Combined contraceptive pill

What is the combined pill?

• The combined pill is a pill you take once a day to prevent pregnancy.
• When it’s taken correctly, it’s more than 99% effective.
• In everyday life, the pill may not be taken perfectly all the time. This typical use lowers its effectiveness to 93%.
• The combined pill usually makes periods lighter, regular and less painful.
• You can use the pill to help control when you get any bleeding.
• You can choose not to have any periods at all.

How does the combined pill work?

• The combined pill contains the hormones oestrogen and progestogen. They mimic natural hormones made by the ovaries.
• The pill stops the ovaries releasing an egg each month (ovulation).
• It thickens the mucus in the cervix (entrance to the womb) so sperm can’t get to an egg to fertilise it.
• It thins the womb lining so it’s hard for a fertilised egg to implant there.

How effective is the combined pill?

• The combined pill is over 99% effective when always taken correctly.
• Not everyone takes the pill correctly all the time. People might forget pills or take the wrong one. This is called ‘typical use’ and can mean the pill is less effective. Around 7 in 100 typical pill users will become pregnant in a year.

Taking the combined pill

There are different types and brands of combined pill. For most brands, if you start taking the pill during the first 5 days of your period, you'll be protected from pregnancy straight away.

If you start taking the pill after the 5th day of your period, you won’t be protected from pregnancy for the first 7 days. Use condoms if you have sex during this time.

You take the pill every day until you finish the pack. Depending on the type, your pack will have 21 or 28 pills. For 21-pill packs, you may then have a 7-day break, a 4-day break or no break before starting a new pack. This depends on the type of pill and your preference. For 28-pill packs, you always start the next pack the day after you finish the previous pack.

Types of combined pill

There are 3 main types of combined pill. Most people starting the combined pill for the first time will be offered a monophasic 21-day pill.

Monophasic 21-day pill

There are 21 pills in a pack. Each pill has the same amount of hormone. You take 1 pill a day for 21 days. Traditionally, you then have a 7-day hormone-free break with no pills. You start the next pack on the 8th day. You’ll likely have a withdrawal bleed (see "What is a withdrawal bleed?" in the FAQs below) during the 7-day break. It’s ok to start your next pack if you’re still bleeding on the 8th day.

Everyday monophasic pill 

There are 28 pills in a pack. There are either 21 or 24 active pills with hormones. The pack also has either 7 or 4 placebo (dummy) pills with no hormones. You take 1 pill a day. Take the active pills first, then take the placebo pills. There is no break between packs. You finish one pack and start the next pack the day after. You’ll likely have a withdrawal bleed (see "What is a withdrawal bleed?" in the FAQs below) while taking the placebo pills. It’s ok to start your next pack even if you’re still bleeding.

Tailored pill use

There are also other ways you can take monophasic pills. For example, for 21-day pills you can have a shorter 4-day break between packs. Or you can miss out the break altogether so that you don’t have a bleed. For Everyday pills you can miss out the placebo pills so that you don’t have a bleed.

There are no known risks from shortening or missing the break and withdrawal bleed. It’s up to you what you prefer.

Missing the break can be associated with a lower risk of pregnancy. It can also help people who get painful bleeding, headaches or mood changes during the pill-free break. You can miss the break every month, occasionally or not at all. It’s your choice.

Talk to a doctor, nurse or pharmacist to find out more about different ways to take monophasic pills. You can also read more at Tailored Pill Taking Guide.

Phasic 

There are usually 21 pills in a pack. The pills have varying amounts of hormone. It’s important you take them in order. The pack is colour-coded to make it easier. After you’ve taken all the pills you have a 7-day break. You’ll likely have a withdrawal bleed during the break. Start your next pack on the 8th day, even if you’re still bleeding. There are also a few types of everyday phasic pills with 28 pills in a pack. You must take them in the right order with no break between packs.

Common combined pill brands

There are various brands of combined pill. Different brands can have different quantities and types of the 2 hormones. For example, some brands have lower doses of oestrogen and some have different types of progestogen. People’s bodies respond to the hormones differently. So you sometimes need to try different brands to find what suits you best.

