Combined pill

Combined pill

Your contraception guide

It is common practice to refer to the combined oral contraceptive pill simply as “the pill.” It includes synthetic forms of the female hormones estrogen and progesterone, both of which are naturally generated in the ovaries.

It is possible for there to be a pregnancy if the sperm can reach the egg (ovum). In most cases, contraception will attempt to prevent this from occurring by physically separating the egg and the sperm or preventing an egg’s release (ovulation).

At a glance: the combined pill

  • When used precisely as directed, the pill has an effectiveness rate of over 99 percent in preventing conception.
  • This translates to a pregnancy risk much lower than 1 in 100 for women who use the combination pill as their primary method of birth control.
  • The recommended course of action for taking the pill is to take one tablet each day for the first 21 days, followed by a break of seven days, during which time you will have bleeding similar to that of a period.
  • After a week has passed, you resume taking the medication as directed.
  • You may be able to take some kinds of pills with either no breaks at all or shorter pauses (a customized regimen), which could lessen the severity of some of the adverse effects.
  • Talk to a medical professional or a nurse about the choices you have.
  • It is essential that you remember to take the tablet at around the same time every day. If you do not do this, or if you skip a pill, or if you throw up, or if you have severe diarrhea, you run the risk of becoming pregnant.
  • It’s possible that some medications will make the tablet less effective. Inquire about any other medications you could take with your primary care physician.
  • PMS (premenstrual syndrome) or endometriosis, which is treated with a combination pill, could be helpful if you have heavy, painful periods or heavy cycles.
  • Some people have minor side effects such as mood swings, nausea, breast soreness, and headaches; however, these symptoms often disappear after a few months of treatment.
  • There is no evidence to support the claim that taking the tablet would cause you to put on weight.
  • The likelihood of experiencing majsignificantverse effects, such as blood clots or cervical cancer, is relatively low.
  • If you are over the age of 35 or a smoker or have some medical issues, you should not take the combo tablet.
  • Because taking the pill alone will not protect you from sexually transmitted infections (STIs), you should also wear a condom.
  • There is some indication of a connection between the pill and depression; however, the data is inconsistent, and further study is required.

The mechanism of action of the combination pill

How it stops women from becoming pregnant

Because of the pill, the ovaries are prevented from producing an egg every month (ovulation). Additionally:

  • Increases the thickness of the mucus in the womb’s neck, making it more difficult for sperm to enter the womb and find an egg;
  • Decreases the thickness of the womb’s lining, making it less likely that a fertilized egg will implant in the womb and be able to grow;
  • And increases the risk of miscarriage.

If used precisely as directed, the pill has a success rate of above 99 percent. Other forms of contraception, such as the intrauterine device (IUD), intrauterine system (IUS), implant, and injectable, are more effective at preventing conception.

There are numerous distinct brands of pills, which may be broken down into three primary categories:

Monophasic tablets for a period of 21 days

This is by far the most typical kind. The quantity of the hormone included in each tablet is the same. A single tablet is swallowed daily for the first 21 days, after which no pills are taken for the next seven days. This category of medicine includes brands such as Microgynon and Marvelon, and Yasmin.

Phasic tablets for 21 days

The packages of phasic tablets often have two or three portions, each of which contains a different colored pill. There is a variance in the total quantity of hormones found in each area. A single tablet is swallowed daily for the first 21 days, after which no pills are taken for the next seven days. The phasic tablets have to be consumed in the specific sequence specified. One example of this kind of drug is called Logynon.

Pills are taken every day (ED)

One package contains 28 pills total, 21 of which are the real deal and 7 of which are placebos.

The two varieties of the pill each have a distinctive appearance. One tablet is to be taken daily for a total of 28 days, and there is no break between the individual packets of pills. The sequence in which you take your regular medication is critical. One example of this kind of medication is known as Microgynon ED.

Please ensure that you are following the directions that are included with your package. If you have any questions, you should see a physician, a registered nurse, or a pharmacist.

Because skipping tablets or taking them simultaneously as other medications can reduce the effectiveness of the treatment, it is essential to take the pills exactly as directed.

Standard protocol for administering the tablets over 21 days

  • You should take your first pill from the package that is labeled with the day of the week that it is, or you should take the first pill that is the first color (phasic pills).
  • Maintain the routine of taking one pill simultaneously every day until the whole pack has been used.
  • Stop taking medications for 7 days (during these 7 days, you will get a bleed).
  • On the eighth day, regardless of whether or not you are still experiencing bleeding, you should begin taking the following box of tablets. You must take this medication on the same day of the week as the first one you took.

How to take every day pills

  • You should start by taking the first tablet that is included in the portion of the package that is labeled “start.” This will be a pill with some kind of effect.
  • Continue to take one pill daily, making sure to take them in the correct sequence and aiming to do so around the same time each day until the pack is empty (28 days).
  • You will have bleeding at some point throughout the seven days when the inactive tablets are in your system.
  • You should begin the second pack of tablets after you have completed the first pack, regardless of whether or not you are still experiencing bleeding.

