The combined oral contraceptive pill

The combined oral contraceptive pill (COCP) is a form of hormonal contraception containing a combination of two hormones. The COCP is most commonly known as just ‘the pill’.

Unlike the progesterone-only pill (POP or ‘mini-pill’), which only contains one hormone, the COCP contains 2 synthetic female hormones, oestrogen and progesterone. These mimic the hormones made naturally in the ovaries and work in different ways to protect against pregnancy.

How effective is ‘the pill’?

When taken correctly, it is over 99% effective Trusted source National Institute for Health and Care Excellence (NICE) Government Source Go to source at preventing pregnancy. Some hormonal combinations may be more effective than others for treating certain conditions such as acne.

The COCP works in different ways to prevent pregnancy. Once a month, your ovaries release a mature egg that travels down the fallopian tubes towards the uterus (womb). This is a process called ovulation.

While ovulation happens, the lining of your womb begins to thicken as it prepares to host a fertilised egg. At the same time, the mucus in the cervix becomes thinner to make it easier for sperm to reach the womb.

The combined pill stops all of the following processes.

• It stops the ovaries from releasing an egg each month.
• It thickens the cervical mucus, making it harder for sperm to enter the womb and reach an egg.
• It thins the lining of the womb, which makes it difficult for a fertilised egg to implant into the womb and grow.

With a wide variety of contraceptive pills available, your doctor can advise you on the correct pill for you.

The main types of combined pills available are monophasic and multiphasic. They differ in how many doses of hormones there are across the pack and how many pills the packs contain.

Monophasic pills

These are the most common type of combined pill and are usually what doctors prescribe for first-time users.

Each tablet contains the same amount of hormones across the pack. One tablet is taken each day for 21 days, followed by a break for the next 7 days where you will get a withdrawal bleed. When you finish your 7-day break, you should start your next pack, even if you are still bleeding.

The most common monophasic brands include:

• Brevinor
• Cilest
• Femodene
• Femodette
• Loestrin
• Marvelon
• Mercilon
• Microgynon
• Ovranette
• Yasmin

Some packs of monophasic pills contain 28 tablets in total. Of these, 21 are active tablets and 7 are inactive tablets (or a variation of this combination). This means that one tablet is taken daily for 28 days with no break in between packs.

This might be a good option if you prefer to take a tablet every day without a break so you don’t forget when to stop and start. During the days you take the inactive tablets, you will get a ‘withdrawal bleed’.

Examples of these pills include Microgynon 30 ED, Femodene ED, Eloine and Zoely.

Multiphasic pills

Multiphasic pills contain various sections within a pack and each section contains different amounts of hormones. Each section is marked by different coloured tablets. The varying amounts of hormones are thought to copy the way your hormones fluctuate during your menstrual cycle. You must take these tablets in the correct order for them to be effective.

Multiphasic pills are available in packs of 21 and 28 tablets. The 21-day pills are taken once a day followed by a 7-day break. The 28-day pills are taken every day however, the last 7 tablets in the pack do not contain any hormones.

The 3 types of multiphasic pills are:

• Biphasic (e.g. Binovum) where the level of progestogen changes about halfway through the cycle. The level of oestrogen stays the same throughout.
• Triphasic (e.g. Logynon) where there is a change in the dose of hormones 3 times during the cycle.
• Quadriphasic (e.g. Qlaira) where there is a change in the dose of hormones 4 times during the cycle.

The main benefit of contraceptive pills is that they prevent pregnancy. However, there are several additional benefits, such as:

• making your periods more regular or they can be used to skip your periods
• reducing menstrual cramps
• reducing PMS symptoms such as mood swings and irritability
• making your periods lighter
• improving your skin and reducing outbreaks of acne
• helping with symptoms of endometriosis and PCOS (polycystic ovary syndrome)
• reducing the risk of womb and ovarian cancers

Consult with your doctor if you’re looking to improve a specific symptom or condition.

The pill will not prevent you from contracting sexually transmitted infections (STIs). Use a condom for STI protection and visit a sexual health clinic if you’re concerned you have an STI.

The most important part of taking oral contraceptives is that you take them at the same time each day. Taking a tablet too late or missing one could reduce its effectiveness.

How you take it will depend on what type of pill it is. Your doctor will explain how to take this medication. You can also refer to your patient information leaflet for more information.

When to start the pill

For immediate protection against pregnancy, start taking the active tablets within the first 5 days of your period.

You can start 'the pill' at any other time during your cycle, however, you will need to use a barrier method of contraception for the next 7 days before you are protected.

How do I delay my period on the pill?

You can also use the combined pill to delay your periods. If you take a 21-day pill, simply skip the 7-day break and immediately start your next pack. Similarly, if you take an everyday pill, you can skip the inactive tablets and immediately start the next strip of active tablets.