Common combined pill brands include:

Monophasic: Microgynon, Rigevidon, Yasmin, Marvelon, Ovranette, Gedarel, Milinette, Mercilon, Brevinor, Cilique, Katya

Everyday: MicrogynonED, Eloine

Phasic: Logynon

For more information on the combined pill brands available from SHL, please see: SHL.UK Contraceptives Ingredients

Things to consider when taking the combined pill

• The pill doesn’t prevent you from getting sexually transmitted infections (STIs) so, you may want to use condoms too.
• If you’re sick (vomit) within 3 hours of taking your pill or you have severe diarrhoea lasting more than 24 hours, the pill might not be absorbed properly. Take another pill. If you continue to vomit or have severe diarrhoea, use condoms until you’ve had 7 days without being sick or having diarrhoea.
• You need a clinical consultation before being prescribed the combined contraceptive pill. This is to make sure it’s medically suitable for you. This can be done at your GP surgery, at many pharmacies, at a sexual health service or through the SHL.UK online contraception service. During your consultation, give as much information as possible about your health and any medications you take.
• If you’re aged over 35 and smoke or vape, or gave up within the last year, the combined pill might not be suitable for you.
• The pill might not be suitable for you if you’re aged over 50, very overweight, take certain medications including some types of weight loss medication or have recently given birth.
• The pill won’t usually be suitable if you’re at higher risk of deep vein thrombosis or cardiovascular disease, have migraines with aura or have certain other medical conditions.
• Some medicines reduce the effectiveness of the combined pill. If you’re prescribed medicine when using the pill, tell your doctor and they can advise whether it will affect the patch.
• For other contraception options, see below: Is the combined pill right for me?

Benefits of the combined pill

• It usually makes periods lighter, regular and less painful.
• You can control when you get your period and choose not to have a monthly bleed if you don’t want one. Talk to your healthcare professional for more information or see above: Taking the combined pill.
• The pill reduces acne (spotty skin) and premenstrual symptoms.
• It may reduce the risk of cancer of the ovary, uterus and colon.
• It can help manage symptoms in people with fibroids, adenomyosis and endometriosis.
• Using the pill to regulate your bleeding pattern can be helpful for people with irregular periods such as those with polyendocrine metabolic ovarian syndrome (PMOS) - previously called PCOS.
• It may reduce menopause symptoms.
• Your fertility will return to whatever is normal for you once you stop using the combined pill.

Possible side effects and risks of the combined pill

Some people might get side effects when taking the combined pill, including:

• Side effects like breast tenderness, headaches, nausea (feeling sick) and mood changes. These usually stop within a few months as your body adjusts to the hormones in the pill.
• Unexpected ‘breakthrough’ bleeding (bleeding separate from your usual withdrawal bleed) in the first few months of using the pill.
• Increased blood pressure.

There are also some rare risks to be aware of:

• A small increased risk of developing blood clots. Your consultation will assess any risk factors related to this.
• A small increased risk of breast and cervical cancers compared to people who don’t use hormonal contraception. The increased risk reduces over time after stopping the pill and is eventually undetectable. Whether taking the pill or not, everyone is advised to check their breasts or chest regularly. And cervical screening (a smear test) can help detect any changes that could lead to cancer.
• The type of progestogen in some types of combined pills can slightly increase your risk of meningioma (a type of brain tumour). The overall risk remains small. If you’ve ever had meningioma, tell your pill provider.

Missing a pill

If you miss 1 pill, or start your new pack 1 day late, you’ll still be protected from pregnancy. Take a pill as soon as you remember, even if that means taking 2 pills in a single day. You won’t need to use condoms or emergency contraception.

If you’ve missed 2 or more pills or start your new pack 48 hours or more late, take the last pill you missed now, even if it means taking 2 pills in a single day. Carry on taking your pill as normal but use condoms if you have sex during the next 7 days. If you have sex without using condoms during this time, you may need emergency contraception.

If you miss any pills in the last 7 days of your pack, you can run your packs back-to-back. Do not have a pill-free break. You do not need to use condoms if you have sex unless you’ve missed more than one pill.

