FAQs: Combined hormonal contraception
What is the contraceptive pill?
The contraceptive pill is a tablet containing hormones, taken regularly by women, that protects against pregnancy. There are two types. The combined pill (COC), contains both oestrogen and progestogen, and is often simply known as 'The Pill'. The other, mostly used when the combined pill cannot be taken, contains only progestogen and is called the progestogen-only pill (POP) or mini pill.
How does the combined contraceptive pill work?
The combined pill works by stopping an egg being released each month from the ovaries. It also thickens mucous in the cervix making it more difficult for sperm to get through and thins the womb lining making it difficult for a fertilized egg to grow.
Why choose the contraceptive pill?
The contraceptive 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 pills 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, womb, and bowel.
Which is the best contraceptive pill?
Women often ask 'which is the best pill?'. The simple answer is that all women are different, and thankfully there are a range of contraceptive pill options which usually means there will be a pill brand out there to suit you. There isn't really a 'best pill' - it's just important to find the best one for you.
What other contraception options are there?
There are other forms of hormonal contraceptives: implants, injections, progesterone releasing intrauterine systems, patches, and vaginal rings.
A non hormonal option is the copper intrauterine device sometimes called a 'coil' or 'copper coil'.
There are also barrier contraceptives: condoms (male and female) and contraceptive caps and diaphragms.
Further details see NHS: contraception guide - what is contraception?
Please consult your GP or a sexual health clinic to discuss options and to see which is the best for you.
What is LARC?
LARC refers to Long Acting Reversible Contraception. LARC methods are the most reliable forms of contraception. They include injections, implants and coils and intrauterine systems. These can be obtained from sexual health services and many GPs.
What do CHC, COC, CVR, mean?
- CHC is Combined Hormonal Contraception, containing two female hormones, oestrogen and progestogen. CHC includes combined pills, Evra patches, and contraceptive vaginal rings.
- COC is Combined Oral Contraception, or the combined pill often just called 'The Pill'. COC contains two female hormones, oestrogen and progestogen in a tablet. It is different from the 'mini pill' (POP) which only contains one female hormone - progestogen.
- CVR is Combined/Contraceptive Vaginal Ring. The CVR contains two female hormones - oestrogen and progestogen - in a soft vaginal ring.
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 Dr Fox can supply desogestrel POP, or see your GP, a sexual health 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 get 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 condoms as well as the pill gives protection against STIs too. If no contraception is used, morning after pills are an option. These are most effective when taken as soon as possible after intercourse.
Do I need to use condoms as well as COC?
There are two reasons to use condoms as well.
Until you have taken enough pills for the pill to be effective (usually 7 days, check the PIL) so either when you first start COC or if you have forgotten to take pills.
Condoms will also protect you from the risk of catching a sexually transmitted infection if you are at increased risk, e.g. in a new relationship. The combined pill does not prevent sexually transmitted infections.
Can under 16s get contraceptives?
Yes they can. Under 16s needing contraception can see a GP or nurse, or visit a sexual health clinic. Parents don't have to be informed, as long as there is good understanding and the young person is not vulnerable and in need of protection.
Find a local sexual health clinic
Note: Dr Fox supplies medication online only to adults (18 years or older).
Will the pill, contraceptive patch, or contraceptive vaginal ring protect me from sexually transmitted disease?
No. If you are in a new relationship or otherwise at risk, you need to use condoms as well to protect from sexually transmitted disease.
Can the Pill put women off sex?
The Pill rarely has 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 original prescriber will discuss your options with you and choose an appropriate pill to start with. The 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 combined contraceptive pill (COC)?
You can obtain contraception from your GP surgery, a sexual health clinic, a Brook Advisory Centre (if you are under 25) or online - remote prescribing with no physical monitoring means that Dr Fox can only prescribe the combined pill safely for women who are established and stable on their pill (for over one year).
Find a local sexual health clinic
Why do I have to have regular 'pill checks'?
Regular pill checks, usually once a year, are needed when taking any COC. Your GP or sexual health advisor will check your blood pressure and weight/body mass index (BMI). They also check if the pill is still the best contraceptive for you and if you are experiencing any problems or concerns. These checks may be by phone call or face to face appointment. Dr Fox can only prescribe if you have had a pill check within the previous 12 months.
