×

Got a question?

Use the Ask Brook 24/7 tool to answer your query or search FAQs

Find a service

Search for your nearest Brook sexual health service here

Combined pill

Often just called ‘the pill’, the combined pill is a type of female contraception that prevents pregnancy. It gets its name because it contains a combination of two hormones similar to those produced naturally by the body; progestogen and oestrogen.

Here are some key facts:

  • It is over 99% effective if taken correctly
  • It can help if your periods are heavy or painful
  • It can help premenstrual symptoms (PMS)
  • It can help with acne
  • There are three different types and many different brands
  • With each type or brand you usually experience a monthly ‘withdrawal bleed’
  • Vomiting, diarrhoea and other medications can affect how the combined pill works
  • It can cause side effects at first
  • It does not sexually transmitted infections (STIs) so use a condoms as well 
  • There is another type of pill called the progestogen-only pill or POP

This page should tell you everything you need to know about the combined pill but if you have more questions, you can take a look at our Ask Brook 24/7 tool.

Finally, if you are taking the combined pill Qlaira some of the information below will not apply to you. If you use this pill you should contact the doctor or nurse who prescribed it if you are not sure how to take it, or download the manufacturers leaflet

How does the combined pill work?

Pregnancy happens when sperm reaches an egg and fertilises it. The combined pill works in three ways to interrupt this process:

  • It stops eggs being released from the ovaries (ovulation)
  • It makes it harder for the sperm to reach the egg
  • It makes the uterus (or womb) lining thinner so a fertilised egg cannot implant

If it’s taken correctly, the combined pill is over 99% effective at preventing pregnancy. This means that less than one woman in 100 will get pregnant in a year.

 

How do I get the combined pill?

The combined pill is available free of charge from a range of services including contraceptive clinics, your GP and Brook. Find your nearest one using our find a service tool.

When you go to get the combined pill, an appointment will typically include:

  • A few questions about your medical and family history, to work out what would suit you best
  • You'll discuss other medicines you are taking in case they make the combined pill less effective
  • The doctor or nurse will take your blood pressure and weigh you

You will not be required to have an internal or breast examination for the combined pill.

When you first start the combined pill you will usually be given a three month supply. Follow up appointments and reviews are then usually every 6-12 months providing there are no issues. You can return to the clinic at any time if you are worried about anything.

Contraception and sexual health services such as Brook are free and confidential, including for people under the age of 16. Health professionals work to strict guidelines and won’t tell anyone else about your visit unless they believe you're at serious risk of immediate harm. Find out more about Brook’s confidentiality policy

Types of combined pill and how you take them

When you first take the pill, choose the time of day that suits you best, then take it at the same time every day until you finish the packet. This is helpful for remembering and getting into the habit of taking it.

Although there are many different brands of pill, there are three main types:

Monophasic 21-day pills are the most common type of pill. Each pill has the same amount of hormone in it, and you take one pill every day for 21 days, and then have a seven day break before starting the next pack of pills. Microgynon, Brevinor and Cilest are examples of this type of pill.

Phasic 21-day pills contain two or three sections of different coloured pills in a pack, each of these sections contacts a different amount of hormones and you take one pill every day for 21 days, and then have a seven day break before starting the next pack. It is really important that you take phasic pills in the right order. Binovum and Logynon are examples of this type of pill.

Every day (ED) pills contain 21 active pills, and seven placebo (dummy) pills so you take 28 pills in total with no break. The two types of pill look different, and it is really important that they are taken in the right order. Microgynon ED and Logynon ED are examples of this type of pill.

The pills prescribed by Brook or your GP may vary. Whatever type of combined pill you are taking, follow the instructions that come with the packet, paying careful attention to which medicines and antibiotics might affect it. 

You can also ask whoever prescribed it to you for more information. 

Advantages of the combined pill

  • It doesn't interrupt sex
  • There is no evidence that it causes additional weight gain
  • There are no long term effects to your fertility
  • It can help make your periods lighter, more regular, and reduce period pains
  • It may also help to reduce premenstrual symptoms (PMS)
  • Certain brands can improve acne
  • The pill can also have additional health benefits, such as reducing the risk of cancer of the ovaries, womb and colon

Disadvantages of the combined pill

Any medication can have some side effects or disadvantages but for most women the benefits will outweigh the possible risks. Things to watch out for include:

  • Temporary side effects during the first few months, like headaches, nausea, breast tenderness and mood swings
  • It can increase your blood pressure
  • It does not protect you from STIs
  • Breakthrough bleeding and spotting (this means bleeding outside of the seven day break) is common when you first start taking it

A very small number of women may develop complications, but discussing you and your family’s medical history with the doctor or nurse will help reduce the risk of negative side effects.

Starting the pill and when you are protected from pregnancy

If you start taking the combined pill at the beginning of your period (day one) you will be protected against pregnancy straight away. You can also start the pill up to, and including, the fifth day of your period and you will be protected from pregnancy immediately.

If you have a short menstrual cycle, where your period normally comes every 23 days or less, starting the pill as late as the fifth day of your period may mean you are not immediately protected (because you might ovulate early in your menstrual cycle).

