Contraception – the combined pill

About the pill#

There are 2 types of oral contraception: the combined pill, known as ’the pill’, and the progestogen only pill (sometimes called the mini pill).

The combined pill contains the hormones oestrogen and progestogen, which are similar to hormones produced by the ovaries. The progestogen only pill contains only progestogen. Both are taken daily and are available on prescription.

How effective is the pill?#

The pill is a very effective form of contraception when used correctly.

• Used correctly, the pill is at least 99% effective at preventing pregnancy.
• Allowing for mistakes in everyday use, it is about 93% effective.

The pill may not work if:

• you miss a pill, or take it more than 24 hours late
• you vomit within 3 hours of taking it
• you have very severe diarrhoea
• you are taking some medications or natural remedies (check with your doctor, nurse or pharmacist)

How the pill works#

The pill works by stopping the ovaries from releasing an egg each month. It also thickens the fluid around the cervix (the opening to the uterus or womb) to stop sperm from entering.

When you start the pill for the first time, or after a break, it can take up to 12 days to start working to prevent pregnancy. This depends on whether you begin with a hormone pill or a sugar pill. Speak with a doctor, nurse or pharmacist about the best way to start.

How to use the pill#

You take the pill by swallowing one pill at around the same time every day. There are many different brands, and most come in a 28-day pack that includes both hormone pills and sugar (inactive) pills. You will usually have your period (bleeding from the vagina) while taking the sugar pills.

You can skip your period by missing the sugar pills and continuing to take the hormone pills each day.

Speak to your doctor, nurse or pharmacist about which brand is most suitable for you.

If you miss a pill#

• Take the missed pill as soon as you notice (this may mean taking 2 pills on the same day).
• Continue to take your pills as normal.
• Use condoms for a period of time, depending on where you are up to in the pill packet (check with your doctor, nurse or pharmacist).
• If you have had sex without a condom in the 7 days before missing a pill, you may need emergency contraception.

Benefits of the pill#

The pill can:

• be used to skip your period
• make your periods lighter, more regular and less painful
• improve acne
• reduce your chance of cancer of the uterus (womb), ovaries and bowel
• help with symptoms of polycystic ovary syndrome (PCOS) and endometriosis

Once you stop taking the pill, your fertility quickly returns to normal.

Side effects#

Possible side effects for a small number of people who take the pill include:

• irregular vaginal bleeding
• nausea
• sore or tender breasts
• headaches
• bloating
• changes to your skin
• mood changes

These side effects often settle with time. The pill has not been shown to cause weight gain.

Serious health problems and the pill#

The pill causes a very small increase in your risk of deep vein thrombosis (blood clot), heart attack or stroke. It may also lead to a tiny increase in your risk of breast cancer. Overall, serious problems are rare.

When the pill may not be a good option#

The pill may not be the best option for you if you:

• find remembering a daily tablet difficult
• are taking certain medications that might stop the pill from working (check with your doctor, nurse or pharmacist)
• are unable to move around for a long time (for example, because of surgery or disability)
• have certain types of migraine or headache
• are very overweight
• have a close family member who has had a deep vein thrombosis
• have had health conditions such as high blood pressure, deep vein thrombosis, heart or liver disease (check with your doctor, nurse or pharmacist)
• are over 35 years and smoke
• have been treated for breast cancer

The pill, pregnancy and after having a baby#

If you get pregnant while taking the pill, the pill will not harm the pregnancy. It is safe to continue the pregnancy (and stop the pill) or to have an abortion.

After having a baby:

• If you are breastfeeding, you can use the pill after about 6 weeks, but other types of contraception might be better choices (check with your doctor, nurse or pharmacist).
• If you are not breastfeeding, you can start the pill once your baby is 3 to 6 weeks old (check with your doctor, nurse or pharmacist).

You can stop the pill at any time and your fertility will quickly return.

Where to get the pill#

Your doctor can provide a prescription for the pill, which you take to a pharmacy. Some brands may be more expensive than others.

If you run out of pills and cannot see a doctor for a new prescription, speak to a pharmacist. They can often supply a small quantity of pills without a prescription. If possible, show them your old pill packet.

Many community health services and some public hospitals have a family planning clinic, a sexual health clinic or a women’s health clinic where you can book an appointment.

Protection from STIs#

The pill does not protect you from sexually transmissible infections (STIs). The best way to lessen the risk of STIs is to use barrier protection, such as internal and external condoms, with all new sexual partners.

Key points#

• Used correctly, the pill is at least 99% effective at preventing pregnancy.
• It also thickens the fluid around the cervix (the opening to the uterus or womb) to stop sperm from entering.
• The pill has not been shown to cause weight gain.
• It may lead to a tiny increase in your risk of breast cancer.

Where to get help#