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COMBINED CONTRACEPTIVE PILL

What is the Combined Contraceptive Pill?

This is usually called simply "the pill". It contains two synthetic hormones – oestrogen and progestogen. These are similar to the natural hormones, oestrogen and progesterone, which are responsible for the menstrual cycle, which involves ovulation and periods. There are many different types of combined pills and different pills suit different women. Not everyone can take the combined pill: a doctor or nurse will advise you.

How effective is the Combined Contraceptive Pill?

It is very effective. If used according to instructions it is over 99% effective. This means that less than 1 woman in 100 will get pregnant in a year. If the pill is not taken according to instructions, the chance of pregnancy is much higher.

How does the Combined Contraceptive Pill work?

The main effect is to stop the ovaries releasing an egg each month (ovulation). It also thickens the mucus at the entrance of the womb (cervix). This makes it difficult for sperm to move through it and reach an egg.

What are the advantages of the Combined Contraceptive Pill?

It is reliable, and does not interfere with sex. It usually makes periods shorter, lighter and less painful and can help with pre-menstrual symptoms. It protects against cancer of the ovary and cancer of the womb and some pelvic infections. It reduces the risk of fibroids (tumours in the womb that are not cancer), ovarian cysts and breast disease that is not cancer.

What are the disadvantages of the Combined Contraceptive Pill?

You may get temporary side-effects when you first start the pill. These include headaches, weight gain or loss, nausea, breast tenderness, bleeding between periods and mood changes. These side-effects should stop within three months. If not, changing the type of pill may help. The pill may increase your blood pressure which should be checked regularly. Your doctor or nurse will need to ask you about your own and your family's medical history. Do mention any illness or operations you have had. The pill can have some serious side-effects, but these are rare. A very small number of women may develop a blood clot which can block a vein (venous thrombosis) or an artery (arterial thrombosis or heart attack or stroke). If you have ever had a thrombosis, you should not use the pill. Some types of pill appear to be associated with a slightly higher risk of venous thrombosis. The risk of venous thrombosis is greatest if any of the following apply to you: you are very overweight, are immobile (use a wheelchair), have severe varicose veins or a member of your immediate family had a venous thrombosis before they were 45. The risk of arterial thrombosis is greatest if any of the following apply to you: you smoke, are diabetic, have high blood pressure, are very overweight, or a member of your immediate family had a heart attack or stroke before they were 45. Research shows that women who take the combined pill have an increased risk of being diagnosed with breast cancer. This risk disappears over a ten-year period after stopping the pill. Studies are being done to see why this occurs, and how it relates to pill use, or if women taking the pill are diagnosed earlier than women who don't take the pill. There is also some research to suggest a link between using the pill and developing cervical cancer. Some research suggests a link between using the combined pill and developing a very rare liver cancer.

How is the Combined Contraceptive Pill used?

For the 21-day monophasic (pills are all the same) and phasic pill (pills are different): take the first pill on the first day of your period. You are then immediately protected against becoming pregnant. Take all 21 pills in the pack: you must take all the "phasic" pills in the right order. You then take no pills for the next seven days during which you will normally bleed. You then start a new pack on the same day of the week. For EveryDay pills: take one pill a day for 28 days with no break between packets. There are 21 active pills and seven inactive pills which don't contain any hormones. You must take these pills in the right order.

What to watch out for during use of the Combined Contraceptive Pill

Never make the mistake of starting your next pack late. If the break is longer than seven days, you may ovulate (release an egg). Do not worry if you are up to 12 hours late with a pill: take it straight away and carry on as usual. What do you do if you are more than 12 hours late? If there are less than seven pills left, take the pill you missed straight away. Take the rest of the pack as usual and use an extra contraceptive method such as condoms for the next seven days. When you have finished the pack, start your next pack the next day. Do not have the usual seven day break. You may have some bleeding while on the pill, or you may not bleed at all. Both are quite normal. If there are seven or more pills left, take the last pill you missed straight away, but leave any other pills in the pack that you have missed. Take the rest of the pack as usual and use another contraceptive method (such as condoms) for the next seven days.

When you have finished the pack leave the usual seven day break before you start the next pack. If you do become pregnant while taking the pill, research to date has shown that no harm will come to your baby. Can anything make the pill less effective? The pill may not work if you miss one or more pills or take it more than 12 hours late. It may also not work if you vomit within three hours of taking a pill or if you have very severe diarrhoea. Should any of these happen continue taking the pill as usual and use an extra method, such as a condom, while you are ill and for seven days afterwards. If any days of using extra contraception go into your pill free week start a new pack of pills immediately and do not have the usual seven day break.If you take a medicine prescribed by a doctor, dentist or hospital always say you are taking the pill. This is because some medicines, for example antibiotics, affect the way the pill works. Some complementary medicines may also affect how the pill works. You may need to use an extra contraceptive method, such as condoms, while you are taking the medicine and for seven days afterwards. If any days of using extra contraception go into your pill free week, start a new pack of pills immediately and do not have the usual break. You may or may not bleed, this is normal.

Other points to keep in mind

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