Oral Contraceptive Pill

There are two types of oral contraception:

• One is the combined oral contraceptive pill (that also comes in a patch or a ring), this has 2 hormones in it (oestrogen and progesterone) and works by suppressing ovulation (stops an egg being released).
• The other is a progestogen only pill, the most common one used is desogestrel (commonly known as cerazette) this also works by suppressing ovulation, there are also other progestogen only pills called ‘mini pills’.
• The ‘mini pills’ work by changing the environment in the vagina to make it hostile to sperm, so need to be taken at the exact time (give or take 3 hours) for them to work effectively.

If pills are taken correctly they are more than 99% effective (that means only 1 in 100 people would get pregnant using them), but the issue is they are reliant on being taken at the correct time, and that you have not been unwell with any diarrhoea or vomiting or on any medication that may affect how quickly the drugs are broken down.

More effective methods of contraception are the LARCs (long-acting methods of contraception) such as the coil, implant and contraceptive injections these have a 1 in 200 risk of pregnancy.

If you do forget to take your pill or are unwell with diarrhoea and vomiting and then have sex, you may need emergency contraception.

Risks with taking the pill

There are some risks associated with taking the combined oral contraceptive pill that may prevent us from being able to give it to you.The pill increases your risk of blood clots and breast cancer.

If you are very overweight with a BMI of >35; suffer with high blood pressure; suffer with migraines particular those where you have an aura (warning) before hand; are a smoker >35years old; have a strong family history of breast cancer or blood clots; are over 50 years of age we would offer you the progesterone only pill as it does not carry these risks.

If you are on medication for epilepsy or infections like TB these may interfere with your pill so please check with your GP if you start any new medication. Also St John’s Wort a herbal treatment for depression can affect how well the pill works.

Side effects from the pill

Often patients can get side effects from the pill, if you find that the pill affects your mood, weight, skin or you feel sick and have breast tenderness please let us know. Frequently the side effects settle but if not there are lots of different pills we can try to see which suits you best.

Sometimes people can get irregular bleeding with the pill, particularly the progesterone only, again please contact the surgery to discuss this if it is an issue.

For more information on the pills please click here  there is further information available here

How to get started on the pill

If you are interested in starting the contraceptive pill please contact the surgery for a consultation. Once you are happy on it we can put it on repeat prescription for you, but you will need an annual BP and weight check and to complete our online form to ensure your medical history has not changed and it is safe for you to use it still.

New guidance came out in 2019 advising there are 'New ways to take the pill' for further information please listen to this podcast or read the information below:

New Ways To Take Your Combined Pill

If you take the Combined Contraceptive Pill you may have been told to take a 7 day break after every packet or 21 tablets. We are now advising different ways to take your pill that may reduce your chances of getting pregnant and make you periods easier to manage or plan around.

The 7-day Break and Its Problems

The 7-day break was invented when the contraceptive pill was created as they thought that women would want to have a bleed every month. The bleed you get when you stop the pill is not a “real period”: it is just a withdrawal from the hormones in the pill and it is not necessary. The pill stops you getting pregnant partly by stopping your body ovulating (popping out an egg). If you take a 7-day break your body starts getting ready to pop out an egg. If you accidentally have an 8 day break you have a high change of ovulating and could therefore get pregnant. To put it another way, a 7 day break gives you very little room for error with remembering to start your new packet. There are 3 ways you could take your pill that help reduce this problem.

1. The 4 Day Break You can take a shorter gap: for example 4 days instead of 7. This means you are very unlikely to ovulate: even if you accidentally take a 5 or 6 day break (just as long as it is not longer than 7 days). So you would take: 21 days of pill perhaps taking your last pill on a Monday. You would then start the next packet after 4 days without a pill – on Saturday. After another 21 days, you would do the same thing. You might want to use an app or phone reminder to help you remember.
2. Tricycling Doctors have been recommending this for many years especially for patients who have heavy or painful periods. It’s called tricycling because you take 3 packs of pills one after each other without a break. Then take a break – again we would recommend a shorter break like 4 days to keep the risk of pregnancy low.
3. Continuous Pill Taking In this method, you keep taking your pill, without any breaks. If you get some bleeding with this method you have 2 options:

• Just keep taking the pill every day and it may well stop.
• If the bleeding bothers you, you can take 4 day break and then start again.

If you do choose to take a break you need to remember: You must have taken 7 pills in a row before any break and your break can not be longer than 7 days. (This rule is actually true for all the new methods of taking the combined contraceptive pill. This is because the pill takes 7 days to get in control of your hormones and prevent pregnancy. If you take more than 7 days off the pill, you are at risk of pregnancy again and need 7 days of perfect pill taking before you are protected again.)

A few more details you should know: This leaflet is all about Combined Contraceptive pills. This means pills that have 2 ingredients: an oestrogen (called ethinylestradiol) and a progesterone (which has different names depending on the brand). If your pill is a “Progesterone only” you should be taking your pill every day

Please contact a pharmacist or the surgery as soon as possible if you think you might need the morning after pill. Everyone who is taking the combined pill should have their blood pressure checked each year and have a chat with a nurse or doctor to check it is still the right, safest method for you or submit our online questionnaire.

The information on this page was up-to-date when it was written in June 2020 (reviewed Oct 2022) and is based on current advice from the WHO, FSRH and this paper: MacGregor EA, Guillebaud J The 7-day contraceptive hormone-free interval should be consigned to history . BMJ Sex Reprod Health 2018; 44: 214-220.

If after reading this you have any questions regarding the oral pill please contact us online