The combined oral contraceptive pill is usually just called “the pill”. It contains artificial versions of female hormones oestrogen and progesterone, which women produce naturally in their ovaries.
A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening usually by keeping the egg and sperm apart or by stopping the release of an egg (ovulation).
At a glance: the combined pill
When taken correctly, the pill is over 99% effective at preventing pregnancy.
Other methods, such as the IUD, implant and injection, are more effective.
The usual way to take the pill is to take one every day for 21 days, then stop for seven days, and during this week you have a period-type bleed. You start taking the pill again after seven days.
You need to take the pill at around the same time every day. You could get pregnant if you don’t do this, or if you miss a pill, or vomit or have severe diarrhoea.
Some medicines may make the pill less effective. Check with your doctor if you’re taking any other tablets.
Minor side effects include mood swings, nausea, breast tenderness and headaches.
There is no evidence that the pill makes women gain weight.
There’s a very low risk of serious side effects, such as blood clots and cervical cancer.
The combined pill is not suitable for women over 35 who smoke, or women with certain medical conditions.
The pill does not protect against sexually transmitted infections (STIs), so using a condom as well will help to protect you against STIs.
There are many different brands of pill, made up of three main types:
Monophasic 21-day pills
This is the most common type. Each pill has the same amount of hormone in it. One pill is taken each day for 21 days and then no pills are taken for the next seven days. Microgynon, Marvelon, Yasmine and Cilest are examples of this type of pill.
Phasic 21-day pills
Phasic pills contain two or three sections of different coloured pills in a pack. Each section contains a different amount of hormones. One pill is taken each day for 21 days and then no pills are taken for the next seven days. Phasic pills need to be taken in the right order. Logynon is an example of this type of pill.
Every day (ED) pills
There are 21 active pills and seven inactive (dummy) pills in a pack. The two types of pill look different. One pill is taken each day for 28 days with no break between packets of pills. Every day pills need to be taken in the right order. Microgynon ED is an example of this type of pill.
Follow the instructions that come with your packet. If you have any questions, ask your GP, practice nurse or pharmacist.
It’s important to take the pills as instructed, because missing pills or taking them at the same time as certain medicines may make them less effective.
Starting the combined pill
Most women can start the pill at any time in their menstrual cycle. There is special guidance if you have just had a baby, abortion or miscarriage.
You may need to use additional contraception during your first days on the pill – this depends on when in your menstrual cycle you start taking it.
Starting on the first day of your period
If you start the combined pill on the first day of your period (day one of your menstrual cycle) you will be protected from pregnancy straight away. You will not need additional contraception.
Starting on the fifth day of your cycle or before
If you start the pill on the fifth day of your period or before, you will still be protected from pregnancy straight away, unless you have a short menstrual cycle (your period is every 23 days or less). If you have a short menstrual cycle, you will need additional contraception, such as condoms, until you have taken the pill for seven days.
Starting after the fifth day of your cycle
You will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for seven days.
If you start the pill after the fifth day of your cycle, make sure you have not put yourself at risk of pregnancy since your last period. If you’re worried you’re pregnant when you start the pill, take a pregnancy test three weeks after the last time you had unprotected sex.
What to do if you miss a pill
If you miss a pill or pills, or you start a pack late, this can make the pill less effective at preventing pregnancy. The chance of getting pregnant after missing a pill or pills depends on:
when the pills are missed
how many pills are missed
Vomiting and diarrhoea
If you vomit within two hours of taking the combined pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.
If you continue to be sick, keep using another form of contraception until you’ve taken the pill again for seven days without vomiting.
Very severe diarrhoea (six to eight watery stools in 24 hours) may also mean that the pill doesn’t work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for two days after recovering.
Speak to your GP or contraception nurse or call NHS 111 for more information, or if your sickness or diarrhoea continues.
Who can use the combined pill
If there are no medical reasons why you cannot take the pill, and you don’t smoke, you can take the pill until your menopause. However, the pill is not suitable for all women. To find out whether the pill is right for you, talk to your GP, practice nurse or pharmacist.
