order, with an example being Logynon.

A pack of every day pills contains 21 active pills and seven inactive (dummy) pills. These pills look different and need to be taken in the right order. You take one pill each day for 28 days with no break between packets. An example of an every day pill is Microgynon ED.

Progestogen-only pills contain only the hormone progestogen. This means that they can be used by women who can’t use types of contraception that contain oestrogen. Traditional POPs only thicken the cervical mucus, however, some pills containing high dose desogestrel also prevents ovulation.

A pack of mini-pills contains 28 pills. You take one pill every day, either within 3 or 12 hours of the same time depending on which type of mini-pill you’re taking. When you finish a pack, you start the next one immediately the next day without any break.

1. Take your first pill from the packet marked with the correct day of the week.
2. Continue to take one pill at the same time each day until you finish the pack.
3. Stop taking pills for the next seven days. During this time you should get a bleed.
4. Start the next pack on the eighth day, whether you are still bleeding or not. This should be the same day of the week as the first pill.

1. From the first colour of your pack, take the first pill.
2. Carry on taking one pill daily in order, at the same time, finishing each colour in turn until the pack is empty.
3. Do not take any pills for the next seven days. You will get a bleed during this break.
4. Regardless of if you have or haven’t bled, start a new pack on the eighth day.

1. Take the first pill from the “start” section of the packet. This will be an active pill.
2. Take a pill every day until the pack is finished. Make sure to take pills in the correct order and at the same time each day, finishing with the seven inactive pills.
3. You should get a bleed during the seven days of inactive pills.
4. Start a new pack after finishing the first, whether you are still bleeding or not.

Choose a convenient time to take your first pill. This can be at any point during the day, but you will need to take it at the same time each day afterwards until you finish a pack.

Follow the instructions that come with your pill packet, taking one pill each day. Once you finish your pack, start a new pack the next day.

If you start taking the pill or the mini-pill on the first day of your cycle, you’ll be protected from pregnancy straight away.

Unless you have a short menstrual cycle, taking the pill or the mini-pill on the second to fifth day of your cycle will protect you from pregnancy immediately.

If you start taking the pill or the mini-pill after the fifth day of your cycle, you will not be protected from pregnancy straight away. You will need to use additional contraception until you have taken your birth control option for seven days for the combined pill and 2 days for the POP.

There are no known health benefits to starting the contraceptive pill midcycle. However, there are benefits to starting birth control sooner.

If you’re likely to forget your doctor’s advice on how to take the pill while you wait for your next period, it might make more sense to start right away. However, this will not protect you immediately and additional contraception will be required initially.

The contraceptive pill is intended to mimic your menstrual cycle while preventing pregnancy. This means that if you start midcycle, you are going against your body’s natural rhythm.

Starting the pill midcycle may cause irregular bleeding or spotting for the first couple of months. Other possible side effects, such as nausea and dizziness, are the same regardless of when you start the pill.

If you’ve missed 1 contraceptive pill, take the last pill you missed right away even if it means taking 2 pills in a day. Then, carry on using the rest of the pack as normal.

If you’ve missed 2 or more pills, you should take the last pill you missed immediately, even if it means taking 2 pills in a day. Then, carry on taking the rest of the pack as normal, using a secondary contraceptive method such as male or female condoms for the next 7 days.

If you are unsure of what to do, continue to follow your pill plan, use a secondary method of contraception, and consult a healthcare professional as soon as possible.

If you are using the combined pill and are less than 12 hours late of your regular time you are still protected from pregnancy. Take a pill as soon as you remember and take the next pill at the same time.

Don’t worry if you’ve taken an extra contraceptive pill by accident, you shouldn’t have any symptoms. If you’ve taken multiple by accident, you may feel slightly sick, be sick or have some vaginal bleeding, but these symptoms will pass.

Continue taking the rest of your packet as normal, at the same time every day as before. If the days on your pill packet are now out of order, you can correct this by replacing the missing pill with a pill from a spare packet.

If you are looking to change your contraceptive pill, you can visit your GP, contraceptive nurse or sexual health clinic. You should not have a break between packs, so you should start the new pill immediately after you finish taking your old pills.

During this transition, you may be advised to use secondary contraception as the new pill may take a few days to take effect.

While the contraceptive pill can be up to 99% effective, it does not fully guarantee protection from pregnancy. Though the chances are low, contraceptive pills can fail. Certain factors such as missing a pill, vomiting, or taking certain medication, can increase the risk of unwanted pregnancy.

Vomiting and diarrhoea can prevent contraceptive pills from being fully absorbed into your bloodstream. Keep taking your pill as normal but use an additional contraception method to avoid unwanted pregnancy.

You should also avoid the pill if you have or have had any of the following medical conditions:

• Thrombosis in a vein
• Strokes or any other disease that narrows the arteries
• A family history of blood clots under the age of 45
• A heart abnormality or heart disease, including high blood pressure
• Severe migraines, especially with aura
• Breast cancer
• Liver or gallbladder disease
• Diabetes with complications, or diabetes for over 20 years
• A strong family history of some cancers such as breast and womb cancer

Most women who have just had a baby and are not breastfeeding can start taking the combined pill or POPs 21 days after the birth. After checking with your doctor to see if this is the case, you will be protected against pregnancy immediately.