See also Importance of annual pill checks.
Will I have to pay for contraception?
Contraception is available free on the NHS from GP surgeries, sexual health clinics and Brook Centres (if you are under 25). If you wish to access your contraception privately, including online, charges apply - see contraceptive pill prices from Dr Fox.
I've missed a pill and had sex - 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. See NHS for details missed progestogen-only pills and missed combined pills.
Will antibiotics stop my contraceptive working?
It depends on which antibiotics and which contraception you are using. Current understanding (2022) is that the only types of antibiotic that interact with hormonal contraception and make it less effective are rifampicin-like medicines (rifampicin and rifabutin - rarely used, mostly to treat tuberculosis and meningitis) and griseofulvin (for fungal infections). The types of contraceptives that would be affected are combined pill, the progestogen-only pill (POP), 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 antiretroviral medicines (HIV treatment). Full lists of interactions can be found in the manufacturer's leaflet supplied with the contraception - see links to these on the contraception page.
What over the counter products interfere with the pill?
St John's Wort - the herbal remedy for low mood - reduces the effectiveness of hormonal contraceptives.
I've had a 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 should be considered not taken, i.e a 'missed pill'. Missed pill information can be found on the NHS website: combined pill and progestogen-only pill.
You can also contact NHS 111 or the Sexual Health Line on 0300 1237123.
Do I really need to take my combined pill at the same time each day?
This depends on which pill you take. The short answer is 'no' if taking the combined pill.
The combined contraceptive pill can be taken up to 24 hours late.
Despite the leeway, it is usually easier to remember your pill if you do try and take it at the same time each day. Sometimes using a mobile phone alarm or app can help you remember. If you have trouble remembering your pills, then a LARC method of contraception may suit you better.
I'm pregnant, what contraception will I need after having my baby?
The combined pill can reduce your flow of breast milk. You can use the combined pill but not until at least 6 weeks after the birth, once breastfeeding is well established. You are not protected for the first 7 days of pills, whilst the hormones build up, so condoms would be required during that time.
Breastfeeding is 98% effective as contraception. This is called the LAM method but is ONLY effective if all three of the following apply:
- The baby must be under 6 months of age AND
- The woman must not have had a period AND
- The baby must be exclusively breastfed (no formula or pablum/baby rice with breastfeeds at least every 4 hours during the day and at least every 6 hours at night).
If these conditions do not apply, or you prefer greater security, a POP is usually used until breastfeeding stops. This can be started immediately after the birth. If you start more than 3 weeks later, then you would not be protected for the first 2 days of pills, whilst the hormones build up, so condoms would be required as well during that time.
If you have had a baby and are not breastfeeding, you may ovulate a month or so after giving birth. To prevent pregnancy, start the combined contraceptive pill on day 21 after the birth. Starting earlier is not recommended because of increased thrombosis risk in the first weeks after delivery. You are not protected for the first 7 days whilst the hormones build up, so condoms would be required during that time.
When can I start the COC after a miscarriage or an abortion?
You can start COC anytime within the first 5 days after a miscarriage or abortion - no extra condom use is needed. If you start later than 5 days after the miscarriage or abortion, then 7 days condom use for the combined pill is recommended.
When can I start COC after using emergency contraception?
- You can wait to start the COC until the first day of your period and use condoms until this time.
- If you are unable to wait then you can start on the same day if you have used emergency contraception containing levonorgestrel (Levonelle) and use condoms as well for the first 7 days of use of the COC.
- If you have used ulipristal acetate (EllaOne) then wait 5 days before starting the COC and use condoms as well during this time and for the first 7 days of taking the COC (12 days condom use in total).
- If you start COC before your next period then you need to check a pregnancy test, 3 weeks after the sex leading to the use of the emergency contraceptive pill.
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 often called 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 which can help pinpoint this time. 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.
When using combined hormonal contraceptives (CHC) the riskiest time is reversed. It is around the break/period time. Taking the hormone break allows the ovaries to begin to 'Wake Up'. Unless the CHC is started again on time, then there is a risk of pregnancy from having sex during the break.
How long can I stay on the pill for?
