DEFINITIVE GUIDE

The contraceptive pill

The combined contraceptive pill is the most popular method of birth control in the UK. With perfect use, it can be up to 99.9% effective.

Understanding how best to use the pill, and which type is best for you, will help ensure that you are comfortable with this method of contraception. Understand how best to use the pill with our definitive guide.

Written by Dr Abby Hyams and Dr Gill Jenkins. Reviewed by Dr Maheinthan Yogeswaran. Last reviewed on 01/08/2019. Next review date 01/08/2022.

Fast facts

How effective are contraceptive pills?

With perfect use, the contraceptive pill can be up to 99.9% effective. This means that less than 1 in every 100 women will get pregnant when taking the pill correctly each year. With typical use, however, the contraceptive pill is around 91% effective. This means that around 9 in every 100 women will get pregnant when using the pill each year.

Where can I get the contraceptive pill?

If you’re wondering how to get contraceptive pills, both the combined pill and progestogen-only pill are available for free from sexual health clinics, GUM clinics, community contraception clinics, most GP surgeries, and some young people’s surgeries.

CHAPTER ONE

What are the types of contraceptive pills?

The contraceptive pill is available in two main types: the combined pill, commonly known as ‘the pill’ and the progestogen-only pill (POP), commonly known as the mini pill.

The combined pill contains the hormones oestrogen and progestogen. Most pills are taken in a cycle of every day for three weeks and then stopping for a week. There are some combined pills that can be taken every day. The progestogen-only pill contains only progestogen and is taken every day.

The combined pill is not suitable for everyone. Speak with a doctor so they can assess what type of contraceptive pill is right for you.

How do contraceptive pills work?

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.

What are monophasic 21-day pills?

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.

What are phasic 21-day pills?

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.

What are every day (ED) pills and extended-cycle pills?

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.

What are progestogen-only pills?

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.

CHAPTER TWO

How to take the contraceptive pill

Depending on whether you are taking monophasic 21-day pills, phasic 21-day pills, every day pills or POPs, your birth control routine will change slightly.

Make sure to follow the instructions for your contraceptive pill closely and take the pill at the same time every day. It is also important to note that certain medicines may interfere with types of contraceptive pills. If you’re unsure of how to take the pill, we can help with:

What is the correct way to take birth control pills? And are you protected on the 7 day break from the pill?

How to take monophasic 21-day pills

  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.

How to take phasic 21-day pills

  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.

How to take every day pills

  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.

How to take progestogen-only pills

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.

Important

Mini-pills come in two types: 3-hour progestogen-only pills (traditional), and 12-hour progestogen-only pills (desogestrel). Depending on which type of contraceptive pill you use, you will need to take it within these same time periods each day.

Can I take the contraceptive pill with other medicines?

Some drugs can reduce the effectiveness of birth control pills. These include the antibiotics rifampicin and rifabutin, as well as epilepsy and HIV medicines. If you are prescribed one of these medications, consult your GP or healthcare professional for advice.

CHAPTER THREE

When can I start taking the contraceptive pill?

Women can usually start taking the contraceptive pill at any point during their menstrual cycle. However, which day of your menstrual cycle when you start taking the birth control pill will impact how soon it starts to become effective. If you start it on the first day of your period it will become effective immediately.

Alongside this, if you have just had a baby, abortion or miscarriage you may need to visit your GP or healthcare provider for individual advice. If you’re looking for guidance on when to start taking the pill, we can help with:

Can you start birth control at any time? And can you start the pill midcycle?

Starting on the first day of your period

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.

Starting within five days of your cycle

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.

Important

If you have a short menstrual cycle (your period is every 23 days or less), you will need to use additional contraception, such as condoms, until you have taken the pill for seven days.

Starting after five days of your cycle

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.

Are there benefits to starting midcycle?

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.

Are there side effects to starting midcycle?

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.

CHAPTER FOUR

Common worries about the contraceptive pill

Despite its effectiveness and ease of use, many women are still uncertain about many aspects of the contraceptive pill. Common worries include missing a pill, taking one by accident, and whether contraceptive pills make you gain weight.

To ensure perfect use of the pill, it is important to know the answers to each of these questions. If you have any lingering questions about the contraceptive pill, we can help with:

Can you get pregnant if you miss one pill? And what happens if I take 2 birth control pills in one day?

What should I do if I miss a 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.

Tip

If you’re taking POPs and are less than 3 hours late of your regular time, you’re still protected from pregnancy. Take a pill as soon as you remember, and take your next pill at the usual time.

Important

There are a few pills that are the exception to these rules and if you take Daylette, Eloine, Qlaira or Zoely you should consult the literature found in the pill pack for specific instructions for missing any of these pills.

What happens if I take a pill by accident?

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.

How do I change to a different pill?

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.

Can you get pregnant on the contraceptive pill?

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.

What happens if I’m on the contraceptive pill and I’m sick or have diarrhoea?

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.

Does the contraceptive pill make you gain weight?

Studies have found no evidence that contraceptive pills make you gain weight. Your weight may change due to fluid retention, but this is generally minimal and should pass.

CHAPTER FIVE

Who can use the contraceptive pill?

While contraceptive pills are available to all women, they are not suitable for everyone. Certain lifestyle factors and histories of health problems may mean you need to consider alternatives to the pill and different types of contraception. Speak with a healthcare professional so they can assess what pill is best for you.

There are also special considerations for when using the pill after birth, when breastfeeding or following a miscarriage or abortion. If you’re unsure whether the contraceptive pill is suitable for you, we can help with:

How soon after giving birth can you go on the pill? And can a 16 year old get birth control without parental consent?