If you choose to start the combined pill after 21 days after the birth, you will need to use a secondary birth control option for the next seven days. If you start the mini-pill more than 21 days after birth, you will need to use additional contraception for the next two days.

If you are breastfeeding, you are advised not to take the combined pill until six weeks after the birth.

If you’ve had an abortion or miscarriage, you can start taking the pill up to five days after this and be protected from pregnancy immediately. If you start taking the pill after five days, you’ll need to use a secondary birth control option for the first seven days of taking the pill.

Contraceptive pills are available freely and confidentially if you’re under 16, as long as you understand the information and decisions involved. The pill is available from sexual health or GUM clinics, community contraception clinics, some GP surgeries and some young people’s surgeries.

If you’re under 13, your healthcare provider may decide to involve your parents, legal guardians or a social worker. You will still be allowed the pill, but they will want to ensure your safety.

There are many benefits to being on the pill compared to other types of contraception. These advantages include:

• No interruption to sex
• Often lightens periods and makes them less painful
• Reduces the risk of ovarian, womb and colon cancer
• Can reduce the symptoms of PMS (premenstrual syndrome)
• Occasionally reduces acne
• May protect against pelvic inflammatory disease
• May reduce the risk of ovarian cysts, fibroids and non-cancerous breast disease
• Can help with symptoms of endometriosis

With perfect use, the contraceptive pill can be one of the most effective birth control options. Less than 1 in every 100 women experience unwanted pregnancy each year.

All you have to do is remember to take the pill around the same time every day, and start your new packs on time.

While there are side effects to taking contraceptive pills, these aren’t always a bad thing. The combination pill and the mini-pill can both lighten periods, reduce menstrual cramps and lower your risk of ectopic pregnancy.

The combination pill can also help reduce or prevent acne, bone thinning, ovarian cysts, ovarian cancer, iron deficiency and premenstrual syndrome.

Contraceptive pills can easily be made a part of your daily routine. You don’t have to think about taking them before every time you have sex, and can choose a regular time that best suits you. As packs of contraceptive pills are small, they can be easily carried around with you.

While the pill and mini-pill are highly effective forms of contraception, there is a small risk you may suffer some side effects. These side effects are most likely to occur during the first few months of taking the pill and include:

• Headaches
• Nausea
• Breast tenderness
• Mood swings
• Increased blood pressure
• Spotting
• Skin changes

There have been lots of different studies looking at this question. Some big studies have shown a possible link with depression and contraception but this seems to be very dependent on which pill you are taking. The increase in chance is thought to be very small if there is one at all.

While taking a pill every day can be a benefit, it also creates the risk of missing a pill. If you miss one or more pills, you may not be protected from pregnancy.

If you live a particularly busy life and think you might forget to take the pill each day, more permanent types of contraception such as coils or the implant may be more suitable.

Most women get a bleed in the 7 day break from their pill. This is like a period but is actually an artificial withdrawal bleed from the pill they are on.

Bleeding patterns vary for women taking the POP, some women get irregular periods or spotting (light variable bleeding). However, some get their usual periods, infrequent periods or no periods at all.

If you want to miss your withdrawal bleed, you can. There are no known risks to doing so and it isn’t harmful. You may still get some slight bleeding, but this is nothing to worry about. Your contraceptive pill will also still protect you from pregnancy. However, it is recommended that you do not do this for more than 2 months in a row.

Approximately 40% of people taking POPs and up to 50% of people taking combined pills will experience irregular bleeding initially. These side effects are most common during the first three months of taking the contraceptive pill. If bleeding mid-cycle persists or you are getting bleeding with sex you should see your doctor for a review. These symptoms do not increase the likelihood of unwanted pregnancy.

You can stop taking contraceptive pills in a way that best suits you. You can stop taking your pills in the middle of the pack, or finish the pack and not start another. If you finish your current pill pack, your period should come at its normal time. However, if you stop mid-pack, you could get your period right away or it may come late.

When you stop taking the pill, your body will then need to adjust to the new balance of hormones. You may experience some slight side effects initially, however, these should go away on their own.

When first coming off contraceptive pills you may experience some mild side effects. These should pass after time and include the following:

• Irregular periods
• Heavy, painful periods
• Hormonal acne
• Mood swings

Most women will start ovulating again after a few weeks of stopping the contraceptive pill. However, for some women, it may take some months. In general, your body should have returned to its normal rhythm within two to three months after stopping the pill.

The Medicspot clinical station allows doctors to measure your blood pressure so they can prescribe the right contraceptive pill for you.

Find your nearest GP today.

Dr Abby Hyams grew up in Manchester and did her medical training in Bristol. She has been a GP for over ten years, many of them as a partner in an NHS practice in Hemel Hempstead. Dr Hyams loves being a GP because of the wide spectrum of people she encounters every day.

Dr Gill Jenkins is a GP in Bristol, working part-time in general practice and part-time as an aeromedical flight doctor. She has a particular interest in travel health, lifestyle management and diabetes. She has 3 children and in her spare time is a warm glass artist.

Dr Maheinthan Yogeswaran qualified as a doctor from Aberdeen Medical School in 2007. He subsequently trained as a GP and now works as a GP for Medicspot alongside an NHS practice in Essex. He has a wide spectrum of experience; notably in palliative care. Dr Yogeswaran also works on training future generations of GPs as a GP trainer.

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.