It is safe to take contraceptive pills until the menopause. After the age of around 40 fertility decreases, and depending on other risk factors, doctors may prefer to prescribe the POP which has fewer risks than the combined contraceptive pill. You should not take the combined pill after you reach 50 years of age. You can take the POP or speak to your GP about alternative forms of contraception which you should then use until 1 year after your periods stops or until age 55.
Should I give my body a break from using the pill, the contraceptive patch, or the contraceptive vaginal ring every few years or so?
No. You don't need to take a break because the hormones don't build-up in your body. There are no known benefits to your health or fertility from taking a break, and you may be more likely to become pregnant by mistake if you stop a reliable contraceptive. Also there is an increased risk of developing blood clots (thrombosis) in the first year after starting or after restarting combined hormonal contraception, after more than a 1 month break.
Does being on the pill decrease fertility?
No. Fertility returns as soon as you stop the pill. A common cause of infertility, PCOS (Polycystic Ovary Syndrome), 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 contraceptive pill (COC) 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. Taking pills in this way with no pill-free gap is safe and common, but is not covered by the medicine's original licensing. It is an off-label use. Occasionally there may be some light spot bleeding during the second pack but it is usually much lighter than a normal period.
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, weight, and other medications - all these issues are factors.
Our doctors have written an in-depth article which explores all aspects of the reliability of different forms of contraception, and what to do if it fails.
Can I request a different combined contraceptive pill from Dr Fox to the one I usually use?
You can choose to order a different brand containing the same hormone combination as your usual brand, if it's cheaper or if your usual brand is unavailable.
However, you cannot choose to swap to a combined contraceptive pill with a different hormone combination. You need to be established and stable on that hormone combination pill for 12 months before we can prescribe remotely with no physical monitoring. If you would like to change your type of combined contraceptive pill please speak with your original prescriber.
You can start the desogestrel POP from Dr Fox either as a swap from another hormonal contraceptive or as your first contraceptive pill.
Is there a risk of blood clots when using combined hormonal contraceptives?
Yes. There is a slight increased risk of developing blood clots when using combined contraceptive pills, patches, or vaginal rings, but the total risk is still very small. The risk is greatest in the first few months after starting or if restarting after more than 4 weeks off.
If you have had a blood clot in the past, or have a known increased risk of developing one, then you should not use combined hormonal contraceptives. The risk varies slightly between different hormones within the pill, patch, or ring.
|Type of Combined Hormonal Contraception (CHC)||Risk of blood clots per 10,000 healthy women over 1 year|
|Healthy non-pregnant woman, No CHC||2|
|Healthy pregnant woman||29|
|Pill containing ethinylestradiol with levonorgestrel norgestimate or norethisterone||5–7|
|Vaginal Ring containing ethinylestradiol with etonogestrel or Patch containing ethinyloestradiol with norelgestromin||6–12|
|Pill containing ethinylestradiol with gestodene, desogestrel, drospirenone or cyproterone acetate||9–12|
The manufacturer's patient leaflet included with contraceptive pill medicine packs has details on how to recognise a blood clot. Also see NHS: blood clots.
Further questions answered at NHS: Combined pill.
Should I stop my CHC before having an operation?
Yes. It is recommended that you stop using a combined hormonal product for contraception 4 weeks before planned major surgery as there is an increased risk of blood clots after surgery. You can swap to a POP during this time. The CHC can be restarted at your first period/menstruation after being fully mobile again for at least 2 weeks.
Is there a risk of cancer when using combined hormonal contraceptives?
There is a very small increase in the risk of developing breast and possibly cervical cancer whilst taking combined hormonal contraceptives. This reduces after stopping the CHC and is balanced by a lifetime, small reduction in risk of cancer of the ovaries, bowel, blood, and womb.
Are combined hormonal pills only used for contraception?
Combined pills are usually taken for contraception, but they can also be used to treat heavy or painful periods, PMS (premenstrual syndrome) and endometriosis.
- FSRH, 2020, Clinical Guideline: Combined Hormonal Contraception, accessed 16 November 2022
- FSRH, 2019, UK MEC, accessed 16 November 2022
- NICE, 2022, Contraception - combined hormonal methods, accessed 21 July 2021