A Guide To The Combined Contraceptive Pill

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The combined oral contraceptive pill is most often referred to as "the pill". It contains artificial versions of the female hormones oestrogen and progesterone. When taken correctly, the pill is over 99% effective at preventing pregnancy. There are many advantages to taking the combined oral contraceptive pill. Besides providing protection against pregnancy, it is helpful if you have heavy periods, painful periods, PMS (premenstrual syndrome) or endometriosis.

The pill carries a low risk of serious side effects, such as blood clots and cervical cancer. You might, however, experience some minor side effects when you start taking the pill which usually settle down in a few months. These side effects can include mood swings, nausea, breast tenderness and headaches.


How Does The Combination Pill Work?

The aim of contraception is to prevent the fertilisation of an egg with sperm. The combined contraceptive pill achieves this in the following 3 ways:

  • The pill works by stopping ovulation (the release of an egg from the ovaries every month).
  • The oral contraceptive thickens the mucous around the cervix (neck of the womb), to make it harder for sperm to penetrate the uterus and reach an egg.
  • The pill thins the lining of the uterus (womb), so there is less chance of a fertilised egg implanting into the womb and being able to grow. 


How Do You Take The Combination Pill?

Each pack contains 28 tablets, which matches your natural menstrual cycle. The standard way to take the pill is to take 1 every day for 21 days, then have a break for 7 days. You will take placebo (dummy) tablets during this week and have a bleed like a normal period. The placebo pills are non-hormonal and meant to help you remember to take your pill every day and start your next pack on time.


When Should You Take The Pill?

You should take the pill at the same time every day. There is a chance of getting pregnant if you do not do this, or if you miss a pill, or vomit or have severe diarrhoea.


Can I Take The Pill at Any Time During My Cycle?

You can normally start taking the pill at any point in your menstrual cycle. Your GP or nurse will give you special guidance if you have just had a baby, abortion, or miscarriage. If you start the combined pill on the 1st day of your period (day 1 of your menstrual cycle) you will be immediately protected from pregnancy. If you start taking the pill after the 5th day of your cycle, you will need to use additional contraception, such as condoms, for 7-14 days.


Listening to Your Doctor

Your doctor may suggest a tailored regime to treat certain medical conditions or ease the symptoms associated with withdrawal bleeds. This may include taking the pill for 21 days and stopping for 4 days or taking the pill continuously without a break. Taking the hormone pills continuously without a break can be useful in treating disorders such as endometriosis.


The Different Kinds of Combined Pills

There are many different brands of the pill, made up of 3 main types, namely:


Monophasic 21-day Pills

This is the most common type with each pill containing the same amount of hormone. One pill is taken each day for 21 days and then no pills are taken for the next 7 days.


Phasic 21-day Pills

These pills contain 2 or 3 sections of different coloured pills in a pack. Each section contains a different quantity of hormones. One pill is taken each day for 21 days and then no pills are taken for the next 7 days.


Every Day (ED) Pills

There are 21 active pills and 7 placebo (dummy) pills in a pack. You do not take any breaks between packets and so it may be prescribed for you if you find it difficult to remember to start your next packet on the right day.


What Are The Benefits Of Taking The Pill?

Besides being up to 99% effective at preventing pregnancy if taken correctly, the combined contraceptive pill offers many additions health benefits, including:

  • Regulating or lightening menstruation
  • Preventing anaemia by making periods lighter or shorter
  • Lessening menstrual cramps (dysmenorrhea)
  • Improving the symptoms of premenstrual syndrome (PMS)
  • Treating polycystic ovary syndrome (PCOS), endometriosis or uterine fibroids
  • Lowering the risk of ovarian cancer, uterine cancer, and colon cancer
  • Improving acne
  • Stopping unwanted hair growth
  • Reducing migraines
  • Controlling hot flashes during the transition into menopause


 What Are The Disadvantages Of Taking The Pill?

The pill has been available for 60 years, as is safe for most women, however, some women experience unpleasant side effects when they start taking the pill. These symptoms normally improve after a couple of months. These symptoms can include breast tenderness or swelling, headaches, irritability, nausea and spotting between periods. If you continue to have adverse side effects, your healthcare provider may let you to switch to a different brand that doesn’t cause problems.


Other disadvantages and risk associated with taking the pill include:

  • You should not take the pill if you are over 35 and smoke.
  • You should not take the pill if you have a history of blood clots, stroke, heart attack, coronary artery disease, breast cancer or cancer of uterus, cervix, or vagina, liver disease, high blood pressure, diabetes, lupus, or migraines.
  • Some medicines may make the pill less effective. These include rifampicin-like antibiotics, some drugs used to treat epilepsy and certain antiretroviral drugs used to treat HIV. 
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