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The Combined Oral Contraceptive Pill

What is the Combined Oral Contraceptive Pill?

The Combined Contraceptive Pill, also known as the combined pill, is a pill that is taken to prevent pregnancies. The combined pill contains two synthetic hormones, oestrogen and progesterone. 

 

What is the difference between the combined pill and the mini pill?

One of the main differences between the mini pill and the combined pill, is that the mini pill only contains one hormone (progestogen), whereas the combined pill contains two (progestogen and oestrogen). The mini pill has to be taken every day without a break, and a bleed will not happen at any point. The combined pill has to be taken on the first day of the period for 21 days, with a 7 day break where the tablet is not taken. During these 7 days, women will experience a bleed. 

 

How does the combined pill work?

  • Female eggs live in the ovaries and the hormones that control the menstrual cycle cause 
    • A few eggs to mature each month 
    • Thickening of the lining of the uterus (this is optimal conditions for a fertilised egg to implant itself there)
  • ​​Around halfway through the menstrual cycle, a mature egg is released from the ovaries (a process known as ovulation) and travels through the fallopian tubes toward the uterus. 
  • The eggs stay within the fallopian tubes for around 12-24 hours, waiting for sperm. If sperm is present, is fertilises the egg (known as fertilisation) which then implants itself in the uterus. If this occurs, the female is considered pregnant. 
  • The combined pill contains two hormones oestrogen and progesterone, that work in three different ways to prevent pregnancy 
    1. Oestrogen suppresses the release of Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH). This stops the ovaries from releasing eggs (ovulation)
    2. Progesterone thickens the mucus at the entrance of the womb so that sperm is unable to enter and reach the fallopian tubes
    3. The progesterone also thins the lining of the uterus, creating hostile conditions for a fertilised egg to successfully implant

 

How many different types of combined pills are there?

There are three different combined contraceptive pills. Monophasic 21-day pills, phasic 21-day pills and ED (Everyday pills). 

Monophasic pills - These are the most commonly prescribed combined pills. Every pill has the same amount of hormones in them and they are taken for 21 days, followed by a 7 day break where a breakthrough bleed will be experienced. Most women start on this pill and will only usually switch if they are experiencing any side-effects. Examples of common monophasic pills are

ED (Everyday pills) - These pills are similar to monophasic pills and contain the same amount of hormones in each tablet. Instead of taking it for 21 days, you continue to take it for the full 28 days. The last 7 tablets that are taken after the 21 days, are placebo (dummy) pills and it is important the tablets are taken in the correct order.

Phasic Pills - These pills contain two or three different sections with coloured pills. Each section has different amounts of oestrogen and progesterone. Phasic pills need to be taken in the correct order and are taken for 21 days with a 7-day break, which is when a breakthrough bleed will occur. Phasic pills are usually taken by women who experience side-effects with monophasic pills. Example of common phasic pills include:

  • ​Binovium (biphasic, containing two different strengths of hormone)
  • Logynon (triphasic, containing three different strengths of hormone)
  • Trinovum (triphasic, containing three different strengths of hormone)​
  • Qlaira (quadriphasic, containing four different strengths of hormone)​

 

What are the advantages of the combined contraceptive pill?

The advantages of the combined pill are

  • ​It is over 99% effective when taken correctly
  • It usually makes periods lighter, shorter and less painful
  • It reduces the cancer risk of the ovaries, womb and colon
  • It can lower the risk of Pelvic Inflammatory Disease
  • It may help improve skin conditions such as acne and spots
  • It can help reduce bleeding and pain associated with endometriosis and fibroids

 

What are the disadvantages of the combined contraceptive pill?

  • ​It needs to be taken every day (remembering to do this may be difficult at first)
  • The effectiveness can be affected if the user is experiencing nausea or vomiting
  • It cannot be taken by certain women such as those that have high blood pressure, migraines, are overweight, smokers over 35 
  • It does not protect against Sexually Transmitted Diseases
  • Some medication can alter the effectiveness of the pill

 

How do I take the combined pill?

Take one pill at the same time each day for 21 days, followed by a 7 day "pill free interval", when you will experience a period type bleed. After 7 days, start taking the pill again for 21 days. In most cases, it is best to start the pill on the first day of your period, but the combined pill can be started at any time during the menstrual cycle. Always read the Patient Information Leaflet on how best to take the pill when starting during your cycle. Additional contraception for the first seven days may be required in these cases. 

