How does the combined pill work?
The combined pill is a pill you take daily for either 21 or 24 days. It contains hormones oestrogen and progestogen which mimic natural hormones produced by the ovaries. The pill stops the ovaries from releasing an egg each month. It also thickens the mucus in the cervix so sperm can’t get to the egg to fertilise it and thins the lining of the womb making it difficult for a fertilised egg to implant there.
The pill is over 99% effective when taken correctly, however typical use reduces the effectiveness of the pill. In typical use people might forget to take a pill or take the wrong one. Around 9 in 100 pill users a year will become pregnant 1.
Taking the combined pill
There are different types of combined pill which can be taken for different lengths of time before you have a short break for a withdrawal bleed. You can read more about these in the next section.
If you start taking the pill on the first day of your period, you will be protected from pregnancy straight away. If you start taking the pill on the 5th day of your period, or any day before, you will also be protected from pregnancy immediately. If you start taking the pill after the 5th day of your period, you’ll need to use condoms for 7 days and then you will be protected from pregnancy.
Types of combined pill
There are 3 types of combined pill: monophasic, every day and phasic.
Monophasic – a type of pill that comes with 21 pills to a pack, with each pill containing the same amount of hormone. You can take them for 21 days and then have a 7-day break before starting the next pack. You take your next pill on the 8th day. You will likely have a withdrawal bleed during this time. It’s ok to start your next pack if you’re still bleeding on the 8th day.
Every day - with this type you will take one pill every day for 28 days. There are 2 kinds of this pill. One has 21 pills with hormone in and 7 placebo pills that don’t have hormone in them. The other has 24 pills with active hormone and 4 placebo pills.
There are alternative ways you can take monophasic/everyday pills. For example you could have a shorter pill-free (or hormone free) interval or miss out the pill-free (or hormone free) break altogether. You can read about these on the Sexwise combined pill information page or speak to your doctor to find out more.
Phasic - this type of pill also comes in packs of 21 however, they contain varying amounts of hormone. It’s important you take them in order – the packets are colour coded to make it easier. After you’ve taken them all you have a 7-day break. Start your next packet on the 8th day, even if you’re still bleeding.
Common combined pill brands
There are a few different combined pill brands for each type of combined pill. The brands differ in that they can have different quantities of hormones. For example, there are low dose oestrogen containing combined pills. People’s bodies respond to these differently and some people may need to try different types to find what suits them best.
Common combined pill brand names by type:
Monophasic – Microgynon, Rigevidon, Yasmin, Marvelon, Ovranette, Gedarel , Milinette, Mercilon, Brevinor, Cilique, Katya
Every day - MicrogynonED, Eloine
Phasic - Logynon
Things to consider when taking the combined pill
- The pill doesn’t prevent you from getting sexually transmitted infections (STIs) so, you may want to use condoms too.
- If you’re sick (vomit) within 3 hours of taking your pill or have severe diarrhoea that lasts more than 24 hours, the pill might not have been absorbed properly. Take another pill. If you continue to vomit you should use condoms until you’ve had 7 days without being sick.
- You will need to have a consultation before being prescribed the combined contraceptive pill to ensure it’s medically suitable for you. This can be done by your GP, at a sexual health service or through the SHL.UK website.
- If you’re over 35 and smoke (or gave up within the last year) the combined pill might not be suitable for you.
- The pill may also not be suitable for you if you are very overweight or have had (or currently have) certain other health conditions. During your consultation give as much information as possible about your health and any medications you take.
- Your fertility will return to whatever is normal for you once you stop taking the pill.
Benefits of using the combined contraceptive pill
- It often makes periods, lighter, more regular, and less painful.
- It can help people who suffer from conditions like endometriosis and fibroids.
- The pill reduces acne (spotty skin) and premenstrual symptoms.
- Using the pill can enable you to regulate your cycle/bleeding pattern. This can be helpful for people with irregular periods such as those with polycystic ovarian syndrome.
- It may reduce the risk of cancer of the ovary, uterus and colon.
- Taking the combined pill can protect you against fibroids and ovarian cysts.
- It may reduce menopausal symptoms.
- You can control when you get your period. Talk to your healthcare professional for more information.
Potential combined pill side effects
Some people might experience problems with the combined pill, these can include:
- Breast tenderness, headaches, nausea and mood swings. These side effects usually stop within a few months.
- Some people’s blood pressure can be increased by the pill.
- A small increased risk of developing blood clots when using the combined pill. Your consultation will assess any risk factors related to this.
- You may have unexpected ‘breakthrough’ bleeding in the first few months of using the pill.
- A small increased risk of breast and cervical cancers among hormonal contraception users compared to people who don’t use hormonal contraception. This reduces after stopping the pill.
Missing a pill
If you miss a pill, or start your new pack a day late, you will still be protected against pregnancy. You should take another straight away, even if that means taking 2 in a single day. You won’t need to use condoms.
If you’ve missed 2 pills or it’s been 48 hours since you were due to start your new pack, take the last pill you missed now, even if means taking 2 in a single day. Carry on taking your pill as normal but use condoms or avoid sex for 7 days. If you don’t use condoms or avoid sex you may need to use emergency contraception.
If your missed pills were in the last 7 days of your pack, you can run your packs back to back (without having a pill-free break). You don’t need to use condoms or avoid sex.
If you’ve had unprotected sex recently and have missed pills from the first 7 days of your pack you may need emergency contraception
If you’re not sure what to do, keep taking your pill, use condoms or avoid sex and phone your doctor or sexual health clinic for further advice.
Can I take the combined pill for acne?
Taking the combined pill can improve acne, however it can be a few months before you see an improvement 2.
Coming off the combined pill
If you are planning to come off the pill it’s best to do so when you finish a pack. If you’re not planning to get pregnant you should speak to a healthcare professional before you stop taking the pill to decide on your next contraceptive option.
Where can I get the combined pill free?
You can get the combined contraceptive pill for free at NHS sexual health clinics, contraception clinics, GP surgeries and some young people’s services.
If you live in an eligible borough, you can take a consultation and order the combined pill online for free from SHL.UK. It will be delivered to you by post or will be made available for collection at a local LloydsPharmacy branch within an hour of your prescription being approved. Register or Login to see if the service is available to you.
Other contraception options
If the combined pill is not right for you, you might be interested in long-acting reversible contraception which is more effective and protects against pregnancy for longer. These methods include the intrauterine device, the intrauterine system, the contraceptive implant or the contraceptive injection.
There are also other contraceptives available that offer a bit more flexibility including the progestogen-only (mini) pill, the contraceptive patch and the vaginal contraceptive ring.
Reviewed by our clinical team: December 2020 (next review date: April 2022)
1. Source: Sexwise Combined pill (COC) - Contraception - Sexwise
2. Source: NHS Combined pill - NHS (www.nhs.uk)