What is the combined pill?
The combined pill is usually just called “the pill”. It contains two female hormones; oestrogen and progestogen. There are many different types of combined pill.
How does the pill work?
- It stops the ovaries from producing an egg (ovulation) every month.
- It thickens the mucus in your cervix, which will stop sperm reaching your egg.
- It thins the lining of the womb
How effective is the pill?
The effectiveness of the pill depends on the woman taking it. At best it is over 99% effective (when no pills are missed). However, failure rates can be much higher (9-15%) if you do not remember to take the pill properly.
About 3 women in 1,000 using the pill correctly will become pregnant each year. Correct use means not missing any pills, re-starting the pill on time after the pill-free week and taking extra contraceptive precautions when necessary
Why would I choose the pill?
- It is very effective.
- It does not interfere with sex.
- Periods are regular and may be less painful and lighter.
- It relieves premenstrual tension for some women.
- It improves acne in some women.
- It reduces the risk of developing cancers of the ovary, colon and womb (uterus). The protection against cancer of the ovary is quite marked and seems to continue for many years after stopping the pill. It may also reduce the risk of developing certain types of cyst in the ovary.
- It may also reduce the risk of pelvic infection (as the thicker mucus prevents germs (bacteria), as well as sperm, from getting into the womb).
- It may help to protect against some non-cancerous (benign) breast disease.
Advantages of the pill
- It usually makes periods lighter, shorter and less painful. • It may improve acne in some women.
- It reduces the risk of cancer of the ovary, uterus and colon. • It may reduce menopausal symptoms.
- It may help with premenstrual symptoms.
- It may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease.
- It doesn’t interfere with sex.
Disadvantages of the pill
- You may get some temporary side effects such as headaches, nausea, breast tenderness and mood changes, If these do not improve speak to your gynaecologist about them.
- It may increase your blood pressure.
- Breakthrough bleeding or spotting is common in the first few months.
How do I take the pill?
- You can start the pill anytime in your menstrual cycle if you are sure you are not pregnant.
- If you start on the first day of your period, you are protected from pregnancy straightaway.
- If you start your pill at any other time you will need to use condoms for the first 7 days
Does the pill protect me from sexually transmitted infections (STIs)?
No, the pill only protects you from pregnancy. To avoid STIs including chlamydia, gonorrhea & HIV, it is important to use condoms as well.
Are there any risks in taking the pill?
People taking the pill have a small increased risk of developing a blood clot (thrombosis). Blood clots can cause blockages in veins (causing deep vein thrombosis or pulmonary embolism) or in arteries (which can cause heart attacks or strokes). This is more so in the first year of taking the pill. This is why people with a higher risk of blood clots cannot take the pill. The things that might mean you are at a higher risk are listed in the section ‘Who cannot take the pill?’, below. The risk of a blood clot from taking the pill is considerably smaller than the risk of a blood clot if you were pregnant.
Taking the pill can increase the risk of some types of cancer but also protect against other types. Research into the risk of breast cancer in people taking the pill is complicated and the results are not straightforward. Some studies suggest a possible link between the pill and a slightly increased risk of cancer of the neck of the womb (cervix) if the pill is taken for more than eight years. Some research suggests a link between using the pill and developing a rare liver cancer.
However, there is a reduced risk of developing cancer of the ovary, womb (uterus) and colon in people taking the pill. When all cancers are grouped together, the overall risk of developing a cancer is reduced if you take the pill. Further research is ongoing.
Side effects when taking the pill
Most women who take the pill do not develop any side effects. However, a small number of women feel sick, have headaches or find their breasts are sore when they take the pill. These usually go away within days or weeks of starting the pill. If they continue (persist) there are many different brands of pill you can try, which may suit you better.
Other side-effects are uncommon and include tiredness, change in sex drive, skin changes and mood changes. These are unusual and you should tell your doctor if you have any lasting side-effects. Many people believe that taking the pill makes you put on weight; however, this has never been proven in studies.
The pill sometimes causes a rise in blood pressure, so people taking it should have their blood pressure checked every six months. The pill may need to be stopped if your blood pressure becomes too high.
It is common to have some light bleeding between periods when you start the pill. This is nothing to worry about. It usually settles by the end of the third packet. If it does not, you should tell your doctor.
You should see a doctor straightaway if you have any of the following:
- Severe chest pains, breathlessness or coughing up blood
- Painful swelling in the leg
- Severe migraine
- Sudden weakness or numbness in an arm or leg
- Sudden problems with speech or eyesight
- Jaundice (yellowing of skin or eyes)
- Fainting attack
Who cannot take the pill?
Most women can take the pill. If you are healthy, not overweight, do not smoke and have no medical reasons for you not to take the pill, you can take it until your menopause. Women using the pill will need to change to another method of contraception at the age of 50 years. Your gynaecologist will discuss any current and past diseases that you have had. Some diseases cause an increased risk or other problems with taking the pill. Therefore, the pill will not be prescribed to some women with certain diseases – for example, hepatitis or breast cancer, or if you are taking certain medicines.
Will other medicines affect my pill?
Always check with your clinician as some medication can reduce the effectiveness of the pill, including some over the counter medicines like St John’s Wort.
What should I do if I am sick or have diarrhea?
If you vomit within 3 hours of taking a pill it will not be absorbed and you should take another one. If you have severe sickness and diarrhoea and cannot take your pill then start taking the pill again when you feel well enough but you will need to use condoms for the next 7 days.
Dr Efterpi Tingi
Consultant Obstetrician and Gynaecologist