Specifically crafted regimens

In addition, you may use the combination pill as a custom regimen for yourself. This may include taking the tablet for a total of 21 days before pausing for 4 days, or it may involve taking the drug nonstop for the whole 30 days. Please see a medical professional or a nurse for more information.

The mechanism of action of the combination pill
The mechanism of action of the combination pill

Taking the first tablet of the combination

In most cases, you are free to begin taking the pill whenever you choose throughout your menstrual cycle. If you have recently had a baby, an abortion, or a miscarriage, you are eligible for further support and assistance. If you have a shorter menstrual cycle than average, the advice may also differ. If necessary, consult a medical professional, such as a doctor or nurse. Depending on when you begin taking the pill in your monthly cycle, you may or may not need to use an extra method of birth control during the first few days of taking the medication.

Beginning on the first day of your menstruation, you should…

If you begin taking the combination pill on day one of your period (day one of your monthly cycle), you will immediately be protected against becoming pregnant. Day one of your menstruation is considered day one of your menstrual cycle. You won’t need any other forms of birth control.

Beginning on day 5 of your cycle or earlier, whichever comes first,

You will still be protected against pregnancy as soon as you start taking the pill, regardless of when during your period you decide to do so, as long as it is before the fifth day.

After the fifth day of your cycle, you will begin to see results.

You will not be protected against pregnancy right immediately. You will need additional contraception until you have taken the pill for a whole week before you can consider yourself fully protected.

If you start taking the pill after the fifth day of your cycle, you should be sure that in the time since your previous period, you have not done anything that might put you in danger of becoming pregnant. Suppose you are concerned about becoming pregnant while taking the pill. In that case, you should get a pregnancy test three weeks after the most recent time you engaged in sexual activity without using protection.

What to do if you forget to take a medication

If you start a pack late or skip a tablet or pills altogether, this might cause the birth control pill to be less effective in preventing pregnancy. After missing a pill or tablets, the likelihood of becoming pregnant is dependent on the following factors:

  • When there is a shortage of the medicines;
  • How many of the tablets are not taken.

Find out what you should do if you forget to take a combination medication.

Vomiting and diarrhea

If you throw up less than three hours after taking the combination tablet, there is a possibility that it was not completely absorbed into your circulation. Take another tablet immediately, and then take the next pill when you usually would.

If you continue to feel nauseous, you should use an additional method of birth control until you have successfully taken the pill for a period of seven days straight without throwing up.

It’s possible that the tablet isn’t working effectively if you have severe diarrhea, which is defined as six to eight loose bowel movements in 24 hours. You should continue to take your pill as directed, but you should also use a different form of contraception, such as condoms, while you have diarrhea and for the next two days after you have recovered from it.

If you continue to feel ill or have diarrhea, it is best to see a general practitioner (GP) or a nurse or phone NHS 111 for additional advice.

Who is eligible to use the combination pill?

You can continue taking the pill up to the time of menopause if you do not smoke and there are no medical grounds that prevent you from taking the medication. The drug is not appropriate for everyone. Talk to your primary care physician, a nurse, or a pharmacist if you want to find out whether the medication is proper for you.

You should probably avoid taking the tablet if any of the following apply if you:

  • Are significantly overweight;
  • Take certain medications;
  • Are pregnant;
  • Smoke and are at least 35 years old;
  • Quit smoking within the last year and are at least 35 years old.

In addition, you should not take the tablet if you have (or have had had) any of the following conditions:

  • Clots of blood that form in veins, such as those seen in the leg or lungs;
  • A stroke;
  • Any other condition that causes the arteries to constrict;
  • Everyone in your immediate family who is under the age of 45 who has a blood clot;
  • A cardiac anomaly or heart illness, including high blood pressure, should have their blood pressure checked regularly;
  • Migraines of a severe nature, particularly when accompanied by an aura (warning symptoms);
  • A history of breast cancer;
  • Gallbladder or liver illness;
  • Diabetes with complications, or diabetes over the last 20 years.

Following giving birth

If you have just given birth and are not planning to nurse your infant, you may most likely begin taking the pill on day 21 after the delivery; however, you should verify this information with your physician before doing so. You won’t have to worry about becoming pregnant right soon because of this method.

If you start taking the pill later than 21 days after giving birth, you will need additional contraception (such as condoms) for the next seven days until you may start taking the pill usually.

It is recommended that nursing women wait at least six weeks after giving birth before taking the combination pill.

Following a failed pregnancy attempt or an abortion

You can start taking the pill up to five days after having an abortion or a miscarriage. At this point, you will be immediately safeguarded against becoming pregnant by the medication. Suppose you begin taking the pill more than five days after the abortion or miscarriage. In that case, you will be required to utilize additional contraception until you have taken medicine for a whole week.

