Combined Contraceptive Pills

The combined pill offers several benefits, including:

• Reduced acne: The hormones in the pill can help reduce acne.
• Reduced risk of certain cancers: It can lower the risk of ovarian, uterine, and colon cancers, as well as fibroids, ovarian cysts, and non-cancerous breast disease.
• High effectiveness: When taken correctly, it is over 99% effective at preventing pregnancy.
• Help with heavy and painful periods: It can alleviate premenstrual symptoms and make periods lighter and less painful.

Possible side effects include:

• Temporary side effects: In the first few months, you may experience headaches, nausea, breast tenderness, mood swings, or breakthrough bleeding. These usually subside over time.
• Increased blood pressure: The pill can increase blood pressure, which is why it is monitored before you start and annually thereafter.
• Breasts: Hormones in the pill can cause temporary breast tenderness, but there is no evidence that it will permanently increase your breast size.
• Weight: There is no evidence that the combined pill causes weight gain, though some women may experience increased appetite or fluid retention.
• Small increased risk of VTE: There is a slightly increased risk of blood clots (Venous Thromboembolism or VTE), especially when you first start taking the pill. This risk stabilizes over time, which is why stopping and restarting the method is not advised.
• Small increased risk of breast cancer: The risk of breast cancer is slightly increased while on the pill but returns to a baseline risk after stopping.

While the combined pill is safe for most women, it may not be suitable for those with a history of:

• Blood clotting, stroke, heart disease, or atrial fibrillation.
• Migraines (especially with aura).
• Breast cancer.
• Thrombogenic mutations or a family history of VTE under age 45.

Additionally, it may not be suitable for those with:

• Uncontrolled high blood pressure.
• Acute liver disease.
• A BMI of 35 or over.
• Aged 35 or over and who smoke.
• Multiple risk factors for cardiovascular disease.
• Those taking medications for Epilepsy, HIV, or Tuberculosis.
• Anyone undergoing major surgery with prolonged immobilization.

The effectiveness of the combined pill can be reduced by:

• Missing a pill: Missing one pill is usually fine, but missing two or more, especially in the first week, can increase the risk of pregnancy.
• Vomiting: Vomiting within 2-3 hours of taking a pill means it may not have been absorbed.
• Serious diarrhoea: A day of serious diarrhoea can make the pill less effective.
• Certain medications: Medications for epilepsy, tuberculosis, HIV, and some over-the-counter herbal remedies (like St. John's Wort) can reduce the pill's effectiveness.
• Common antibiotics: These do not routinely affect the pill, but if they cause vomiting or diarrhoea, this can impact its effectiveness.

There is no specific correct time to take the combined pill. You can find a time that works best for your daily routine, such as with breakfast, at bedtime, or with a daily phone alarm. If the pill causes nausea, taking it at night may help.

The best time to start the pill is during the first five days of your period, as this provides immediate protection. If you start at any other time in your cycle, it will take seven days for the pill to become effective. If you are switching from another contraceptive, it is advisable to continue using that method, use condoms, or abstain from sex for the first 7 days.

When you take the combined pill, you stop releasing an egg and the lining of the womb doesn’t build up as much. During your week off the pill, the body has a withdrawal bleed due to the drop in hormones. This is typically shorter, lighter, and less painful than a regular period. Alternatively, you can take the pill continuously to skip the withdrawal bleed entirely.

To stop the combined pill without risking pregnancy, the safest way is to switch to another contraceptive method and continue taking the combined pill for the first 7 days of the new method. If you are planning to become pregnant, you can finish your current packet, have your bleed, and then not start a new packet. Stopping the pill in the first 7 days after your bleed could result in a pregnancy if you have unprotected sex.

Fertility can return after the first pill-free week when your body can release an egg again. For some women, it may take a few months for their regular periods and hormonal balance to return to normal.

You should wait at least four weeks after delivery before starting the combined pill. It's important to note that the risk of VTE is much higher after giving birth, and this will be discussed with you before the pills are dispensed.

Yes. If the pregnancy was under 20 weeks, you can start the pill immediately. If the pregnancy was over 20 weeks, you should wait until day 21 of your cycle or when your usual cycle starts to begin taking the pill.

If your child was born early, small for their gestational age, or growth-retarded, you may want to consider another method of contraception. There is some evidence that the hormones from the pill can pass to the child and may affect milk production and supply.