If you think this might be the case, speak with a doctor or nurse about whether you need to use additional contraception, such as condoms, for the first seven days.

If you start the pill at any other time in your menstrual cycle you will need to use additional contraception, such as condoms, for the first seven pill taking days.

This information does not apply to the combined pill Qlaira. If you use this pill you should contact the doctor or nurse who prescribed it if you are not sure how to take it or read the manufacturer’s instructions.

Missed pill information

One pill missed:

If you have missed one pill, or if you have started the new pack one day late:

  • Take the last pill you missed, now
  • Continue taking the rest of the pack as usual
  • Emergency contraception is not usually required but may need to be considered if pills have been missed earlier in the pack or in the last week of the previous pack

Two or more pills missed:

If you have missed two or more pills or if you have started the new pack two or more days late:

  • Take the last pill you missed, now
  • Continue taking the rest of the pack as usual
  • Leave any earlier missed pills
  • Use an additional method of contraception for the next seven days
  • If you have had unprotected sex in the previous seven days, you may need emergency contraception. Find out more about how to get emergency contraception

If seven or more pills are left in the pack after the missed pill:

  • Finish the pack
  • Have the usual seven day break or take the placebo tablets

If fewer than seven pills are left in the pack after the missed pill:

  • Finish the pack and begin a new one the next day (this means missing out the break or not taking the placebo tablets)

Please note if you have missed a pill and need to take two, this is not the same as taking emergency contraception. If you have missed a pill and are worried talk to a nurse of doctor.

This information does not apply to the combined pill Qlaira. If you use this pill you should contact the doctor or nurse who prescribed it if you are not sure how to take it or read the manufacturer’s instructions.

What can make the combined pill less effective?

  • Taking it more than 24 hours late
  • Vomiting within two hours of taking it
  • Very severe diarrhoea that lasts for more than 24 hours
  • Some medicines can reduce the effectiveness of the combined pill, such as those used to treat epilepsy, HIV and TB and the complementary medicine St John's Wort. Antibiotics used to treat STIs and antidepressants can also have an effect. Commonly used antibiotics do not reduce the effectiveness of the pill, but it is always best to check with the doctor, nurse or pharmacist first

If you are given medication by a doctor or a nurse always say that you are taking the combined pill. Sometimes different medication can interact.  

How will it affect my periods?

During your pill-free week, or when you are taking the placebo (dummy) pills you may get a bleed. This isn’t a proper period, but is called a ‘withdrawal bleed’ (which doesn’t always happen) and is caused by you not taking hormones in the pill-free week.

This can happen at any point during this pill-free week, and you should start your next pack on time whether or not you are still bleeding.

When you first start taking the combined pill, bleeding is very common, and can take up to three months to settle down, this isn’t usually anything to worry about. Bleeding can also be caused by not taking the pill correctly, or by a sexually transmitted infection. If you are worried, as your doctor or nurse for further advice. 

Taking pills back to back

Some people do this when they want to put off bleeding, for example if they are going on holiday or want to have sex. Some people find it easier to remember to take the pill by missing the pill free interval. You can ask your doctor or nurse for further advice.

When taking pills back to back you sometimes still get some bleeding. If you are concerned please ask your doctor or nurse.

Coming off the pill

Maybe you want to get pregnant or prehaps you’d like to use a form of long acting reversible contraception (LARC) that doesn’t involve taking a tablet every day. Here's what happens when you stop taking the pill. 

How quickly it leaves your system: the hormones from the pill will usually leave your body within a couple of days - no matter how long you have been taking the pill for.

How quickly you can get pregnant: this will vary, and will depend on when ovulation (releasing an egg) starts up again. For some people, it may be a matter of days or weeks, for others it may take up to three months. But generally speaking, fertility levels should return quite rapidly, so use condoms or another method if you don’t want to get pregnant.

What happens to your periods: if you find you have irregular periods after stopping taking the pill and are worried, or if it's taking a long time for your periods to start again, you can ask your doctor or nurse for advice.

What physical changes there might be: everyone reacts slightly differently to coming off the pill. For example, some people are prescribed the pill in order to control acne, so stopping it may cause skin problems to become more severe, although as your hormone levels self-regulate over the course of a few weeks or months, symptoms may subside once again. If symptoms persist or worsen please see your doctor or nurse for help and advice. 

If you stop taking the pill but don't want to become pregnant remember to use another method of contraception. Condoms will also protect againt STIs.

Taking the pill after having a baby

You can start taking the combined pill 21 days after you have given birth. If you start taking the combined pill on day 21, you will be protected against pregnancy. If you start after this point you will need to use a barrier method of contraception (such as condoms) for seven days.

If your baby is under six months old and you are breastfeeding, it is usually recommended that you use a different method of contraception as the combined pill can reduce your flow of milk.

Taking the pill after having an abortion or miscarriage

You can start taking the combined pill up to five days after a miscarriage or abortion and you will be protected from pregnancy immediately. If you start the pill more than five days after the miscarriage or abortion, you'll need to a barrier method of contraception, such as condoms for seven days.

Reviewed: August 2017
Next review: August 2019