You can only skip your period with combined hormonal pills. If you take a progestin-only pill (POP or mini pill), take every pill in your pack.

When can I take the pill after giving birth?

When deciding what contraception to use after birth, how soon you can take it plays a big part in the decision.

If you’re not breastfeeding, you can take the combined pill 3 weeks after giving birth however, you will need to check with your doctor. If you are breastfeeding, you must wait at least 6 weeks after giving birth to take this medicine. If in doubt, consult your midwife or doctor.

If you have just had an abortion or miscarriage, you can start taking it immediately. If you take it within 5 days of an abortion or miscarriage, it will be effective straight away. Otherwise, you will need to use additional forms of birth control (like condoms) until you have taken an active tablet for 7 days in a row.

If you are more than 24 hours late (or 12 hours for certain COCPs), or if you frequently miss tablets, this medicine will be less effective at preventing pregnancy. It's important to use additional contraception if you have missed two or more tablets in your blister pack. You may need to seek emergency contraception if you have had sex during this time.

Advice for missing a pill is different for each type of pill, and in which week in your pack this occurred, so ensure you read the patient information leaflet thoroughly.

Use our interactive tool below on what to do if you miss one or multiple tablets in one month (menstrual cycle). Simply click to begin.

Missing one or more pills

Taking a tablet more than 24 hours late (or 12 hours for some COCPs) counts as a missed pill. If you miss one tablet, the general advice is to take the missed tablet as soon as possible, even if this means taking 2 tablets in 1 day. It is also advisable to use barrier contraception for at least 7 days. If you have had unprotected sex during that period, you may need to use emergency contraception.

Vomiting and diarrhoea

If you have severe diarrhoea or you vomit within 3 hours of taking the pill, it may not be absorbed properly and therefore might not be as effective. If this happens, you should follow the advice for a missed pill where appropriate.

The combined pill can cause side effects, especially within the first few months of taking it.

Some side effects of the combined contraceptive pill are:

• headaches
• breast tenderness
• spotting between periods or breakthrough bleeding
• mood swings
• changes in your sex drive
• weight gain

See our diagram below for more side effects.

Neurological

Headaches are a common side effect of contraceptive pills. More serious headaches and migraines are less common.

Gastric

Stomach upsets are fairly common and can occasionally result in vomiting. Some women experience slight weight gain, but weight loss is rare.

Gynaecological

Some women who take a contraceptive pill will experience changes in their sex drive.

Breast

It is quite common to experience breast soreness or tenderness in the first few weeks or months after starting a new pill. In very rare cases, you may notice breast discharge.

Contraceptive pill side effects

Click on the relevant area of the body to find out about how it may be affected by your contraceptive pill

Most of the common side effects are mild. However, if you experience any worrying side effects, talk to your doctor. They may suggest you try a different contraceptive.

While hormonal contraception is safe for most women, some health factors may increase your risk of side effects and complications.

This medication may not be suitable if you:

• are over the age of 35 and smoke
• have a high BMI
• have conditions such as high blood pressure, diabetes (with complications), or liver or gallbladder disease
• have frequent migraines
• have a personal or family history of blood clots
• have breast cancer
• have heart conditions such as a stroke

The pill may also affect other medicines, such as:

• medicines for epilepsy
• medicines for HIV
• certain antibiotics
• St John’s Wort (a herbal remedy)
• certain antifungals

These medicines may reduce the effectiveness of the pill. In many cases, women who can't use this treatment may be able to use another form of hormonal contraception, such as the POP.

Cancer

Taking the combined pill reduces your risk of ovarian, colorectal and endometrial cancer. Research Trusted source National Cancer Institute (NCI) Government Source Go to source has shown that it slightly increases the risk of breast cancer and cervical cancer compared to people who do not take it. However, this risk reduces and eventually reverses after 10 years of stopping it.

Make sure you monitor your breasts or any other health changes.

Blood clots

Another complication is a small increase in the risk of blood clots (thrombosis). While the risk is low, your doctor will check if you have certain risk factors before prescribing this medication.

If you have any signs of a blood clot such as swelling, redness or warmth in the leg, seek immediate medical attention.

Although the contraceptive pill is safe and effective, some people may decide that it is not for them, or want to take a break from taking it. It’s important to understand what effects this might have on your body.

Some side effects of stopping the pill might include:

• headaches
• weight change
• acne
• mood swings
• missed periods or irregular periods

If you are using a combined contraceptive pill, you can order it online at euroClinix. All you have to do is complete a quick online medical questionnaire. Then, one of our doctors will review your responses to ensure it's right for you. Once approved, your order will be dispensed and dispatched with fast, free delivery.