When to avoid using the pill

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

How soon can I start birth control pills after having a baby?

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.

Can I use contraceptive pills after abortion or miscarriage?

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.

Can I get the pill if I’m under 16?

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.

CHAPTER SIX

What are the benefits of the contraceptive pill?

The contraceptive pill is one of the most effective types of contraception. However, there are other benefits to taking the pill beyond helping to prevent pregnancy.

Contraceptive pills have a number of potential health benefits and can positively impact your period. Compared to other birth control options, the convenience and simplicity of the pill is also appealing.

If you want to know the advantages of being on the pill, we can help with:

What are the advantages of taking the pill? And what else can the pill be used for?

What are the main benefits of contraceptive pills?

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

Contraceptive pills help prevent pregnancy

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.

Contraceptive pills have health benefits

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 are convenient

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.

Tip

Setting a reminder on your phone or using apps such as MyPill or MyTherapy can help remove the pressure of remembering when to take your contraceptive pill.

You can get pregnant when you stop taking contraceptive pills

Many people take the pill until the time is right to have children. With contraceptive pills, you can get pregnant straight after you stop taking them. While your periods may be irregular or may not return for a few months, it’s still possible to get pregnant when you’re not taking the pill.

CHAPTER SEVEN

What are the disadvantages of the pill?

While contraceptive pills can have many benefits, there are also potential risks and side effects. When deciding whether the contraceptive pill is the right type of contraception for you, it is important to understand the potential downsides.

If you are concerned about the risks of the contraceptive pill, we can help with:

What are the side effects of birth control pills? And how does the pill affect your mental health?

Contraceptive pills can have negative side effects

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
Tip

If you have any negative side effects from your birth control, speak with a doctor and they can prescribe an alternative pill if appropriate.

Can contraceptive pills cause depression?

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.

Remember to take your contraceptive pill every day you are meant to

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.

Tip

You can use apps such as MyPill or MyTherapy to help with the pressure of remembering when to take your contraceptive pill. Another option is to set a daily reminder on your phone to make sure you never miss a pill.

Contraceptive pills can have rare health risks

When taking a contraceptive pill, there is a small increased risk of blood clots. Your healthcare professional will check whether you have any risk factors involved with this before prescribing the pill.

Amongst other possible risks research also suggests that there may be a small link between contraceptive pills and some cancers such as breast and cervical cancer. They may also increase the risk of a rare form of liver cancer. POPs also carry a small risk of causing fluid-filled cysts to develop on the ovaries, but these aren’t dangerous and usually disappear without treatment.

CHAPTER EIGHT

The contraceptive pill and periods

As with many birth control options, contraceptive pills often directly affect your period. Your period may stop, become heavier or lighter, or become irregular while taking the pill.

While these changes can be worrying, they are most often the result of the hormones within the contraceptive pill helping to prevent pregnancy. If you have any concerns about how the pill may affect your periods, we can help with:

Why am I not getting my period on the pill? And can birth control pills cause spotting?

Does the contraceptive pill stop periods?

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.

Can I miss out my withdrawal bleed?

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.

Spotting and irregular bleeding when on the pill

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.

Important

If you experience chest pain, shortness of breath, abdominal pain or severe bleeding, you should visit your doctor immediately. These symptoms may indicate something more severe.

I didn’t bleed in my pill-free week - am I pregnant?

If you have taken all of your pills correctly, haven’t suffered from vomiting or diarrhoea, and aren’t taking any medicines which might affect the pill, you’re probably not pregnant. Start your next pack at the usual time.

If you’re still concerned, carry out a pregnancy test or consult your doctor or nurse. If you miss more than one expected bleed, always take a test or speak to a health professional.

CHAPTER NINE

Coming off the contraceptive pill

There are many reasons why you might want to come off the contraceptive pill. These include trying to get pregnant or seeking a different birth control option. However, while a lot of advice is available on taking the pill, coming off the pill is often overlooked.

It is just as important to know the potential side effects of stopping the pill and the alternative types of contraception available to you afterwards. Changes in weight, mood swings, spotting and irregular periods may all be caused by stopping the pill.

If you’re thinking of coming off contraceptive pills, we can help with:

What happens to your body when you come off the pill? And how quickly can you get pregnant after stopping the pill?

How do you stop taking contraceptive pills?

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.

Tip

It’s very important to remember that once you stop taking the contraceptive pill, you can get pregnant. If you are not looking to have a child, it is important to start using a new type of contraception immediately.

Are there side effects to coming off the contraceptive pill?

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

How long after stopping the pill will I ovulate?

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.

Important

If you suffered from ovulation problems before taking contraceptive pills, such as heavy periods, these will most likely return once you stop taking the pill.

Getting pregnant after the pill

If you’ve stopped taking combination pills, the rate of pregnancy may depend on the type of pill you were taking. If you were taking 21-day pills and finished your pack, it’s possible to get pregnant the next month after menstruation.

If you’ve stopped taking POPs, it’s possible to get pregnant within days after you quit. It is a myth that using the contraceptive pill will have impacted your fertility. For advice on a health conception, consult your doctor.

CHAPTER TEN

Get same day treatment with Medicspot

Our vision is to change lives with transformative, accessible care. With over 200 private GP surgeries across the UK, you can find your nearest clinic and see a doctor in minutes.

It’s quick and easy to get the contraceptive pill with Medicspot. Our doctors can measure your blood pressure and provide expert advice so you can get the most appropriate birth control. We can help with:

Where is your nearest GP surgery? And how can Medicspot help?

How it works

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.

CHAPTER ELEVEN

About the authors

Dr Abby Hyams

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

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

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.

Disclaimer

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.