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What is the contraceptive pill?

The contraceptive pill is a generic name that’s used to describe a number of different hormonal pills designed to prevent pregnancy. Widely known as ‘the pill’, this is a popular and effective form of hormonal contraception. Some women also take the contraceptive pill to help regulate painful or heavy periods, or to alleviate the symptoms of acne.

How does the contraceptive pill work?

There are two main types of contraceptive pill:

  • The combined pill, which contains the hormones oestrogen and progestogen
  • The progestogen-only pill (mini-pill), which as the name suggests, contains progestogen only.

Both types work to prevent pregnancy, by thickening the mucus in the cervix to stop sperm from getting through and fertilising an egg. Combined contraceptive pills (and the desogestrel progestogen-only pill) also work by stopping the ovaries from releasing an egg each month.   A low-dose pill is also available, which works in the same way but contains lower levels of oestrogen.  

How long does it take for the contraceptive pill to work?

That depends on when in your cycle you start to take it. For a normal cycle, if you start taking your contraceptive pill in the first five days after the start of your period, you will be protected straight away.   If you start taking the pill at any time after this, or if you have a shorter than normal cycle, you will need to use additional forms of contraception for a short time:

  • Seven days for the combined pill
  • Two days for the progestogen-only pill

How reliable is the contraceptive pill?

Taken as directed, both the combined pill and the mini-pill are more than 99% effective. This means that in 1 year, out of 100 women taking either pill, less than 1 would fall pregnant.   It is very important to follow the instructions included with your pill packet, because failure to do so may make your pill less effective. Remember to take your pill every day without a break, and to follow the instructions if you forget a dose. If you experience an episode of vomiting or diarrhoea, this may stop your pill from working, so use an additional form of contraception until you have recovered.

Treatment

What are the different types of contraceptive pill?

There is a range of different types of contraceptive pill available. These are:  

  • Mini-pill. Contains progestogen but no oestrogen
  • Combined pill. Contains both progestogen and oestrogen
  • Low-dose pill. A combined pill that contains a lower-than-usual dose of oestrogen
  • Every day pill. A contraceptive pill that is taken every day, with no seven-day break.

Mini-pill vs combined contraceptive pill

The combined pill contains both oestrogen and progestogen. The oestrogen prevents ovulation, stopping an egg from being released from the womb each month. Because of this, some women may feel more confident taking this than the mini-pill, which does not contain oestrogen.   The progestogen-only pill is sometimes known as the mini-pill. An oestrogen-free alternative to the combined contraceptive pill, it may be the right choice for you if you are breastfeeding, are a smoker or are over 35 years old.

What are the alternatives to the contraceptive pill?

For those who prefer not to use hormonal contraception, there are a range of barrier methods available, including male and female condoms and the contraceptive cap. These types of contraception prevent conception by creating a physical barrier between sperm and egg.   Some people want to use hormonal contraception but want to avoid the responsibility of remembering to take the pill each day. Alternative methods of hormonal contraception include the implant, the contraceptive injection, the contraceptive patch, the hormonal coil (IUS) and the vaginal ring.   The IUD (copper coil) releases copper, rather than hormones, to prevent conception.   If you are looking for a permanent form of contraception, you may also want to consider male or female sterilisation.  

What is the most effective contraceptive pill?

We’ve seen that when they are taken according to the instructions on the packet, both the combined pill and the mini-pill are equally effective.   Your choice of which one to take is likely to come down to other factors, such as your age or weight, whether you smoke, or the side-effects you experience.  

How to tell if you’re taking the wrong contraceptive pill

Some women experience unwanted side effects when taking the contraceptive pill, such as headaches and migraines, acne and mood swings. If you experience any of these whilst on the pill, talk to your GP or family planning nurse about alternative forms of contraception.

What are multiphasic pills?

Most contraceptive pills are monophasic, which means that they contain the same amount of progestogen and / or oestrogen every day. Multiphasic and biphasic contraceptive pills (sometimes called phasic pills) use different doses of hormones at different times of the month.

Phasic pills vary the dosage of hormones throughout the month, before a seven-day break. This is usually done in order to reduce the impact of any side effects, by mimicking the woman’s natural cycle more closely. It is important that the pills are taken in the right order, or they could be less effective.

