The two types of contraceptive pills, the combined pill and the mini pill (also known as the progestogen only pill or POP) are a popular form of contraception amongst many women.
In this blog, we give you the lowdown on the differences, side effects and our user experiences of both the contraceptive pills.
What is the difference?
Combined oral contraceptive pill: This contains artificial versions of hormones oestrogen and progesterone, which are produced naturally in the ovaries.
Progestogen only pill: This contains a synthetic progestogen hormone, similar to the natural progesterone produced by the ovaries.
POPs are different to combined pills because they don’t contain the hormone estrogen.
How do they work?
Both the combined pill and POP are a small tablet you swallow daily.
The combined pill prevents pregnancy in three ways: by stopping ovulation, making the fluid in your cervix thicker (which makes it more difficult for sperm to enter the womb) and preventing the lining of your womb thickening enough for a fertilised egg to implant and grow in it.
POP: This prevents pregnancy by making the fluid in your cervix thicker (which makes it more difficult for sperm to enter the womb), and preventing the lining of your womb thickening enough for a fertilised egg to implant and grow in it. POPs containing desogestrel can also stop ovulation.
How do you take each pill?
- You can start taking the pill at any point in your menstrual cycle if you are sure you are not pregnant
- There is special advice if you have just had a baby, miscarriage or abortion
- If you start up to an including 5th day of your period you are protected against pregnancy immediately (if you have short menstrual cycles (less than 28 days) this may not be the case so get advice)
- If you start at any other time in menstrual cycle use additional contraception such as condoms for first 7 days of pill taking
- The standard way of taking combined pill is to take a pill every day for 21 days (the length of a packet) then have a 7 day break during which you will have a bleed like a period, before starting a new pack again
- You can also take the combined pill as a tailored regimen. This may include taking the pill for 21 days and stopping for 4, taking 2 or 3 packets back to back without a break, or taking the pill continuously without a break. For more information speak to a doctor or nurse.
- You can start at any time in menstrual cycle if sure not pregnant
- If you start taking the pill during the first 5 days of your period you are protected against pregnancy immediately (if you have short menstrual cycles (less than 28 days) this may not be the case so get advice)
- If you start at any other time in your menstrual cycle use additional contraception such as condoms for the first 2 full days of pill taking
- You should continue to take the pill every day, at the same time each day, with no breaks between packs.
- For POPs containing desogestrel you need to remember to take your pill within 12 hours of your usual time, for other POPs you have a 3 hour window to remember.
What to do if you miss a pill?
You may need to use additional contraception such as condoms and consider emergency contraception depending on which pill you’re taking, how many pills you miss and where in your packet you are. Advice is different for combined pill vs POP – so you will need to visit the NHS website, check the pill packet instructions or speak to doctor/nurse. The Lowdown team are currently working on a Missed Pill Calculator that we hope to be able to share with you soon!
Side effects of the pill:
- Mood swings
- Changes to libido (sex drive)
- Enlarged Breasts and breast tenderness
- Vaginal Discharge
These are usually temporary and settle after the first few months. However if they continue or are bothering you speak to your doctor or nurse.
- Spots or acne
- Irregular bleeding or spotting
- Tender and enlarged Breasts
- Mood changes
- Changes to libido (sex drive)
- Small fluid-filled sacs (cysts) on your ovaries that are usually harmless and disappear without treatment
Generally the POP is well tolerated. Side effects are rare and likely to improve after the first few months of taking it. If they continue or are bothering you speak to your doctor or nurse.
- Usually makes your bleeds regular, lighter and less painful
- Gives you the choice not to have a monthly bleed
- May help with premenstrual symptoms
- Improves acne in some people
- May reduce menopausal symptoms
- Helps with problems associated with polycystic ovarian syndrome (PCOS)
- May reduce the risk of recurrent endometriosis after surgery
- Reduces the risk of cancer of the ovary, uterus, and colon
- May reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease
- Periods may get lighter, less frequent or stop altogether
- Useful if you can’t take oestrogen, like those found in the combined pill, contraceptive patch or contraceptive vaginal ring
- You can use it at any age, but it’s especially useful if you smoke and are 35 or over
- May help with premenstrual symptoms and painful periods
- You can use it if you’re breastfeeding
There are some serious possible side effects:
- You may get temporary side effects at first including headaches, nausea, breast tenderness and mood changes; if these don’t stop within a few months, discussing with your doctor or nurse and possibly changing the type of pill or contraception method may help
- The pill doesn’t protect you from sexually transmitted infections, so you may need to use condoms as well
- Breakthrough bleeding (unexpected vaginal bleeding on pill taking days) and spotting is common in the first few months of use.
- The pill may increase your blood pressure
- Taking the pill is associated with an increased risk of some serious health conditions, such as blood clots and breast cancer
There are no serious but some possible side effects:
- Your periods may change in a way that’s not acceptable to you (your periods may be lighter, more or less frequent, or may stop altogether, and you may get spotting between periods)
- The POP doesn’t protect you against sexually transmitted infections, so you may need to use condoms as well.
- You have to remember to take the pill at the same time every day.
- You may get some side effects when you first start taking the POP, such as spotty skin, breast tenderness and headaches. These may stop within a few months.
‘Made my skin loads better. Did take around 6-8 months for my skin to improve though. The first week of taking the pill I became so emotionally sensitive, which is unlike me. But after a week I seemed to return to normal. I am pretty prone to thrush but I found it has increased my likelihood. Other than that I would recommend this pill’ – COMBINED PILL
‘Been on it for a few years now. Highly recommend don’t have a period at all now.’ – POPCheck out more reviews and leave your own reviews here
Where can you get the the combined pill or POP from?
You will need to speak to GP or sexual health clinic before going on the pill. You will be asked questions about your medical and family history and for the combined pill you will need a recent blood pressure and weight measurement. Due to Covid-19 most consultations will be done over the phone initially and face to face appointments organised if clinically needed.
Family Planning Association
Published and last reviewed on 01/02/21 in line with our content policy.