FAQs: Contraceptive pills
What is the contraceptive pill?
The pill is a tablet containing hormones, that when taken regularly, protects against pregnancy. There are two types. The commoner combined pill, contains both oestrogen and progesterone, and is simply known as 'The Pill'. The other, mostly used when the combined pill cannot be taken, contains only progesterone and is called the progesterone-only or mini-pill. The mini-pill works mainly by thickening cervical mucus making it difficult for sperm to get into the womb.
Why choose the pill?
The pill is for women who do not wish to become pregnant and want a method that does not interrupt sex, does not reduce subsequent fertility, and in the case of some combined pill can have health benefits such as reducing spots and acne, making periods regular, light and pain free, and reducing the risk of cancer of the ovary and womb.
What other contraception options are there?
There are other forms of hormonal contraceptives: implants, injections, inter-uterine devices (hormonal coil), patches and vaginal rings.
There are also barrier contraceptives: condoms (male and female) and the contraceptive caps.
Further details NHS Choices: contraception guide - what is contraception?
Please see your GP or family planning clinic to discuss options and to see which is the best for you.
Is it true that you can't get pregnant the first time you have sex?
Unfortunately and importantly, no. This myth causes unwanted pregnancies. If you think you may need contraception see your GP, family planning clinic or Brook Centre (if you are under 25).
Is it true that you can't get pregnant if you have sex standing up?
No. Gravity will not prevent sperm from reaching their destination. You can fall pregnant in any position.
Is it true that I won't get pregnant if my partner pulls out at the last minute?
Not really. Using the withdrawal method is not very reliable. Sperm leaks out before ejaculation and sometimes men do not withdraw in time.
My friends say that condoms are no use, because they split. Are they right?
Condoms can break, but if handled carefully and correctly this is rare. When people say that a condom split, it more commonly means that in the heat of the moment the condom didn't actually make it out of the packet! Using a condom is very much safer than not using one at all, but the pill is much more effective than condoms. Using both is the safest option, and using condoms gives protection against STIs too.
I know that women get pregnant in the middle part of the menstrual cycle. Are we safe if we have sex only around the time of my period?
This is call the rhythm method or natural family planning and is not as safe as other methods. Women are usually at their most fertile mid-cycle, when ovulation occurs. If periods are regular this may be predictable and some women experience ovulation symptoms. There could be some mild low abdominal pain and bloating, sore breasts, raised body temperature and increased libido. However cycles can vary in length so you can easily be caught out.
Can the Pill put women off sex?
Rarely, does the pill have a negative effect on libido. Being able to relax in the knowledge that the pill is protecting against unplanned pregnancy is more likely to have the opposite effect.
Which contraceptive pill?
There are over 30 different pills to choose from. Your prescriber will discuss your options with you. Your choice may depend on your age, health issues such as skin spots or migraines and other medicines you may be taking. For further information see How one doctor recommends a contraceptive pill.
Where can I get the pill?
You can obtain contraception from your GP, a family planning clinic, a Brook Advisory Centre (if you are under 25) or online - remote prescribing with no physical monitoring means that only women who are established and stable on their pill (for over one year) can be safely prescribed for.
Will I have to pay for contraception?
I've missed a pill and had sex, what should I do? Do I need emergency contraception?
There are different rules about taking pills late or missing them, depending on which type of contraceptive pill you are taking and where in the pill pack cycle you are.
Will antibiotics stop my contraceptive working?
It depends on which antibiotics and which contraception you're using. Current understanding is that the only types of antibiotic that interact with hormonal contraception and make it less effective are Rifampicin-like medicines (rifampicin and rifabutin.) These are rarely used, mostly to treat or prevent diseases including tuberculosis and meningitis. The types of contraceptives that would be affected are combined pill, the mini or progestogen-only pill, the implant, the patch, the vaginal ring. Other forms such as progestogen injection, the coil, the IUS (intrauterine system) and barrier methods are not affected.
What other drugs interact with hormonal contraception?
As well as the antibiotics rifampicin and rifabutin decreasing the strength of hormonal contraceptives, some other medications have a similar effect. These include treatment for epilepsy and anti-retroviral medicines (HIV treatment).
What over the counter products interfere with the pill?
The herbal remedy for low mood St John's Wort reduces the effect of hormonal contraceptives.
I've had stomach bug with sickness and diarrhoea, and I'm on the pill. Am I still protected?
If you vomit within 3 hours of taking the pill or if you have a lot of diarrhoea, the pill may not be fully absorbed and therefore be considered not taken. Please see information regarding missed pills.
Do I really need to take my pill at the same time each day?
This depends on which pill you take. The short answer is 'no' if taking the combined pill, and yes for the progesterone-only (mini pill). With the combined pill you can even miss a day or more without compromising protection. However if you are on a low dose pill delaying a dose or missing pills can lead to a withdrawal bleed. With the progesterone only pill there is a 3 hour window each day; Cerazette acts for longer and can be taken up to 12 hours late.
I'm pregnant, what contraception will I need after having my baby?
The combined pill can reduce your flow of breast milk. So long as you are feeding on demand and that that is every 4 hours or less (including at night) your fertility and periods are unlikely to return until baby is over a year of age. If your baby is less than 6 months old, exclusive breastfeeding (breast milk only) is over 98% effective in preventing pregnancy. In this scenario periods are not expected to have re-started. Weaning and reduced breastfeeding usually trigger periods to start.
If you are not exclusively breast feeding, or don't feed your baby over night, it is recommended you use a progesterone-only or barrier method of contraception until you stop breastfeeding. After breastfeeding has stopped there is the option to take the combined pill.
If you have had a baby and are not breastfeeding, you may ovulate a month or so postnatally. To prevent pregnancy start the pill on day 21 after the birth. If you start later then you would not be protected for the 1st seven days whilst the hormones build up, so condoms would be required during that time.
How long can I stay on the pill for?
It is safe to take till the menopause. After the age of around 40 fertility decreases, and depending on other risk factors, doctors may prefer to prescribe the progesterone only (mini pill) which has less side effects than the more effective combined pill. The only birth control method that should be used for only up to 5 years at a time is the injection. This is because it suppresses oestrogen and can lead to thinning of the bones.
Does being on the pill decrease fertility?
No. Fertility returns as soon as you stop the pill. A common cause of infertility PCOS is improved by the combined pill as the hormones are regulated. In contrast the injection, can take several months (even over a year) to wear off, so it is not a good option if you are planning a family soon.
I've heard I can delay periods using my pill, I'm going on holiday soon, how do I do it?
Yes, that's right, with the combined pill you can. Instead of a pill-free-week (the larger dummy pills in the ED version) go straight onto the new pack. Your period, a withdrawal bleed, will only occur when you have stopped taking pills, and therefore will be deferred.
Another option for women NOT currently taking the pill is to use Norethisterone 5mg tablets.
Can I trust my contraceptive?
The effectiveness of contraception is affected by user reliability, the life span of sperm, stage in the menstrual cycle, age and weight, other medications - all these issues are factors.
Our doctors have written an in-depth article which explores all aspects of reliability of different forms of contraception, and what to do if it fails.
Further questions answered at FPA: The combined pill.