Combined pill

Benefits

  • usually makes periods regular, lighter and less painful

  • may help with premenstrual symptoms

  • reduces the risk of cancer of the ovary, uterus and colon

  • improves acne in some women

  • you are protected from pregnancy straight away if you start taking the combined pill in the first five days of your period

  • when you stop using the pill your fertility will return to normal.

The combined pill (also known as ‘the pill’), is a small round tablet that releases artificial versions of the oestrogen and progesterone hormones. It has to be taken daily. Almost half of all women using contraception take oral contraceptive pills as their primary method of contraception. The combined pill is most popular amongst women aged between 16 and 24.

*for typical use (effectiveness for perfect use 99%)

Which brand of pill should I choose?

There are several different brands of combined pill, each contain slightly different amounts or types of hormone but work in the same way to prevent pregnancy.

We offer the most commonly prescribed combined pills.

We have grouped them below according to their dominant hormone and have described why you might get on with that type better, for example, some pills can help reduce acne or PMT. However most people will have to try a few before they feel like they have found the one that suits them best.

We will assess your medical history before we prescribe your pill. However before ordering we suggest checking our questions section for any medical reasons that may mean you should avoid taking the combined pill.

If you’re unsure about which brand to order, or can’t find the pill you usually take and would like advice on which other brands have a similar formulation, you can email our clinicians for advice at info@fettle.health.

Progestogen +

Most people start on this progestogen dominant formulation of combined pill because it has the lowest increased risk of thrombosis, so if you are over 40 you should start with one of these (more info here). Some people find these help reduce PMT and make periods lighter and less painful.

Other pills that are very similar to these include: Maexeni, Ethinylest/Levonorgest 30 or Loestrin 30.

Oestrogen +

If you have tried a progestogen dominant pill (group one), and experience side effects such as oily hair, low mood, loss of libido or extra hair growth during the second half of your cycle, then you may want to try one of these oestrogen dominant combined pills to see if those side effects reduce. These can also be taken to help reduce acne.

Other pills that are similar to these include: Cilique and Lizinna.

Other

If you have tried both types of pill above, and experience side effects, you might want to try an alternative formulation to see if you respond better to a slightly different dose of hormone.

Other pills options include: Femodene, Millinete 30, Millinette 20, Gedarel 20, Dretine or Triadene.

How it works

How to use it

Combined pill how

The combined pill is supplied in packs of 21. They were originally intended to be taken one per day, for 21 days, followed by a 7 day break allowing for a withdrawal bleed. However there are safe ways to take the pill where you take packets back to back and bleed less often, read about these methods here.

Why it works

Combined pill why

The hormones in the combined pill prevent pregnancy by:

  • thickening the mucus in the neck of the womb, so it is harder for sperm to penetrate the womb and reach an egg
  • thinning the lining of the womb, so there is less chance of a fertilised egg implanting into the womb
  • in some women, the combined pill also stops the ovaries from releasing an egg (ovulation), but most women will continue to ovulate.

Things to consider

The combined pill does not protect you from STIs. You should use a condom as well if you think you are at risk of an STI.

You need to remember to take your pill. If you find that you often forget to take your pill, there are long lasting contraception options available, such as the hormonal coil or the implant . Visit your nearest sexual health clinic or your GP for more information.

What if?

You miss a pill:

  • the chance of getting pregnant depends on when the pills are missed and how many pills are missed. Read more in our Questions section
  • if you are not sure what to do, continue to take your pill and use another method of contraception, such as condoms, and seek advice from our clinicians by replying to a text from us or emailing info@fettle.health.

The pill can become less effective at preventing pregnancy if:

  • you have vomiting and/or diarrhoea, as the pill may not be absorbed into your bloodstream. Read more in our Questions section
  • you are taking some medicines. Always read the information that comes with your medicine and tell your doctor that you are taking the combined pill if you are prescribed any medicines. The health questions in our order form will ask you if you are taking certain medicines that can make the combined pill less effective.

Suitability

Most women can take the combined pill, but we will ask about your family and medical history in our order form to determine whether or not it is the best method for you.

The combined pill is not always suitable for women who:

  • are pregnant
  • smoke (or stopped smoking less than a year ago) and are 35 or older
  • are very overweight.

It may also be unsuitable if you have or have had certain health conditions.

Side effects & risks

Although serious side effects are not common, there are some risks associated with the combined pill.

CommonRare
Short term

can cause temporary side effects such as headaches, nausea, breast tenderness and mood swings – these often improve over time but can be persistent.

some bleeding and spotting in the first few months.

