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 (COC), 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 (POP) or mini-pill.

How does the 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.

The mini-pill works mainly by thickening cervical mucus making it difficult for sperm to get into the womb. The desogestrel progesterone-only pill - branded as Cerazette, Aizea, Cerelle, Feanolla, Hana, and Lovima - can also stop ovulation most of the time.

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, womb, and bowel.

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 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, POP, 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.
  • POP is Progesterone-Only Pill, often referred to as the 'Mini Pill'.
  • 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 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 both is the safest option, and using condoms gives protection against STIs too. If no contraception is used, morning after pills are an option. These are most effective when taken soon after intercourse.

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.

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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?

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 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 safely for women who are established and stable on their pill (for over one year).

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Will I have to pay for contraception?

Contraception is available free on the NHS from GPs, sexual health clinics and Brook Centres (if you are under 25). If you prefer to access your contraceptive 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 progesterone 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 (2021) is that the only types of antibiotic that interact with hormonal contraception and make it less effective are Rifampicin-like medicines (rifampicin and rifabutin for tuberculosis) and griseofulvin (for fungal infections), which are rarely used. 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 antiretroviral medicines (HIV treatment). Full lists of interactions can be found in the manufacturer's leaflet supplied with the pill - see links to these on the contraception page.

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 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 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 progesterone-only pill there is a 3 hour window each day - desogestrel containing pills (such as Cerazette, Aizea, Cerelle, Feanolla, Hana, and Lovima) acts for longer and can be taken up to 12 hours late.

It can be 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.

I'm pregnant, what contraception will I need after having my baby?

The combined pill can reduce your flow of breast milk.

Breastfeeding is 98% effective as contraception, but ONLY if all three of the following apply:

  1. The baby must be under six months of age AND
  2. The woman must not have had a period AND
  3. The baby must be exclusively breastfed (no formula or pablum with breastfeeds at least every four hours during the day and at least every six hours at night).

If these conditions do not apply, or you prefer greater security, a progesterone only pill is usually used until breastfeeding stops.

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.

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 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 fewer risks than the more effective combined pill. You should not take the combined pill after you reach 50 years of age, and speak to your GP about alternative forms of contraception which you should use until 1 year after your periods stop.

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.

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 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. 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.

Another option for women NOT currently taking the pill to delay periods is to use Norethisterone 5mg or Provera 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, 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 pill from Dr Fox to the one I usually use?

Not from Dr Fox, you need to be established and stable on your pill for 12 months before we can prescribe remotely with no physical monitoring. If you would like to change your pill please speak with your original prescriber.

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.

Risk of blood clots using Combined Hormonal Contraception
Type of Combined Hormonal Contraception (CHC)Risk of blood clots per 10,000 healthy women over 1 year
Healthy non-pregnant woman, No CHC2
Healthy pregnant woman29
Pill containing ethinylestradiol with levonorgestrel norgestimate or norethisterone5–7
Vaginal Ring containing ethinylestradiol with etonogestrel or Patch containing ethinyloestradiol with norelgestromin6–12
Pill containing ethinylestradiol with gestodene, desogestrel, drospirenone or cyproterone acetate9–12

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.

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Dr Tony Steele

Authored 18 October 2013 by Dr Tony Steele
MB ChB Sheffield University 1983. Former hospital doctor and GP.

Reviewed by Dr A. Wood, Dr C. Pugh, Dr B. Babor
Last reviewed 21 July 2021
Last updated 21 July 2021

References