You should not take the pill if you:
smoke and are 35 or older
stopped smoking less than a year ago and are 35 or older
are very overweight
take certain medicines (ask your GP or a health professional at a contraception clinic about this)
You should also not take the pill if you have (or have had):
thrombosis (a blood clot) in a vein, for example in your leg or lungs
stroke or any other disease that narrows the arteries
anyone in your close family having a blood clot under the age of 45
a heart abnormality or heart disease, including high blood pressure
severe migraines, especially with aura (warning symptoms)
disease of the gallbladder or liver
diabetes with complications or diabetes for the past 20 years
After having a baby
If you have just had a baby and are not breastfeeding, you can most likely start the pill on day 21 after the birth but you will need to check with your doctor. You will be protected against pregnancy straight away.
If you start the pill later than 21 days after giving birth, you will need additional contraception (such as condoms) for the next seven days.
If you are breastfeeding, you’re not advised to take the combined pill until six weeks after the birth.
After a miscarriage or abortion
If you have had a miscarriage or abortion, you can start the pill up to five days after this and you will be protected from pregnancy straight away. If you start the pill more than five days after the miscarriage or abortion, you’ll need to use additional contraception until you have taken the pill for seven days.
The combined pill with other medicines
Some medicines interact with the combined pill and it doesn’t work properly. Some interactions are listed on this page, but it is not a complete list. If you want to check your medicines are safe to take with the combined pill, you can:
ask your GP, practice nurse or pharmacist
read the patient information leaflet that comes with your medicine
The antibiotics rifampicin and rifabutin (which can be used to treat illnesses including tuberculosis and meningitis) can reduce the effectiveness of the combined pill. Other antibiotics do not have this effect.
If you are prescribed rifampicin or rifabutin, you may need additional contraception (such as condoms) while taking the antibiotic. Speak to your doctor or nurse for advice.
Epilepsy and HIV medicines, and St John’s wort
The combined pill can interact with medicines called enzyme inducers. These speed up the breakdown of hormones by your liver, reducing the effectiveness of the pill.
Examples of enzyme inducers are:
the epilepsy drugs carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate
St John’s wort (a herbal remedy)
antiretroviral medicines used to treat HIV (research suggests that interactions between these medicines and the progestogen-only pill can affect the safety and effectiveness of both)
Your GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines.
Risks of taking the combined pill
There are some risks associated with using the combined contraceptive pill. However, these risks are small and, for most women, the benefits of the pill outweigh the risks.
The oestrogen in the pill may cause your blood to clot more readily. If a blood clot develops, it could cause:
deep vein thrombosis (clot in your leg)
pulmonary embolus (clot in your lung)
The risk of getting a blood clot is very small, but your doctor will check if you have certain risk factors that before prescribing the pill.
The pill can be taken with caution if you have one of the risk factors below. It is unlikely you would be advised to take it if you have two or more risk factors. These include:
being 35 years old or over
being a smoker or having quit smoking in the past year
being very overweight (in women with a BMI of 35 or over, the risks of using the pill usually outweigh the benefits)
having migraines (you should not take the pill if you have severe or regular migraine attacks, especially if you get aura or a warning sign before an attack)
having high blood pressure
having had a blood clot or stroke in the past
having a close relative who had a blood clot when they were younger than 45
being immobile for a long time – for example, in a wheelchair or with a leg in plaster
Research is ongoing into the link between breast cancer and the pill. Research suggests that users of all types of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with women who do not use them. However, 10 years after you stop taking the pill, your risk of breast cancer goes back to normal.
Research has also suggested a link between the pill and the risk of developing cervical cancer and a rare form of liver cancer. However, the pill does offer some protection against developing womb (endometrial) cancer, ovarian cancer and colon cancer.
Where you can get the combined pill
Contraception is free to all women and men through the NHS. Places where you can get contraception include:
community contraception clinics
some genitourinary medicine (GUM) clinics
sexual health clinics – they also offer contraceptive and STI testing services
some GP surgeries – talk to your GP or practice nurse
some young people’s services (call the Sexual Health Line on 0300 123 7123 for more information)
Find your nearest sexual health clinic.