Long term

some loss of libido. changes to skin.

can increase your blood pressure.

small increased risk of some serious health conditions, such as thrombosis (blood clots) and breast cancer or cervical cancer. these risks reduce with time after stopping the pill.

can cause hair loss and chloasma (dark patches over the face).

Questions?

Most women can take the combined pill, but your GP or clinician will ask about your family and medical history to determine whether or not it is the best method for you.

The combined pill is not always suitable for women who:

  • are pregnant
  • smoke (or stopped smoking less than a year ago) and are 35 or older
  • are very overweight
  • are over 50 years old.

It may also be unsuitable if you:

  • take certain medicines, or the herbal medicine St John’s Wort
  • have or have had thrombosis
  • have or have had a heart abnormality or heart disease, including high blood pressure
  • have or have had severe migraines, especially with aura (disturbances of vision or sensation)
  • have or have had breast cancer
  • have or have had disease of the gallbladder or liver
  • have or have had diabetes
  • are immobile for a long period of time or use a wheelchair
  • have systemic lupus erythematosus
  • have a family history of thrombosis
  • have a family history of cardiovascular problems at a young age.

When you stop using the combined pill your fertility will return to normal. (Don’t worry if your periods don’t start immediately. For some women it can take a few months.)

The cost of the pill depends on which brand you choose and how many months supply you order.

Our prices include a prescription from a qualified clinician, access to clinical advice by text (before and after you’ve ordered), 1st class postage and discreet packaging of your pills, text updates to help you track your order, and text reminders to help you reorder before your supply runs out.

This depends on when in your cycle you start taking it. If you start within the first five days of your menstrual cycle then it will be effective immediately. If you start after the first five days of your cycle then the combined pill will not be effective for 7 days. If you are switching from one method of contraception to another then you should talk to your doctor or nurse about using additional contraception.

The combined pill prevents ovulation and limits the build-up of the lining of the womb (endometrium) that is usually lost with your period. This results in a shorter, lighter and often less painful bleed.

Not everyone can take hormonal contraceptives. Here are some common reasons why people are not able to take each type of pill.

Combined pill:

  • suffering from migraines with aura (changes to your vision and/or pins and needles or numbness, before, during or after the headache begins)
  • having high blood pressure
  • a family history of blood clots.

Progestogen only pill:

  • taking enzyme inducing drugs (for epilepsy etc.).

Combined pill (typically provided in packs of 21 pills):

Microgynon, Rigevidon, Yasmin, Cerazette, Binovu, Logynon, Brevinor, Levest and Loestrin 30.

Progestogen only pill (provided in packs of 28 pills):

Aizea, Cerazette, Cerelle and Nacrez.

It’s important that you remember to take your pill every day. Some women prefer other methods of contraception so that they don’t have to worry about forgetting to take it or missing a pill.

If you have missed one pill, anywhere in the pack:

  • take the last pill you missed now, and take the next pill at the normal time
  • continue taking the rest of the pack as usual
  • you don’t need to use additional contraception, such as condoms
  • take your 7 day pill-free break as normal.

If you have missed two or more pills (you are taking your pill more than 48 hours late) anywhere in the pack:

  • take the last pill you missed now, even if it means taking two pills in one day
  • leave any earlier missed pills
  • continue taking the rest of the pack as usual and use an extra method of contraception for the next 7 days
  • check how many pills you have left in your pack. If it is more than 7 pills then complete the pack as usual and take the 7 day break at the end of the packet. If you have less than 7 pills left in the pack then miss the break at the end of this packet and start the new packet immediately without the 7 day pill free interval
  • you may need emergency contraception if you have had unprotected sex since missing the pills or in the 7 days before missing the pills.

If you are not sure what to do, continue to take your pill and use another method of contraception, such as condoms, and seek advice from our clinicians by replying to a text from us or emailing info@fettle.health.

We will send a reminder by text two weeks before your supply is due to run out. You can reorder using the same online order form and your new supply will be dispatched to arrive the next working day. You should always make sure that you have a new supply ready to avoid missing any pills.

Bleeding is common when you first start taking the combined pill. It can take up to 3 months to settle down, but it’s very important to keep taking the pills to the end of the pack, even if your bleeding is heavier than usual.

Once your body is used to the pill, your period should become regular, with bleeding during the pill-free week.

