Combined pill

The combined pill, also simply called “the pill” is the standard oral contraceptive pill that over 100 million women have used to prevent pregnancy since the 1960s. Each pill contains two artificial hormones that replicate the natural hormones produced in your ovaries. By altering the hormone level and cycle, pregnancy can be prevented. Hormonal changes caused by the combined pill may bring some additional health benefits, such as easing the symptoms of PMS and improving oily skin and acne. However, the pill can also have a number of unpleasant side effects that you need to be aware of. For some women taking extra hormones can be risky to their health. There are currently over 3 million women in the UK on the pill, and it is the country’s most popular form of female contraception. The pill is reasonably simple to use, discreet and readily available on prescription (subject to GPs approval). If you use the pill absolutely correctly, there is a 99% likelihood that you will not get pregnant.

How the combined pill works

Each combined pill contains two artificial versions of your body’s natural hormones oestrogen and progesterone. When you swallow a pill the hormones are released into your body. The increased hormone level has an impact on the menstrual cycle and acts threefold to prevent unwanted pregnancy:

1. Prevents ovulation (this is when your ovaries release an egg every month)
2. Thickens the natural mucus in your cervix, preventing sperm from entering the womb
3. Reduces the chances of a fertilised egg (ova) implanting into the womb

Side effects of the pill will only last as long as you continue to take the pill. If you later decide that you want to conceive a baby, you just need to stop taking the pill. Your body will revert to its natural state of fertility in a short time.

Who can use the combined pill?

Doctors will usually consider prescribing an appropriate brand of combined pill to most healthy women of childbearing age. As long as you continue to meet the necessary health requirements, DoktorABC’s GPs can renew your prescription online. 

Doctors do not recommend that all women use the combined pill. In some circumstances, the combined pill may be harmful. These include:

• Oestrogen intolerance
• Obesity (BMI 35+)
• Risk of thrombosis
• Smoking after the age of 35
• Use of prescription medicines
• Suffering from certain serious medical conditions

If you can’t take the combined pill, you may be offered a prescription for an oestrogen free mini pill instead, or be advised to use a different form of contraception.

How do I use a combined contraceptive pill

There are three types of combined pills:

• Monophasic pills are taken daily, usually for 21 days, followed by a 7 day break.
• Multiphasic pills are colour coded according to dosage. They are taken in a specific order, usually for 21 days, followed by a 7 day break.
• Every day pills are taken daily without a break. Each batch of 28 pills contains a small number of inactive (hormone-free) pills. You take these pills to avoid breaking your daily routine. 

Each type of pill (and each brand of pill) comes with specific instructions about how to use it. If you want to achieve the highest likelihood of preventing pregnancy (99% with combined pills) you need to follow the manufacturers and our GP’s instructions exactly. 

There are a few general rules for using combined pills:

1. Establish a personal routine and take each pill at the same time every day. 
2. Follow the packet labelling to ensure that you take each pill on the right day.
3. Keep your pills in a place where you won’t forget them if you want to spend a night away from home. 

N.B. Each packet of pills contains a manufacturer’s leaflet that explains exactly how to use the pills safely and effectively. Read it carefully and keep it with the pills in case you need to refer back to it.

How effective are combined pills?

The success rate of all contraceptive methods and agents in preventing pregnancy is being monitored and studied around the world. The results are calculated and presented in what is called the Pearl Index. Combined pills generate the lowest numbers, meaning they are among the safest. They vary from 0.1 - 0.9.. This variance in the index is due to different types of pills and some women not following the instructions strictly, forgetting a pill, mixing the sequence of multiphasic pills etc.

Other hormonal contraceptive methods, such as  NuvaRing or Evra patch are less affected by these errors, but are in approximately the same range as the combined pill.

What are the advantages of combined pills?

Combined pills are simple to use and the small packets will fit discreetly in your handbag, washbag, or other personal space at home. Used correctly, they are a highly effective way to prevent unwanted pregnancy. Some women find that the combined pill brings additional health benefits:

• Very regular menstrual bleeding
• Improve oily skin and reduce acne.
• Ease difficult menstruation, reducing heavy monthly bleeding, period pains and PMS.
• Protect against fibroids, ovarian cysts, and some forms of breast disease.
• Reduces the risks of cancer of the colon, womb, and ovaries
• Can protect against pelvic inflammatory disease

The combined pill allows you to have a normal sex life, without having to plan in advance and minimal risk of pregnancy.

Combined pill side effects

The use of hormonal contraceptives can cause side effects and it bears certain health risk, that each woman needs to familiarise yourself with, before starting. How the body reacts to the hormone supplement can vary greatly depending on each individual and the composition of the specific pill. Common side effects that almost all combined pills have in common are:

• Headaches 
• Nausea 
• Breast tenderness 
• Mood swings
• Minor vaginal bleeding and spotting 

Consult the GP, if you experience any of these. He can recommend a different pill from the large available variety, with a slightly different combination and dosage of hormones.

In rare cases the pill can cause serious health concerns. If you are known to be at risk of any of the following, it is important to inform the doctor and consider alternative contraceptive methods:  

• High blood pressure 
• Thrombosis 
• Breast cancer

Find more information in the article dedicated to risks and side effects. Before starting any hormonal contraceptive make sure to read the package leaflet. This is provided with the pill and can also be found under the specific product name on this site.

What precautions to take with the combined pill

The combined pill has been used for well over half a century by millions of women worldwide. If it is used correctly, it is generally very safe. As with any prescription medicine, there are certain precautions that you should take:

• Be accurate and open about your health situation when you complete the short online medical questionnaire.
• Follow our online Doctor’s instructions precisely.
• Read the manufacturer's leaflet that comes with your order. Keep it with your pills.
• Ensure that you have a daily routine for taking your pills correctly.
• Refer to the manufacturer's leaflet if you experience vomiting or diarrhea. 
• Refer to the manufacturer's leaflet if you forget to take a pill.
• Do not start smoking if you are over 35.
• Consult our online Doctor if you become very overweight.
• Seek immediate medical assistance if you think that you are experiencing any side effects. In an emergency dial 999.

The pill allows you to have sex whenever you want with almost no risk of pregnancy. Keep in mind that it doesn’t protect against sexually transmitted infections, including HIV, chlamydia, herpes and genital warts. If you think that you may be at risk of contracting an STI, you should use a condom in addition.

Where you can get the combined pill

All combined birth control pills are prescription medications. Therefore you need to consult a GP or Gynaecologist, when you want to use it as your long-term contraceptive solution. After the doctor makes sure hormonal contraceptives are safe for you to use he/she will recommend a product in accordance with your health profile. You can buy the pill in any regular pharmacy.

To renew your prescription it is not required to personally attend the GP or Gynaecologist again. You can request a prescription by completing a short confidential medical questionnaire online. Our duty GP will immediately check to make sure there are no health concerns that would prevent us from completing your order. Checkout price includes prescription, contraceptive pills and next day delivery by UPS courier. 

Can I use combined pills if I smoke?

Smoking is generally not recommended for women who take the pill, because is increases the risk of critical side effects. When you complete the short medical questionnaire, tell us how old you are and how many cigarettes you smoke each day. It is important that you are honest about your smoking habit. 

If you are over the age of 35 you may not be able to take the combined pill, particularly if you are a heavy smoker. You may be advised to request a prescription for an oestrogen-free mini pill which you will then be able to renew online at DoktorABC.