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Combined Pill

The combined pill releases oestrogen and progesterone into the bloodstream. This prevents ovulation, thickens the cervical mucus and thins the uterine lining. These three things prevent sperm fertilising an egg.

The combined pill is a small tablet containing two of the female hormones, that is usually taken once a day for 21 days and then stopped for 7 days. This method can also be used continuously to stop bleeding.

Schedule

One tablet daily for 21 days, then 7 days off for the ‘withdrawal bleed’)

(Alternatively, you can use the combined pill every day)

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Effectiveness

Over 99% effective when taken correctly

Cost of method

£30 (for 3 months supply)

Contraceptive pills, patches and the morning after pill are offered after a telephone call with a Specialist Nurse. If you would like to see a clinician in person, then the consultation fee applies.

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Same day appointments

In Birmingham Clinic

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Highly confidential service

And discreetly located clinics

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Specialists in sexual health

From busy NHS clinics

What are the benefits of the combined pill?

Reduce acne
The combined pill can sometimes reduce acne due to the action of the hormones. However, skin changes can be a temporary side effect and should settle after 3 months.

Reduces risk of…
The combined pill can reduce the risk of ovarian, uterine, colon cancers, fibroids, ovarian cysts and non-cancerous breast disease. 

Effectiveness
If taken correctly it can be up-to 99% effective.

Helps heavy & painful periods
It may help with premenstrual symptoms and painful periods.

What are possible side effects of the combined pill?

Temporary side effects
These can include: headaches, nausea, breast tenderness and mood swings. If these symptoms do not subside within the first few months, we may recommend changing to a different method. Skin changes can be a temporary side effect and should settle after 3 months.

Additionally, there may be breakthrough bleeding and spotting in the first few months.

Increase blood pressure
Taking the combined pill can increase your blood pressure. As such, we will check your blood pressure before you start the pill and then once annually.

Breasts
Oestrogen and progesterone can give you breast tenderness but does not automatically make them larger.

Weight
There is no evidence that the combined pill can make you put on weight. However, hormones affect women in different ways and some can see an increase in appetite or fluid retention.

Small increased risk of VTE
The combined pill has an increased risk in the development of blood clots in the legs and/or lungs (also known as Venous Thromboembolism or VTE).

This risk is highest when first starting the combined pill. However, this risk subsides and remains stable throughout the use of the method.

This means stopping and then restarting the method is therefore discouraged as once the risk settles, it is safe to continue with the method – so long as there is no change in your medical/family history.

Small increased risk of breast cancer
This risk is increased slightly when on the combined pill. However, this goes back to a baseline risk after stopping the combined pill.

Can anyone use the combined pill?

The combined pill is safe for the majority of women. However, those with a history of the following may not be best suited for the combined pill:

  • History of blood clotting
  • History of migraines (and specifically migraine with aura)
  • History of breast cancer
  • History of stroke, heart disease or atrial fibrillation
  • History of thrombogenic mutations
  • Family history of VTE when aged 45 or under

Furthermore, those with the following may also not be suitable:

  • Uncontrolled/high blood pressure (hypertension)
  • Acute liver disease or infection
  • BMI of 35 and over
  • Aged 35 or over & smoke
  • Multiple risk factors for cardiovascular disease (i.e. smoking, hypertension, diabetes, obesity)
  • On medications for Epilepsy, HIV & Tuberculosis
  • Undergoing major surgery with prolonged immobilization

What can reduce the effectiveness of the combined pill?

Missing a pill
If you miss one pill, please take it as soon as you remember and you should still be protected against pregnancy. You do not need any emergency contraception.

If you miss two or more pills in the first week this can allow enough time for the ovaries to release an egg. If you have unprotected sex in this time, you may be at risk of pregnancy and emergency contraception may be recommended.

If you wish to resume taking the combined pill, it will take 7 days for the pill to start working again.

If you miss two or more pills in the second or third week, please continue to take your pills as normal and omit the pill free week. You do not need emergency contraception but will need to abstain for sex (or use condoms) until 7 consecutive pills have been taken.

Vomiting 2-3 hours after taking the pill
Vomiting within 2-3 hours of taking a pill means it has not had enough time in your body to be effective, so this is classed as a missed pill. If this happens more than once in a cycle see the missed pill rules on patient information leaflet.

Serious diarrhoea
A day of serious diarrhoea may make the combined pill less effective. In such circumstances, use an additional method of contraception for 7 days and any unprotected sex may mean that emergency contraception is required.

Use of certain medications
Medications used to treat epilepsy, tuberculosis and HIV can make the pills less effective. This will be discussed with you when offering you the medications.

Furthermore, some over-the-counter medications (e.g. St John’s Wort) can also make the pill less effective.

Common antibiotics
These do not routinely affect the pill. However, if the antibiotics give you diarrhoea/vomiting, then this may affect the effectiveness of the pill (as discussed above).

When should I take the combined pill?

There is no correct time to take the combined pill. Using trial and error, you can find a time that suits you best.

This can be with other medications, with breakfast, at bedtime or with a phone alarm. Some side effects can be eased by changing the pill taking time, for example taking the pill at night if it causes nausea in the morning.

There is no correct time to take the combined pill. Using trial and error, you can find a time that suits you best.

This can be with other medications, with breakfast, at bedtime or with a phone alarm. Some side effects can be eased by changing the pill taking time, for example taking the pill at night if it causes nausea in the morning.

When should I start the combined pill?

The best time to start the pill is in the first five days of the period. This will allow the combined pill to take effect immediately

If you start the pill at another time in the cycle, it can take seven days for the pill to suppress ovulation and for the method to become effective. If you are swapping to the pill from another form of contraception, it is advisable to continue that method for 7 days, use condoms or abstain from sex.

Will I still have a period?

Taking a combined method of contraception stops you from releasing an egg and thus stops the formation of the lining of the womb. When you take a week off the pill, the body has a withdrawal bleed of the two hormones – this is usually short, light and less painful than a regular period.

Alternatively, you can take the combined pill daily and skip the withdrawal bleed.

How do I stop using the combined pill?

The safest way to stop the pill without risk of pregnancy is to swap methods and continue with the combined pill for 7 days.

If you stop the combined pill in the first 7 days after your bleeding, any sexual activity in the pill free week could result in a pregnancy, if no other method is used.

If you are planning to conceive, you can complete one packet, have your bleed and then do not start another packet.

How long after stopping the combined pill can you get pregnant?

Fertility should return after a pill-free week when the body can release an egg with any hormones preventing its release. For some women, it can take a few months for periods and hormonal balance to return to normal.

I’ve just had a baby, can I still use the combined pill?

You should wait at least 4 weeks after delivery before starting the combined pill.

Please note that the combined pill can slightly increase the risk of a VTE which is much higher after having delivery. This will be discussed before dispensing the pills.

Can I use the combined pill after a miscarriage or abortion?

Yes, if the pregnancy was under 20 weeks then you can start using this method immediately. Otherwise, you should wait until day 21 of your cycle (or when your usual cycle starts) to start taking the pill.

Can I use the combined pill if I am breastfeeding?

If your child was born early, small for the gestational age or growth retarded, you may want to consider another method. Furthermore, there is some evidence that oestrogen and progesterone can pass onto the child from breastfeeding and this may have an effect on milk production and supply.

Page reviewed by Julie Milsom (Specialist Nurse at Clarewell Clinics)

Last reviewed date: 1 June 2021
Next review due: 1 June 2024

Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.