Healthy lives for young people
Contraception

Combined pill

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

Quick guide

How it works

The combined pill works to prevent the sperm reaching the egg and fertilising. It prevents pregnancy by interrupting this process in three ways. Read more

Pros & cons

It doesn’t interrupt sex
There is no evidence that it causes additional weight gain
It does not protect you from STIs
It can increase your blood pressure

Read more

Where to get the 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. Read more

How the combined pill works

The combined pill works to prevent the sperm reaching the egg and fertilising it. It prevents pregnancy by interrupting this process in three ways:

  • 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

Pros & cons

Pros

  • It is over 99% effective if taken correctly
  • 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

Cons

  • 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
  • Vomiting, diarrhoea and other medications can affect how the combined pill works

Where to 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.

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.

What happens at an appointment?

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

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.

INFORMATION

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

Types of combined pill and how you take them

Taking the combined pill:

  • choose the time of day that suits you best
  • 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)
  • New guidelines (2019) confirm that there is no harm in taking the pill continuously without a seven day break so speak to your doctor or nurse to see what is right for you

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

Monophasic 21-day pills
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, if you wish (see 2019 guidelines) 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, if you wish (see 2019 guidelines). 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.

Always follow the instructions that come with the packet, paying careful attention to which medicines and antibiotics might affect it.

Starting the pill and when you are protected from pregnancy

If you start taking the combined pill in the first five days of your period, you will be protected against pregnancy straight away.

If you have a short menstrual cycle, where your period is normally 23 days or less, you will need to start taking the pill in the first four days to be immediately protected (because you might ovulate early).

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 a doctor or nurse 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

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 a doctor or nurse 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 does it affect 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 a sexually transmitted infection. If you are worried, as your doctor or nurse for further advice.

Coming off 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. 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 skin problems may 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.
  • ON THIS PAGE

    Other Stuff you might find useful…

    Advice
    Remembering to take your pill
    Contraception
    Info
    Condoms (male)
    Contraception
    Info
    Emergency contraceptive pill
    Contraception
    Info
    Progestogen-only pill
    Contraception

    400+ FREE CLINICS & SERVICES ALL OVER THE UK

    Find a Service near you

    100% FREE & CONFIDENTIAL