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Combined contraceptive

The combined oral contraceptive pill is usually just called “the pill”. It contains the female hormones oestrogen and progesterone, which women produce naturally in their ovaries.
The Combined pill is over 99% effective at preventing pregnancy.

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.
If you have heavy periods or painful periods, PMS (premenstrual syndrome) or endometriosis the combined pill may help.

The pill does not protect against sexually transmitted infections (STIs), so using a condom as well will help to protect you against STIs.

How the combined pill works
1) prevents the ovaries from releasing an egg each month (ovulation).
2)thickens the mucus in the neck of the womb, so it is harder for sperm to penetrate the womb and reach an egg
3)thins the lining of the womb, so there is less chance of a fertilised egg implanting into the womb and being able to grow

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, Yasmin 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.

What to do if you miss a pill

If you continue to be sick, keep using another form of contraception until you’ve taken the pill again for seven days without vomiting.

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:

are pregnant
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)
breast cancer
disease of the gallbladder or liver
diabetes with complications or diabetes for the past 20 years

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.

Blood clots
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)
stroke
heart attack
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
Cancer
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.

Side Effects

Like all medicines, Logynon can cause side effects, although not everybody gets
them. If you get any side effect, particularly if severe and persistent, or have any
change to your health that you think may be due to Logynon, please talk to your doctor.

An increased risk of blood clots in the veins (venous thromboembolism (VTE)) or
blood clots in the arteries (arterial thromboembolism (ATE)) is present for all women

using combined hormonal contraceptives. For more detailed information on the
different risks from taking combined hormonal contraceptives please see section 2
“What you need to know before you use Logynon”.
➜ Tell your doctor, pharmacist or family planning nurse if you are worried
about any side effects which you think may be due to Logynon.
4.1 Serious side effects – see a doctor straight away
Rare side effects (between 1 and 10 in every 10,000 users may be affected)
 harmful blood clots in a vein or artery for example:
o in a leg or foot (i.e. DVT)
o in a lung (i.e. PE)
o heart attack
o stroke
o mini-stroke or temporary stroke-like symptoms, known as a transient
ischaemic attack (TIA)
o blood clots in the liver, stomach/intestine, kidneys or eye.
The chance of having a blood clot may be higher if you have any other conditions
that increase this risk (see section 2.3 for more information on the conditions that
increase risk for blood clots and the symptoms of a blood clot).
Signs of a blood clot (see section 2.3 ‘Blood clots’)
Signs of a severe allergic reaction or worsening of hereditary angioedema:
 swelling of the hands, face, lips, mouth, tongue or throat. A swollen
tongue/throat may lead to difficulty swallowing and breathing
 a red bumpy rash (hives) and itching.
Signs of breast cancer include:
 dimpling of the skin
 changes in the nipple
 any lumps you can see or feel.
Signs of cancer of the cervix include:
 vaginal discharge that smells and/or contains blood
 unusual vaginal bleeding
 pelvic pain
 painful sex.
Signs of severe liver problems include:
 severe pain in your upper abdomen
 yellow skin or eyes (jaundice)
 inflammation of the liver (hepatitis)
 your whole body starts itching.
➜ If you think you may have any of these, see a doctor straight away. You
may need to stop taking Logynon.

Further Information

Patient Information Leaflet