Combined Oral Contraceptive Pills

The combined oral contraceptive pill (COC) is an effective form of contraception containing oestrogen and progestogen. COCs prevent the release of eggs from ovaries (ovulation) in the womb and make it more difficult for the sperm to reach the egg. Also, by making cervical mucus at the cervix thicker, COCs make it harder for the fertilised egg to implant itself into the wall of the uterus. Birth control pills may also be used for the treatment of painful and heavy periods, premenstrual syndrome (PMS), and endometriosis.

Here, we will take a closer look at the combined contraceptive pill, including how they are taken, their effectiveness, side effects, and who is safe to use them.

How effective is the Combined Oral Contraceptive Pill?

Combined hormonal contraception pills are almost 100% effective at preventing pregnancy, if taken correctly, with less than 1 out of 100 women using the pill becoming pregnant annually. In reality, however, approximately 8 out of 100 women may become pregnant. This is usually due to the pill not being taken correctly.

Types of Combined Oral Contraceptive Pills

There are 3 types of COCs. They each vary in their ingredients and dosages. Some COCs contain the same dose of estrogen and progesterone throughout the pill pack, while others will have different doses of hormones present in different parts of the pack. Here are the main types of COC’s:

• Monophasic 21-day pills: This is the most common type of COC, with each tablet containing the same amount of estrogen and progestogen. Each tablet is taken daily for 21 days, with a 7-day pill-free break. E.g. Microgynon, Rigevidon, and Brevinor
• Phasic 21-day pills: These contain 2 or 3 sections of different coloured pills in the pack. Each section contains different combinations of estrogen and progestogen. Each tablet is taken once a day for 21 days, with a 7-day break. You must take the pills in the correct order. E.g. Synphase and Logynon
• Everyday pills: These come in packs of 28, with 21 active pills and 7 dummy pills. The active and dummy pills look different. Each tablet is taken daily for 28 days, without stopping to take a break. A bleed similar to a period will occur when you take the inactive pills for 7 days. E.g. Microgynon ED and Logynon ED

Taking Combined Oral Contraceptive Pills

To ensure the effectiveness of combined oral contraceptive pills, it’s important to take them correctly and consistently. Here are some essential guidelines for taking the pill:

• Pick a time to take the pill every day and stick to it. Taking the pill at the same time each day helps create a routine and reduces the chances of you missing a dose. For example, take it when you brush your teeth in the morning
• Follow your healthcare provider’s instructions carefully. Different brands of combined oral contraceptive pills may have specific instructions, so read the patient information leaflet and consult your healthcare provider if you have any questions
• Take one pill daily as prescribed. If you’re using monophasic or phasic pills, take one active pill every day for 21 days. If you’re using ED pills, take one pill daily for 28 days. You must take the pills in the correct order, without skipping any of the active pills. If you have just given birth, but are not breastfeeding, you can start taking your pills 21 days after giving birth
• Start your next pack as soon as you have finished the previous one, even if you’re still experiencing breakthrough bleeding. This will ensure you are protected against pregnancy
• Understand what to do if you have missed pills. If you have missed one active pill, take it as soon as you can, even if you have to take two pills in one day. Continue taking the rest of your pills as usual. If you have missed two or more pills, follow the instructions provided by your healthcare provider. This may include using other forms of contraception or even using emergency contraception
• Certain medications, such as antibiotics may interact with your combined oral contraceptive pill, reducing its contraceptive effect. Talk to your healthcare provider or pharmacist if you start taking any new medications while also taking the pill

You may also need to use additional contraception when you first start taking the pill. This will depend on where you are in your menstrual cycle when you first start taking the pill.