If you miss 2 or more pills during the first week after a pill-free break and had condomless vaginal sex during this week or during the pill-free break, you may need emergency contraception.

If you’re not sure what to do after missing pills:

• Keep taking your pill
• Use condoms if you have vaginal sex
• Contact your GP, sexual health clinic or pharmacist for advice – or try this missed pill calculator
• Or, if you live in an area covered by the SHL contraception service, you can do an online consultation to check if you need emergency contraception

Where can I get the combined pill?

Free combined pills online from SHL

If you’re 16 or over and your London borough is part of our contraception service you can have a consultation and order free combined pills from SHL.

1. Register or Log in
2. Take our online consultation
3. If the combined pill is right for you, we’ll post it to you, or you can collect it from selected pharmacies or ParcelShops

Free combined pills from London health services

You can get the combined pill for free from these places, even if you’re under 16:

• All London sexual health clinics
• Many London pharmacies
• Many GP surgeries (if you’re registered with them)
• Many young people’s services

Buy combined pills

• You can buy the combined pill from many online and high street pharmacies
• Prices vary depending on the type and brand of pill and any delivery charges
• You still need to have a consultation to check the pill is right for you

How often will I need a review?

When you first start taking the pill, your pill provider will check your blood pressure and weight to make sure the pill is ok for you.

You’ll need a review at least once a year to monitor your blood pressure, weight and general health. Some services may ask you to have a review sooner or more often than this.

Your review may be done online, by phone or at a face-to-face appointment. This depends on what your pill provider offers. To do a review online or by phone you’ll need to be able to give your current weight and a recent accurate blood pressure reading.

Your review is also a chance for you to ask any questions you have. But you can contact your GP, a sexual health clinic, a pharmacist, or your pill provider at any time if you have any questions or concerns. You don’t need to wait until your review.

Is the combined pill right for me?

• The combined pill could suit you if you’re happy to make contraception part of your daily routine and can remember to take your pill every day. An added benefit is that it’s one of the best contraceptive methods for period control. It helps make your periods regular, lighter and less painful and can help with PMS symptoms too. Most pill users can skip having a monthly bleed if they want to – either occasionally or every month.
• Most combined pill users only need to have a review once a year. If you can check your weight and blood pressure yourself, you can often have your review online or over the phone.
• If you need STI protection or sometimes forget your pill, you’ll need to be happy using condoms too. You may sometimes need emergency contraception too. It’s helpful to have a few places you know you could get this quickly. This could include ordering the emergency pill online from SHL.
• Like any hormonal contraception the combined pill can have side effects that may be positive or negative for you. If you’re unhappy with any side effects, talk to your healthcare professional. They may be able to help or they can support you to change to a different method of contraception. Your pill provider will also talk to you about the rare but serious risks associated with the combined pill. Some people may have conditions that mean they can’t use the pill.
• If the combined pill is not right for you, you might be interested in long-acting reversible contraception. This is more effective and protects against pregnancy for longer. This includes the implant (lasts 5 years), the hormonal coil (lasts 3 to 8 years) and the injection (lasts 3 months). Periods usually become lighter, shorter or less painful when using these methods. They can stop completely for some people – but bleeding patterns can sometimes be unpredictable.
• The copper coil is a non-hormonal, long-acting option that lasts for 5 or 10 years. This may not be suitable if you have heavy or painful periods as it can make periods longer, heavier or more painful for some people.
• Flexible options that you need to remember more regularly include the contraceptive patch or the vaginal ring (NuvaRing), and progestogen-only pills. These are all available by post from SHL.

This Brook tool can help you consider the best contraception for you.

Helpful links

• Combined pill - NHS
• Combined Pill | Contraception Choices
• The Combined Pill - Brook

Sources

Combined Hormonal Contraception | CoSRH

FSRH CEU Guidance: Recommended actions after incorrect use of CHC (2020, amended July 2021) | CoSRH

CoSRH Statement: Meningioma and Progestogens | CoSRH

UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) | CoSRH