Bleeding can also be caused by not taking the pill correctly, or by a sexually transmitted infection or pregnancy. If the bleeding does not settle down or if you are concerned, speak to your GP, sexual health clinic or call NHS 111 for advice.

If you vomit within two hours of taking the combined pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

If you continue to be sick, keep using another form of contraception while you're ill and for 7 days after recovering.

Very severe diarrhoea (six to eight watery stools in 24 hours) may also mean that the pill doesn't work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for 7 days after recovering.

Seek advice from our clinicians by replying to a text from us or emailing info@fettle.health or contact your GP or NHS 111 if your sickness or diarrhoea continues.

Taking the combined pill can increase your blood pressure. There is a small increased risk of some serious health conditions, such as thrombosis (blood clots) and breast cancer or cervical cancer. These risks reduce with time after stopping the pill.

Some medicines make the combined pill less effective (including those used to treat epilepsy, HIV and TB, and the herbal medicine St John’s Wort). Ask our clinicians if you’re unsure by emailing info@fettle.health and read the information that comes with your medicine.

Research is ongoing into the link between breast cancer and the pill. Research suggests that users of all types of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with women who do not use them. However, 10 years after you stop taking the pill, your risk of breast cancer goes back to normal.

Research has also suggested a link between the pill and the risk of developing cervical cancer and a rare form of liver cancer. However, the pill does offer some protection against developing endometrium (lining of the womb) cancer, ovarian cancer and colon cancer.

The combined pill may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease.

Research has not shown that the combined pill leads to weight gain. Some women find that their weight changes due to fluid retention or an increase in appetite, but this should settle over time.

It is not harmful to continue to take your next pack of pills without a 7 day break, or miss out inactive (dummy) pills with EveryDay combined pills.

The Faculty of Sexual and Reproductive Healthcare has issued guidance supporting taking the combined pill without a monthly 7 days break:

(It is noted, that these ways of taking the pill are ‘off licence’ use - this does not mean it is unsafe, but that taking the pill in this way is not within the UK product license.)

  • 'Tricycling' is taking a pill each day without any breaks for three continuous packs (9 weeks). Then stop for 7 days - during this time you may or may not bleed. Continue taking the pill in this manner (3 packs continuously followed by 7 days off).
  • 'Extended pill taking' is taking a pill each day without any breaks, until you notice 3-4 days of continuous bleeding (where you need to use a tampon or pad). Stop taking the pill for the next 3-4 days, even if the bleeding stops. Then resume taking the pill every day, and when one pack is finished go straight on to the next pack. Don’t worry if you don't bleed, it doesn’t occur with everyone. When starting this method, you must take a pill for 21 consecutive days before taking a break.

If you would like to discuss taking the pill like this, get in touch by text.

It may reduce menopausal symptoms in some women, but is not recommended for women over 50.

If you have just had a baby and are not breastfeeding, you can start the combined pill on day 21 after the birth. You will be protected against pregnancy straight away. If you start the pill later than 21 days after giving birth, you will need additional contraception (such as condoms) for the next 7 days.

If you are breastfeeding a baby less than six months old, taking the combined pill can reduce your flow of milk. It is recommended that you use a different method of contraception until you stop breastfeeding. The progestogen only pill does not affect your milk supply.

If you have had a miscarriage or abortion, you can start the pill up to five days after this and you will be protected from pregnancy straight away. If you start the pill more than five days after the miscarriage or abortion, you'll need to use additional contraception until you have taken the pill for 7 days.

The combined pill can cause temporary side effects, such as mood swings, when you start taking it. If these do not go away after a few months, contact one of our clinicians by emailing info@fettle.health to find out about using a different form of contraception.

Some reports suggest that there may be a very small increased risk of breast cancer and cervical cancer, but the pill does help protect against other types of cancers such as ovarian, colon and uterine cancers.

There is no evidence to suggest the pill causes infertility. Most women, who have regular periods will find that their normal cycle will return within six months. Some women find that their usual cycles begin again very quickly after stopping, but for others it can take longer.

The benefits of long term use of the pill usually outweigh the risks.

See a doctor straightaway if you have any of the following:

  • pain in the chest, including any sharp pain which is worse when you breathe in
  • breathlessness
  • you cough up blood
  • painful swelling in your leg(s)
  • weakness, numbness, or bad 'pins and needles' in an arm or leg
  • severe stomach pains
  • a bad fainting attack or you collapse
  • unusual headaches or migraines that are worse than usual
  • sudden problems with your speech or eyesight
  • jaundice (yellowing skin or yellowing eyes).