Benefits of Combined Oral Contraceptive Pills

Combined oral contraceptive pills offer benefits other than contraception. These include:

• Regulation of menstrual cycles, leading to more predictable and even lighter periods. Some pills may reduce the number of periods you have each year
• Reduced menstrual pain as well as other symptoms linked to menstruation, such as bloating and breast tenderness
• Improved acne and a reduction of excessive hair growth on the face and body
• Protection against certain diseases, such as ovarian cancer, endometrial cancer, and noncancerous breast diseases. Also, the pill may reduce the development of ovarian cysts and ectopic pregnancies
• The management of conditions such as polycystic ovary syndrome, premenstrual syndrome (PMS), and heavy menstrual bleeding caused by uterine fibroids
• Combined oral contraceptive pills can help regulate menstrual cycles for women approaching menopause, reducing hot flushes, and giving better control over the monthly cycle during perimenopause

The benefits of combined oral contraceptive pills will vary from person to person and the specific type of pill used. You should speak with a healthcare provider to decide if combined oral contraceptive pills are right for you.

Risks and Side Effects of Combined Oral Contraceptive Pills

Combined oral contraceptive pills are generally safe, but like all medications, they do have some risks and possible side effects. You should discuss the risk factors with your doctor or pharmacist. Some considerations to think about include:

• The risk of developing blood clots (and cervical cancer), particularly deep vein thrombosis or pulmonary embolism. The risk is higher in smokers, women who have a history of blood clots, or women with certain medical conditions. Let your healthcare provider know if you have a family history of blood clots
• Women who smoke, are over 35 or have certain medical conditions may have an increased risk of cardiovascular problems, such as heart attacks or stroke. Discuss your medical history and lifestyle with your healthcare provider to evaluate the risks before starting treatment
• Hormonal side effects, such as breast tenderness, headaches, nausea, and mood changes may occur. These are normally mild and will improve over time. Speak to your healthcare provider if your side effects persist or become worse
• Combined oral contraceptive pills do not directly cause weight gain, but some individuals may see slight changes in their weight. You should try to maintain a healthy lifestyle, including regular exercise and a balanced diet. This is regardless of whether you are using the pill or not
• Changes in sex drive, vaginal discharge, or skin pigmentation

Who should not use Combined Oral Contraceptive Pills

Combined oral contraceptive pills may not be suitable for everyone. Discuss your medical history and any other pre-existing medical conditions you may have with your healthcare provider before you start taking the pill. Situations where the pill may not be recommended include:

• Smoking increases the risk of cardiovascular issues, especially in women over 35. It’s generally advised to look for alternative methods of contraception if you smoke and are over 35
• If you have a history of blood clots, deep vein thrombosis, pulmonary embolism, or other clotting disorders, the pill may not be right for you. These conditions may increase the risk of you developing further blood clots
• Women with a history of heart disease, high blood pressure, stroke, or certain other heart conditions may be advised not to use the pill as these conditions may increase the risk of cardiovascular complications
• If you have a history of breast cancer you would generally be recommended not to use combined oral contraceptive pills, as they may affect your hormone levels and increase your risk of breast cancer
• Women who experience migraines with aura may be at an increased risk of suffering a stroke while using the pill. Speak to your healthcare provider about your migraines, to assess whether the pill is a safe option for you

Speak to your healthcare provider to assess your health risks to determine the most suitable contraception option for you.

Conclusion

You should speak to your GP, family planning nurse, or a healthcare provider at a sexual health clinic who will evaluate your medical history, discuss your risks, and provide you with recommendations. They will help you choose the most suitable combined oral contraceptive pill and provide you with guidance on how to take the pill correctly.

Combined oral contraceptive pills do not protect against STIs (sexually transmitted infections), if you have unprotected sex or if STI protection is needed, use additional barrier contraception, such as condoms. Understanding the benefits, risks, and proper use of combined oral contraceptive pills, will help you decide about your needs and help you take control of your health.

Sources

• NHS Inform – Combined Oral Contraceptive Pills
• Mayoclinic – Combined Oral Contraceptive Pills
• Acog – Combined Oral Contraceptive Pills
• Cdc – Combined Oral Contraceptive Pills