Combined contraceptive pill

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

Women who are eligible can obtain a 3-month supply of their current combined contraceptive pill if the following applies:

• You have been taking the same combined contraceptive pill for the last year.
• You have had no problems with your contraceptive pill in the last year.
• You have had a pill check-up in the last year.

Dr Fox has a separate consultation to supply the progestogen-only pill (POP or mini pill), for first time users and for ongoing use.

The service is available only to women 18-49 years of age. Younger women should obtain contraception from their GP or a local pharmacy or sexual health clinic:

UK sexual health clinics

• England
• Wales
• Scotland
• Northern Ireland

Risks of taking the combined contraceptive pill

The risks of taking the combined contraceptive pill vary depending on general health, age and type of pill. For more details please see the patient information leaflet supplied with all pill packs (links to each leaflet are also below). We do not supply contraception to women in high risk groups.

The combined contraceptive pill (pills containing oestrogen and progestogen) increases the risk of thrombosis (blood clots), arterial/heart disease, migraines, and high blood pressure.

There is a very small increase in risk of breast and possibly cervical cancer with these pills. This reduces after stopping taking them and is balanced by a lifetime small decreased risk of cancer of the ovaries, bowel, blood, and womb.

We are unable to supply the combined contraceptive pill online to women aged under 18 or over 50 years. Please consult your regular doctor/nurse or a contraceptive advice service.

Selecting contraception

After a consultation you will, if eligible, be able to choose your current contraceptive pill from the list below.

Dr Fox Pharmacy only allows the supply of your current pill, not changes to new pills. Alternately you can choose to start a new desogestrel progestogen-only pill from Dr Fox.

Selecting suitable contraception is a very personal choice. Some contraceptives require consultation with a doctor or a specialist sexual health advisor. Others require professional administration (intrauterine devices, implants, depot injection), or specialist tuition (cap or diaphragm use), or self injection (Sayana press). Various factors should be considered in making the choice including general health, lifestyle, personal preference, past contraceptive history, past medical history, and current medication, as not all types of contraception are suitable for all women.

Contraception is available free on the NHS and can be provided confidentially to women of all ages including under 16s.

Contraceptive choices

• Combined hormones as pills, patches, or vaginal rings.
• Single progestogen hormone as mini pills, long acting injections, implants, or in a intrauterine system (fitted into the womb).
• Copper coils (fitted into the womb).
• Barrier methods such as condoms, diaphragms, and caps.
• Male or female sterilisation which is non-reversible.

There are also natural methods which rely on having intercourse at non-fertile times.

Each method has its advantages and disadvantages.

The Long-Acting Reversible Contraceptive methods (LARC) such as injections, implants, and intrauterine methods can be the most reliable contraceptives. These are available from GPs and sexual health services.

How effective are combined pills (COC) at preventing pregnancy?

COC can be 99% effective in preventing pregnancy. If taken correctly, only 1 woman in 100 taking any combined pill will become pregnant each year. However in 'typical' use they can prove less effective and up to 9 women in 100 actually get pregnant. User reliability makes a big difference!

See also Can I trust my contraceptive? and NHS: How effective is contraception at preventing pregnancy?.

Sometimes it's hard to remember to take the contraceptive pill at the same time every day. Setting a daily reminder on your phone or using a pill reminder app may help.

Some medications can also affect the absorption of the hormones in the pill so if you are starting on new medication, please ensure you read the patient information leaflet supplied with it to check.

Other forms of contraception, including Long-Acting Reversible Contraception methods (LARC: injections, implants, and intrauterine coils), may be better if pills are regularly forgotten.

How to take combined contraceptive pills

When combined hormonal contraception (CHC) was first developed it was believed that a regular monthly bleed was healthy and would reassure women. The standard routines for combined oral contraceptive pill (COC) use were therefore developed to mimic the natural 28-day cycle, i.e. 3 weeks of contraceptive use, then 1 week off, during which a period type bleed happens.

In more recent years, guidance has been developed around alternative extended use routines which reduce bleeding patterns.

There are several different options but the most common are:

• Tricycling - take the combined contraceptive pill for 9 weeks with no break. Then take a 4-day or a 7-day break before restarting. Bleeding should start within a few days. Restart after 4 or 7 days even if still bleeding. If the pill is not restarted, there is a risk of pregnancy if sex took place during the break. Choosing a 4-day break gives less chance for the ovaries to wake up and begin to release an egg.
• Flexible extended use - continue to take the combined contraceptive pill until period-type bleeding occurs. This can take several months. After 2 days bleeding, take a 4-day break and then restart the pill until the next bleed. Restart after 4 days, even if still bleeding. If the pill is not restarted there is a risk of pregnancy if sex took place since it was last used.

These different routines are suggested in guidance from the FSRH (Faculty of Sexual and Reproductive Health), however they are 'off label' uses and different to the terms of the manufacturers' licence. Doctors take responsibility for the prescribing.

Further information on how to take contraceptive pills.

Patient Information Leaflets:

Missed, forgotten, or vomited pills

If you forget or miss your pill there could be an increased risk of pregnancy. You may need to use emergency contraception. The rules about what to do in these situations are complicated. What to do depends on how much has been missed and when in the cycle.

Details can be found in the patient information leaflet supplied in pill packs and at NHS: Contraception guide - What should I do if I miss a pill (combined pill)? and in the Dr Fox article Missed a Pill? Here's what to do. You can also contact NHS 111 or the Sexual Health Line on 0300 1237123.

If vomiting occurs within three hours, take another pill and the next pill at the usual time. If there is severe diarrhoea lasting over 24 hours, then contraceptive cover is likely to be lost, and you may need to use condoms as well or take emergency contraception, if unprotected sex takes place.

Dr Fox supplies contraceptive pills on prescription to prevent pregnancy - you are required to answer a medical questionnaire before your order can be completed.

Authored 18 March 2010 by Dr Tony Steele
MB ChB Sheffield University 1983. Former hospital doctor and GP. GMC no. 2825328

Reviewed by Dr A. Wood, Dr C. Pugh, Dr B. Babor
Last reviewed 17 October 2022
Last updated 11 December 2024
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