ED (Everyday) combined pills need to be taken every day. 

 

Am I protected from pregnancy during the 7-day break?

You are protected from getting pregnant during the 7-day pill free interval providing you have taken all the pills correctly, you start the next packet on time and there are no other factors (such as starting certain medications) that may change the effectiveness of the pill.

 

Am I protected from pregnancy straight away after taking the combined pill?

Starting on day 1 of your period - You will be protected straight away. You do not need additional contraception

Starting on day 5 or before - Starting the day on day 5 of your period or before, will protect against pregnancy straight away, unless you have shorted menstrual cycles (periods lasting 23 days or less), in which case you would need added contraception such as a condom for the first seven days

Starting on day 6 or after - You will not be protected from getting pregnant straight away and should use extra contraception such as condoms for the first seven days of taking the pill. 

 

What if I forget to take the pill (combined pill)?

If you have missed one pillIf you miss one pill anywhere in your packet, or start a new packet one day late, you are still protected from getting pregnant. You must 

  • ​Take the last pill you missed straight away. Even if this means taking two tablets together
  • Continue taking the rest of the packet as usual
  • Have your 7-day tablet free break as usual (or if you are taking 28 day combined pills, take your 7 dummy pills as normal)
  • No additional contraception is required

If you have missed two pills If you have missed two pills, you should

  • ​Take the last pill that you missed as soon as you remember, even if it means taking two pills at the same time
  • Leave any earlier missed pills 
  • Use additional contraception for the next 7 days
  • If you have had sexual intercourse in the previous seven days, you may need emergency contraception. Seek advice
  • If you have seven or more tablets remaining in the pack, proceed to finish the pack as you normally would and have your 7-day break as usual (or continue to take the dummy tablets in the case of 28 day tablets)
  • If you have less than seven tablets remaining in the pack, continue to finish the pack, but do not have a 7-day break. Begin the next pack (or omit the 7 dummy pills in the case of 28-day tablets) the day after you finish the existing one

The above advice is a general rule for most combined contraceptives but is not valid in the case of Qlaira, Zoely, Eloine or Daylette. Please refer to the individual Patient Information Leaflets for advice on what to do when you have missed taking any of these pills. ​

 

What if I am sick or have diarrhoea when I am taking the combined pill?

Vomiting - If you vomit within two hours of having taken the pill, it is considered to be ineffective as it will not have been absorbed by your body. You should take another pill as soon as you feel well enough to do so. As long as you are not sick again after having taken the second pill, you are protected from pregnancy. 

Diarrhoea - If you have mild diarrhoea, it will not affect the absorption of the pill. If you have severe diarrhoea lasting 24 hours, consider the pill taken as a missed pill and follow the advice above for a missed pill. Severe diarrhoea lasting more than 24 hours will make the pill less effective and you should count each day that you have severe diarrhoea as though you have missed a pill and follow the above advice for missed pills. If you have severe diarrhoea lasting more than 24 hours, you should use another method of contraception for 7 days and seek medical advice. 

 

What if I am taking the combined pill and do not want to have a bleed?

When taking a combined contraceptive pill, it is possible to delay having a period by taking two packets back to back (missing out the pill free days). It is possible to take up to three packets back to back, but it is advisable to speak to your GP if you wish to take more than 2 packets consecutively. This is common practice and works for 21-day monophasic pills such as Microgynon, Yasmin, Rigevidon and Cilest (see above for full list).

If you are taking 28 Every Day pills, the same principle applies. The first 21 tablets are active pills and these should be taken as normal. The next 7 tablets are dummy pills and you should skip taking these tablets and continue to take the active pills of the next packet. 

If you are taking a 21-day phasic pill such as Logynon or Binovium (see above for full list), you should consult your GP or pharmacist. This is because each pill contains a different amount of hormones and need to be taken in a particular order to be effective. ​

Taking the pill in the above way will not affect your contraception. 

 

Is it important to give myself a break while taking the combined pill?

The hormones present in the pill do not have a cumulative effect and therefore do not build up in your body. There is no proven benefit for your fertility or general health in taking a break from the combined pill. 

 

When should I have my pill check-up?

Women should have a pill check-up once a year

 

 

 

The Progestogen Only Pill (mini pill)

What is the Progestogen Only Pill (mini pill)?