Some contraceptive pills contain progestogen and / or oestrogen for the first 21 days, and then include seven days of ‘placebo’ pills which do not contain any hormones. This usually results in a bleed that resembles a period. These pills are called ‘every day’ pills.

Side Effects

What are the risks of the contraceptive pill?

The contraceptive pill is generally safe, but there are some things you should know before you take it: 

  • The pill is over 99% effective when taken as directed. If you do not follow the instructions in your patient information leaflet, however, you may not be fully protected against pregnancy
  • Common side effects of the contraceptive pill include headaches, nausea, tender breasts, acne, mood swings and a change in your periods
  • The contraceptive pill can raise your blood pressure
  • The combined contraceptive pill is associated with a higher risk of blood clots (thrombosis)
  • Some women taking the progestogen-only pill develop harmless ovarian cysts
  • Remember that while the pill will prevent pregnancy, it cannot protect you against sexually transmitted infections
  • Taking the contraceptive pill is associated with a slightly raised risk of breast and cervical cancers, especially if it is taken for 5 years or longer. Ten years after stopping the pill, this risk returns to normal. However, taking the contraceptive pill does reduce your risk of developing both womb cancer and ovarian cancer – and the reduced risk remains even years after you stop using it.

 For many women, the benefits of taking the contraceptive pill outweigh the risks.

How to cope with contraceptive pill side effects

Hormonal contraceptive pills work well for many women, but others experience side effects. Everyone is different, but common side effects can include headaches, tender breasts, mood swings, acne, nausea and changes to your periods. These side effects usually occur when you first start taking the pill and are likely to settle down after three months.   If you are experiencing side effects like headaches or nausea immediately after taking the pill, consider changing the time that you take it. By taking the pill just before bed, you may be able to stop the side effects from affecting your everyday life.   If these or other side effects are having an adverse effect on your life, you may want to speak to your GP or family planning practitioner about alternative forms of contraception.  

Who shouldn’t take the contraceptive pill?

The contraceptive pill isn’t suitable for everyone. The combined pill, which contains oestrogen, should not be taken by women who are:

  • Aged 35 or over and who smoke
  • Very overweight or obese
  • Breastfeeding a baby born in the last six weeks.

For women in these categories, the mini-pill may be a suitable choice. However, both forms of contraceptive pill are unsuitable for women who have experienced:  

  • Stroke or blood clot (thrombosis), or have a family history of these
  • Heart conditions
  • Severe migraines
  • Liver or gallbladder problems.

It’s important to speak to your doctor if you have any doubts about whether either contraceptive pill is a good choice for you.

What is thrombosis?

Thrombosis is another name for blood clots, which are often associated with taking the pill. These are rare but can be discussed in more detail with your GP to find you the most suitable contraceptive.

What is the connection between the contraceptive pill and depression?

It is acknowledged that mood swings and low mood can be side effects of the contraceptive pill.

A 2016 study by researchers at the University of Copenhagen suggested that women who take the contraceptive pill are more likely to be diagnosed with depression. Within the group, the study found that those taking the combined pill were at a higher risk of depression than those on the mini-pill.

However, more research is needed to establish a definitive, causative link between taking the contraceptive pill and developing depression.

Q&A

Is there a contraceptive pill for men?

Although research is ongoing to develop a male contraceptive pill, there is currently no such pill available for men.

When can you get pregnant after taking the contraceptive pill?

While the contraceptive pill effective more than 99% of the time when taken correctly, it is possible to get pregnant whilst on the pill. This is more likely if:  

  • You forget to take a pill, or take it too late
  • You experience vomiting or diarrhoea whilst on the pill, which stops the hormones from entering your bloodstream
  • You are taking other medication, which could interact with the pill and make it less effective.

Do I need a prescription for the contraceptive pill?

Yes, you must have a prescription in order to take the contraceptive pill in the UK. You can get this from your GP or from our online doctor.

What should you do if you miss a pill?

Your pill may not work effectively if you do not take it at the same time each day. Follow the instructions on your patient information leaflet for information related to your particular type of contraceptive pill. You may need to use additional contraception for a short period of time.

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