The Combined Pill – Everything you need to know

Reviewed: July 15, 2021
The magic pill which is 99% effective in preventing pregnancy

The combined pill is often the first method of contraception most of us started on. It is an extremely popular method of contraception due to its accessibility and simplicity, as well as the many different brands available offering lots of choice. Many women also turn to the pill not only as a contraceptive but for help with other problems. This magic pill might be small, but certainly packs a punch when it comes to controlling acne, periods and hormones – so definitely isn’t just a one-trick pony!

What is the combined pill?

The combined pill, also known as ‘The pill’, is an oral contraceptive is taken daily. It contains artificial versions of women’s hormones oestrogen and progesterone. There are many different brands of pill (including Rigevidon, Microgynon and Yasmin), but generally they are designed to be taken in three main ways which all differ slightly.

Monophasic pills:

Each pill has the same amount of hormones in it. One pill is taken each day for 21 days and then no pills are taken for the next 7 days. During this break you experience a withdrawal bleed (like a period). For most brands you can choose to shorten this break or miss it out altogether (and avoid a withdrawal bleed).

Multiphasic pills:

One pill is taken each day for 21 days, but each pill provides different levels of hormones. No pills are taken for the next seven days. Phasic pills need to be taken in the correct order.

Every day (ED) pills:

There are 21 active pills (containing hormones) and seven inactive pills (also known as ‘dummy’ pills, containing no hormones) in a pack – they are identifiable through different colours. One pill is taken each day for 28 days with no break between pill packets. ED pills need to be taken in the right order.

How does the combined pill work?

The pill prevents pregnancy in three ways – by stopping ovulation, by making the fluid in your cervix thicker (which makes it more difficult for sperm to enter the womb), and by preventing the lining of your womb thickening enough for a fertilised egg to implant into it.

How effective is the pill?

If the pill is taken correctly (meaning you don’t miss any), it is over 99% effective.

What are side effects of the pill?

Minor side effects of the pill can include mood swings, nausea, tenderness in breasts and headaches. Despite what people may say, 46% of The Lowdown users report no change in weight and only 25% state they had gained weight after being on the combined pill. After much debate, there is no proof that the combined pill CAUSES weight gain. Research does admit that women can put on weight while using the combined pill, but this is thought to be due to natural weight gain as part of ageing that would happen normally without contraception.

There is a very low risk of serious side effects such as blood clots and breast or cervical cancer. The pill does not protect against STIs, but luckily the trusty condom can be used alongside this contraceptive to avoid any sexually transmitted illnesses.
Graph showing 46% of Lowdown users said the Combined Pill had no effect on their weight

How do I use the combined pill?

The combined pill needs to be prescribed and is not something available over the counter. Before you are prescribed the pill, your doctor or nurse will do some tests to ensure you are safe to go on it. They will check your medical history, make sure you’re not pregnant, check your height and weight and take your blood pressure.

Most women can start the pill at any time in their menstrual cycle. If you start your pill within 5 days of starting your period you will be protected from pregnancy straight away (if you have a short cycle then speak to your doctor or nurse). At any other time in your cycle you will need to use condoms or avoid sex for 7 days before you are covered. Make sure you read the packet carefully and speak to a health professional if switching from another contraception method. There are special instructions for starting the pill if you’ve just had a baby, abortion or miscarriage.

You will normally be given a prescription for three months initially and will need to go back to your doctor for annual check-ups (i.e blood pressure).

It’s important to take the pill around the same day every day – for example, first thing in the morning, or before you go to bed at night. It can often be helpful to associate it with something else in your routine, i.e when you have breakfast, or after you’ve brushed your teeth. You could also keep it somewhere that you look everyday, i.e makeup bag. But if you do have the memory of a fish, you could just set an alarm on your phone to ensure there’s absolutely no way you could forget to take your pill!

What happens if you miss a pill?

If you miss a pill or pills, or you start a pack late, this can make the pill less effective. The chance of getting pregnant after missing a pill or pills depends on when the pills are missed and how many pills are missed. Check the NHS website for advice on what to do if you miss a pill.

If you vomit within two hours of taking the pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and then the next pill at your usual time. If you continue to be sick, keep using another form of contraceptive until you’ve taken the pill again for seven days without vomiting. Very severe diarrhoea (six to eight watery stools in 24 hours) may also mean that the pill won’t work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea, and for two days after recovering. Check out more information here.

How do I stop using the pill?

Stopping the pill is super easy – you literally just stop taking it. However, be aware that as soon as you stop, you are no longer protected from pregnancy. If you’ve taken 21 consecutive pills, you may ovulate from any time from 7 days after you’ve finished the packet so consider if you need to switch to another method for ongoing contraception.

Combined pill VS mini pill

The main difference between these two pills are the hormones present in them. The combined pill contains two hormones, oestrogen and progestogen, while the mini pill only contains progestogen. The combined pill is designed to be taken once a day for 3 weeks, with 7 days pill-free break, but packets can be taken continuously without breaks. The mini pill is to be taken once a day every day – with no break.

Pros and cons of the combined pill

Pros

  • You are able to control when you have withdrawal bleeds or taken the pill continuously and avoid them altogether
  • It doesn’t interrupt sex
  • It can reduce your risk of cancer of the ovaries, womb and colon
  • It can reduce symptoms of PMS
  • It can help improve acne

Cons

  • Some medicines and antibiotics can change the way your body digests the pill (check with a doctor or nurse if you are unsure)
  • You need to remember to take it every day and may forget to take it
  • Vomiting or diarrhoea can make the pill ineffective
  • With any combined type of hormonal contraception, there is a slightly increased risk of developing blood clots
  • It doesn’t protect against STIs
  • Side effects include mood and libido changes, breast tenderness and swelling, headaches, bloating, nausea and vomiting and breakthrough bleeding, although these are usually temporary.

Who shouldn’t use it?

Your doctor or nurse will need to ask about your own and your family’s medical history. The combined pill might not be suitable if:

  • you smoke and are 35 years old or over
  • you’re very overweight
  • you take certain medicines
  • you’re breastfeeding a baby less than 6 weeks old

The combined pill might not be suitable for you if you have ever had a blood clot known as a deep vein thrombosis in the legs or the legs, or risks factors for this, heart disease, stroke or high blood pressure. Other reasons you may not be able to take the combined pill include: migraines with aura, breast cancer or a genetic risk of breast cancer, liver disease, diabetes with complications.

Generally at the age of 50 if you are taking the combined pill you will be advised to switch to another form of contraception. This is because at this age the risks of the combined pill are thought to outweigh the benefits.

Where can I get the pill?

Contraception is free to everyone on the NHS. The pill is available in contraception clinics, sexual health clinics, GP’s surgeries and some young people’s services. You can also buy the pill through our online pharmacy service, you can read more about The Lowdown’s online order service here.

Resources:

Faculty of Sexual and Reproductive Health (FSRH)

NHS UK

Family Planning Association

This guide was brought to you by The Lowdown. We are the world’s first contraception review platform, providing real-life experiences from thousands of reviews collected from our community of men and women.

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