The Progestogen Only Pill, also known as the mini pill, is a type of contraceptive pill which contains only one hormone called progestogen. Different mini-pills contain a different type of progestogen, which all work in the same way to prevent pregnancies. 

 

How does the mini pill work?

Pregnancy occurs when mature eggs are released by the ovaries (ovulation) and fertilised by sperm that has entered through the neck of the womb (cervix). The fertilised egg then implants itself in the uterus. 

The mini pill works to:

  • ​​Thicken the mucus in the cervix, making it hard for sperm to move through the womb and fertilise an egg
  • Thin the lining of the uterus, so that even if an egg is fertilised, the hostile conditions created by thinning the lining of the uterus make it difficult for a fertilised egg to implant itself 
  • Some mini pills containing a certain type of progestogen called desogestrel (present in Cerazette, Cerelle, Zelleta, Desorex and Feanolla) also work by preventing the release of eggs from the ovary (ovulation)

 

How effective is the mini pill?

If taken in the correct way, the mini pill is over 99% effective. However, just like the combined pill, the mini pill does not protect against Sexually Transmitted Diseases (STD's)

 

What are the advantages of the mini pill?

  • ​​When taken correctly, it is over 99% effective in preventing pregnancy
  • It is suitable for women who are experiencing undesirable effects from oestrogen containing pills (combined pills), such as migraines
  • It is suitable for use by women who are overweight, have high blood pressure or a history of blood clots (combined pill is not)
  • It can be used by women over the age of 35 who smoke (combined pill is not suitable in these women)
  • It can be used when breastfeeding (combined pills cannot be taken by women who are breastfeeding)
  • It is safe for a majority of women up until the age of 55
  • It can be used by women 

 

What are the disadvantages of the mini pill?

  • ​Most pills need to be taken at the same time every day, normally within a three-hour window (with the exception of desogestrel containing pills such as Cerelle and Cerezette which have a 12 hour window)
  • Whilst most women do not experience periods whilst taking the mini pill, some women may find they are experiencing irregular bleeding or spotting
  • Some medication such as certain anti-epileptics and St John's wort can reduce the effectiveness of the pill
  • It can cause breast tenderness and spots on the skin in some women

 

How do I take the mini pill?

The mini pill needs to be taken every day without a break. There are 28 tablets in each pack and you should start a new pack as soon as the old one has finished. It should be taken at the same time every day usually within the 3-hour window (or a 12-hour window with desogestrel containing pills such as Cerazette and Cerelle). Any pills taken outside of the 3-hour or 12-hour window should be considered as a missed pill and you should follow the guidance on what to do if you have missed a pill. 

 

When should I start taking the mini pill?

The mini pill can be started at any time during your cycle. Depending on when you take it will determine whether or not you are protected immediately. Please see below for guidance. 

 

Am I protected straight away from the mini pill?

Starting on day 1-5 of your cycle (Within the first 5 days of your period) means you will be protected straight away and there is no need to use extra methods of contraception such as condoms. If your menstrual cycle is short (usually when you period comes every 23 days or less), you should use an extra method of contraception until you have taken the pill for 2 days.

Starting after day 5 of you cycle (5 days after the start of your period) means that you should use an extra method of contraception until you have taken the pill for 2 days. 

What if I forget to take the mini pill?​

If you are over 3 hours late (or 12 hours for desogestrel containing pills such as Cerazette, Cerelle, Noriday), this counts as a missed pill 

  • Take the missed pill as soon as you remember
  • Only take one pill, even if you have missed more than one pill
  • If you do not remember till it's time to take the next pill, take 2 pills together
  • Use additional contraception for the next two days
  • If you have had sex within the last 2 days, you may need emergency contraception (such as the morning after pill)

What if I am sick or have diarrhoea when taking the mini pill?

If you are sick within 2 hours of having taken the mini pill, it will not have been absorbed by your body. As long as you are not sick again, your contraception should not be affected and you should continue to take the next pill at your usual time. If you continue to be sick, seek medical advice. 

If you have severe diarrhoea lasting more than 24 hours, count each day you have diarrhoea as if you have missed a pill and follow the advice for missed pills. If you diarrhoea persists long term, please seek medical advice.

 

Can I take the mini pill if I smoke?

The mini pill is considered to be safe for those women that smoke, unlike the combined pill, which is not suitable for smokers over the age of 35

© 2018 BY CHEMIST CLICK. ALL RIGHTS RESERVED.