Advantages and disadvantages

The following are some of the benefits of taking the pill:

  • It does not prevent sexual activity;
  • It makes your periods more consistent, lighter, and less painful;
  • It lowers your chance of developing cancer of the womb, ovaries, and colon, and it accomplishes all of these things.
  • It has been shown to alleviate the signs and symptoms of premenstrual syndrome (PMS), and
  • It may also help clear up acne and protect against pelvic inflammatory disease.
  • It may lower the likelihood of developing fibroid tumors, ovarian cysts, and non-malignant breast diseases.

The following is a list of some of the pill’s potential drawbacks:

It is possible for it to initially create adverse effects that are only transitory, such as headaches, nausea, breast soreness, and mood swings;

if these side effects do not go away after a few months of usage, switching to a different tablet may be helpful.

It has the potential to raise your blood pressure.

You will not be protected from sexually transmitted illnesses by using it.

It is not uncommon to have breakthrough bleeding and spotting in the first few months of taking the pill.

It has been associated with an increased risk of several major health issues, including blood clots and breast cancer.

The combined pill with other medicines

Because of the interaction of some medications with the combination tablet, it does not function as intended. There is a list of some interactions; however, it is not a comprehensive list. If you wish to be sure that your current medications are compatible with the combination pill, you may do the following:

  • Inquire with your primary care provider, practice nurse, or pharmacist about having the patient information leaflet that accompanies your medication read to you.


Antibiotics such as rifampicin and rifabutin, which are prescribed to treat conditions such as TB and meningitis, can potentially lessen the efficacy of the combination tablet. Any of the other antibiotics do not cause this effect.

If you are given rifampicin or rifabutin, it is possible that you may be recommended to switch to a different method of birth control. In such a case, you will need to use additional contraception (such as condoms) while you are taking the antibiotic and for a short period after you have finished your course of treatment. Consult a medical professional or a registered nurse for assistance.

Medications for epilepsy and HIV, as well as St. John’s wort

The combination tablet can affect other medicines known as enzyme inducers. These cause your liver to break down hormones more quickly, which decreases the efficiency of the pill you are taking.

The following are some examples of enzyme inducers:

  • Carbamazepine, Oxcarbazepine, Phenytoin, Phenobarbital, Primidone, and Topiramate are some medications used to treat epilepsy.
  • St. John’s wort is herbal therapy.
  • Antiretroviral medications are used to treat HIV (research suggests that interactions between these medicines and the progestogen-only pill can affect the safety and effectiveness of both).

While you are on any of these medications, your primary care physician or a nurse may recommend using an extra or alternate method of birth control.

Possible adverse effects of taking both pills together

The utilization of the combined oral contraceptive pill is not without its share of potential side effects. On the other hand, these dangers are relatively minor.

Clots of blood form

The estrogen in the pill may make your blood more likely to clot. If a blood clot forms, it may result in the following:

  • Deep vein thrombosis (clot in your leg);
  • Embolism of the lungs (clot in your lung);
  • Stroke;
  • Heart attack.

Even though the likelihood of developing a blood clot is very low, your physician will examine your medical history to see whether or not you have specific risk factors before prescribing the tablet.


There is some evidence that taking the pill is associated with a somewhat increased risk of getting breast and cervical cancer. Additionally, it has been shown to reduce one’s likelihood of acquiring cancers of the uterus (womb), ovaries, and bowels.

However, if you stop using the pill altogether after ten years, your chance of developing breast and cervical cancer returns to its pre-pill levels.

Where you can get the combined pill

Through the NHS, contraception is provided at no cost to patients. The following are some of the locations where you may get contraception:

Community clinics that provide family planning services;

Some genitourinary medicine (GUM) clinics and sexual health clinics also provide services for testing for sexually transmitted infections and contraception.

GP surgeries – Talk to your primary care physician, a nurse, or someone who works in a youth program. (for more information, contact the Sexual Health Line at the number 0300 123 7123)

Find a center for sexual health care.

What steps do I need to take to switch to a different pill?

You may seek the counsel of a general practitioner (MD), a contraceptive nurse (also known as a family planning nurse), or a sexual health clinic if you have questions about modifying your oral contraceptive.

Because you should not have a break between various packs, you will often be recommended to start the new pill immediately or wait until the day after you take the last of your old drugs before beginning the new pack. Since you should not have a break between different packs,

Because it can take the new pill a little while to start working correctly, your doctor might also suggest that you switch to another form of birth control during the transition.

If you’re under 16 years old

Those under the age of 16 are eligible for contraception services that are both free and confidential. This includes people who are less than 16 years old.

If you are under the age of 16 and desire to use contraception, the physician, nurse, or pharmacist will not notify your parents (or caretaker) as long as they feel you completely comprehend the information that is provided to you and the choices that you make.

When working with patients younger than 16, medical professionals must adhere to several stringent requirements. They will suggest that you discuss it with your parents and urge you to do so, but they will not require you to do so.

If a professional suspect that you are in danger of being harmed, such as by an abusive partner, then and only then will they reveal this information to another person. The threat would need to be significant, and before taking any action, they will typically discuss it with you.