Pill-checks – NHS requirements
Routine medical care for women taking the oral contraceptive pill includes annual check-ups with a doctor or nurse. During these check-ups, blood pressure and weight are normally measured, and you will be advised when your cervical smear is due.
Enquiries will be made to see if the pill being taken is still the best contraception option, and whether changes need to be made, because of side effects, symptoms such as irregular or difficult periods, or simply because of increasing age. Women over 40 often prefer a mini-pill (progesterone only), and women over 35 years who smoke should not normally take a combined pill (pill containing oestrogen).
Women who have recently started or changed their pill, or who are at higher risk, may need pill checks more frequently than 12 months and you will be informed of this at your review. If you want to change your pill then this needs to be done with your usual provider to ensure there are no contraindications to this.
Risks associated with contraceptive pills
An oral contraceptive pill is, for most women, a simple convenient and effective way to prevent pregnancy and control periods. As with any medication, there are potential side effects, some of which could be serious. Large numbers of women take contraceptive pills and there are numerous studies looking at the long-term risks. There is a slightly increased risk of breast cancer in women taking the combined contraceptive pill compared to those not taking it. After 10 years of not taking it your risk is no longer increased. Being overweight or smoking however carry a much higher risk of breast cancer than taking the pill. There may also be an increased risk of cervical cancer but more information is needed to look at the evidence for this. The risk of ovarian and womb cancer is decreased in those women taking the combined pill. Taking the progesterone only pill could increase your risk of ovarian and cervical cancer but more research is needed to confirm this.
Regular pill checks are in addition to any reviews which may be required for symptoms such as irregular bleeding, infections, and symptoms which may be related to taking the pill. These might include skin problems, weight gain, bloating and headaches.
Face-to-face pill checks with a doctor or nurse are important and should not be skipped by women using online services.
Women obtaining repeat supplies of oral contraception online, are usually required to confirm that they have had their regular pill-check and that they will keep their GPs informed. Dr Fox online clinic has a system in place for informing GPs and will not supply repeat contraception to women who fail to provide GP contact details.
Combined pill and mini pill
There is an increase in the risk of thrombosis (blood clots) in women taking pills containing oestrogen, particularly if they are overweight and/or smoke. Some of these women are best switched to a mini pill, which contain a low dose of progesterone, as opposed to standard combined contraceptive pills which contain oestrogen and progesterone.
Some women take contraceptive pills primarily for symptom control, rather than for contraception. Irregular periods can usually be regulated by a pill. Acne in women sometimes improves with pills such as Dianette. Both symptoms are often found in women who have polycystic ovary syndrome. This is a relatively common condition associated with irregular periods, acne, weight gain and reduced fertility.
Alternative contraceptive methods
An oral contraceptive pill is not always the most suitable method of contraception, particularly for younger women who have had previous failures of contraception. Depot formulations, which are given by injection or are inserted under the skin and have an effect lasting from 3 months for some and up to 5 years for others, obviate the need to take regular medication. Other women, who may need contraception only occasionally, may prefer condoms or diaphragms, which have the additional benefit of reducing infection risk.
Women who prefer not to use regular contraception, and who are at risk of pregnancy from unplanned intercourse, sometimes carry standby emergency contraception (morning after pills), although it is best not to rely on this method of contraception on a regular or frequent basis.