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Combined Oral Contraceptive Pills

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Table of contents
OverviewEffectiveness of Combined Oral Contraceptive PillsTypes of Combined Oral Contraceptive PillsTaking Combined Oral Contraceptive PillsBenefits of Combined Oral Contraceptive PillsRisks and side effects of Combined Oral Contraceptive PillsWho should not use Combined Oral Contraceptive PillsConclusionSources
Navin Khosla NowPatientGreen tick
Medically reviewed by Navin Khosla, BPharm and written by Rajive Patel, BPharm - Updated on 26 Jan 2024
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The combined oral contraceptive (COC), commonly known as “the pill,” is a highly effective form of contraception that contains synthetic female hormones, oestrogen, and progestogen. It works by preventing ovulation (the release of an egg from the ovaries) and making it difficult for sperm to reach the egg or for the fertilized egg to implant in the uterus, by making mucus at the opening of the uterus (cervix) thicker. In addition to preventing pregnancy, the pill is also used to treat various conditions such as painful periods, heavy periods, premenstrual syndrome (PMS), and endometriosis. The mini pill only contains the hormone progesterone.

In this comprehensive guide, we will explore the different aspects of combined contraceptive pills, including their effectiveness, how to take them, potential side effects, and who can safely use them. We will draw information from various reputable sources, including the American College of Obstetricians and Gynecologists (ACOG) and Mayo Clinic, to provide you with accurate and up-to-date information.

Effectiveness of Combined Oral Contraceptive Pills

When taken correctly, combined oral contraceptive pills are over 99% effective at preventing pregnancy. This means that fewer than 1 in 100 women who use the pill as contraception will become pregnant in a year. However, it’s important to note that with real-world use, the effectiveness of the pill can be slightly lower. Approximately 8 in 100 women who use the pill may become pregnant due to incorrect use, such as forgetting to take pills.

Types of Combined Oral Contraceptive Pills

There are different types of combined oral contraceptive pills available, and they may vary in their hormone compositions and dosages. Some pills contain a fixed dose of estrogen and progestogen throughout the entire pill pack, while others have different hormone levels in different phases of the pack. Here are the main types of combined oral contraceptive pills:

  • Monophasic 21-day pills: This is the most common type of pill. Each pill in the pack contains the same amount of estrogen and progestogen. One pill is taken daily for 21 days, followed by a 7-day break where no pills are taken. Examples include Microgynon, Rigevidon, and Brevinor
  • Phasic 21-day pills: Phasic pills contain 2 or 3 sections of different colored pills in a pack. Each section contains a different combination of estrogen and progestogen. One pill is taken daily for 21 days, followed by a 7-day break. It’s important to take the pills in the correct order. Examples include Synphase and Logynon
  • Every day (ED) pills: ED pills come in a pack containing 28 pills, with 21 active pills and 7 inactive (dummy) pills. The active and inactive pills look different. One pill is taken daily for 28 days without a break between packs. During the 7 days of taking the inactive pills, a bleed similar to a period occurs. Examples include 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 specific time to take the pill every day and stick to it. Taking the pill at the same time each day helps establish a routine and reduces the chances of missing a dose. For example, you can 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 it’s important to 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. It’s important to take the pills in the correct order and not skip any active pills. If you’ve just had a baby and are not breastfeeding, you may start taking the pill on day 21 after the birth. You will be protected from becoming pregnant straight away
  • Start your next pack immediately after finishing the previous one. Once you finish a pack of combined oral contraceptive pills, start a new pack the next day, even if you’re still experiencing breakthrough bleeding. This ensures continuous protection against pregnancy
  • Understand what to do if you have missed pills. If you miss one active pill, take it as soon as you remember, even if it means taking two pills in one day. Continue taking the rest of the pack as usual. If you miss two or more pills, follow specific guidelines provided by your healthcare provider, which may include using backup contraception and considering emergency contraception
  • Be aware of potential drug interactions. Certain medications, such as antibiotics and anticonvulsants, may interact with combined oral contraceptive pills and reduce their effectiveness. Consult your healthcare provider or pharmacist if you’re starting any new medications while taking the pill

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

Benefits of Combined Oral Contraceptive Pills

Combined oral contraceptive pills offer several benefits beyond contraception. Here are some of the potential advantages of using combined oral contraceptive pills:

  • Regulation of menstrual cycles: Combined oral contraceptive pills can help regulate menstrual cycles, leading to more predictable and lighter periods. Some types of pills can even reduce the number of periods a woman has per year
  • Reduced menstrual pain and symptoms: Combined oral contraceptive pills can help alleviate menstrual cramps, also known as dysmenorrhea. They may also reduce the severity of other symptoms associated with menstruation, such as bloating and breast tenderness
  • Improved acne and excessive hair growth: Certain types of combined oral contraceptive pills can help improve acne and reduce excessive hair growth on the face and body, a condition known as hirsutism
  • Protection against certain diseases: Using combined oral contraceptive pills has been associated with a lower risk of ovarian cancer, endometrial cancer, and noncancerous breast diseases. It may also reduce the risk of developing ovarian cysts and ectopic pregnancy
  • Treatment of specific conditions: Combined oral contraceptive pills can be used to manage conditions such as polycystic ovary syndrome (PCOS), premenstrual syndrome (PMS), and heavy menstrual bleeding caused by uterine fibroids or other underlying causes
  • Smoother transition to menopause: For women approaching menopause, combined oral contraceptive pills can help regulate menstrual cycles, reduce hot flashes, and provide better control over the monthly cycle during the transition period known as perimenopause

It’s important to note that the benefits of combined oral contraceptive pills may vary depending on the individual and the specific type of pill used. It’s recommended to consult with a healthcare provider to determine if combined oral contraceptive pills are the right choice for you and to discuss the potential benefits and risks.

Risks and side effects of Combined Oral Contraceptive Pills

While combined oral contraceptive pills are generally safe and well-tolerated, they do carry some risks and potential side effects. It’s crucial to discuss risk factors with your healthcare provider. They will check it is safe for you to take the pill before prescribing it. Here are some important considerations:

  • Risk of blood clots: There is a small risk of developing blood clots (and cervical cancer), particularly deep vein thrombosis (DVT) or pulmonary embolism, while using combined oral contraceptive pills. The risk is higher in women who smoke, have a history of blood clots, or have certain medical conditions. It’s important to inform your healthcare provider about any personal or family history of blood clots
  • Cardiovascular issues: Women who smoke, are over the age of 35, or have certain medical conditions may be at an increased risk of cardiovascular issues, such as heart attack or stroke, while using combined oral contraceptive pills. It’s crucial to discuss your medical history and lifestyle habits with your healthcare provider to evaluate the potential risks
  • Hormonal side effects: Combined oral contraceptive pills may cause hormonal side effects, such as breast tenderness, headaches, nausea, and mood changes. These side effects are usually mild and improve with time. If side effects persist or become severe, consult your healthcare provider for further guidance
  • Weight changes: There is no evidence to suggest that combined oral contraceptive pills directly cause weight gain. However, some individuals may experience slight fluctuations in weight due to hormonal changes or other factors. It’s important to maintain a healthy lifestyle, including regular exercise and a balanced diet, regardless of using the pill
  • Other potential side effects: Combined oral contraceptive pills may also have other less common side effects, such as changes in libido, vaginal discharge, or skin pigmentation. If you experience any unusual or concerning symptoms while taking the pill, consult your healthcare provider for further evaluation

Who should not use Combined Oral Contraceptive Pills

While combined oral contraceptive pills are safe for most healthy women, they may not be suitable for everyone. It’s important to discuss your medical history and any pre-existing conditions with your healthcare provider before starting the pill. Here are some situations where combined oral contraceptive pills may not be recommended:

  • Smokers over the age of 35: Smoking increases the risk of cardiovascular issues while using combined oral contraceptive pills, especially in women over the age of 35. It’s generally advised to explore alternative methods of contraception if you smoke and are over 35 years old
  • History of blood clots: If you have a history of blood clots, deep vein thrombosis, pulmonary embolism, or certain clotting disorders, combined oral contraceptive pills may not be suitable for you. These conditions increase the risk of developing further blood clots while using the pill
  • History of cardiovascular issues: Women with a history of heart disease, high blood pressure, stroke, or certain heart conditions may be advised against using combined oral contraceptive pills. These conditions can increase the risk of cardiovascular complications while using hormonal contraceptives
  • History of breast cancer: If you have a history of breast cancer, it’s generally recommended to avoid using combined oral contraceptive pills, as they may affect hormone levels and potentially increase the risk of breast cancer recurring
  • migraines with aura: Women who experience migraines with aura (visual disturbances or other neurological symptoms preceding a migraine) may be at an increased risk of stroke while using combined oral contraceptive pills. It’s important to discuss your migraines with your healthcare provider to evaluate the safety of using the pill

These are just a few examples of situations where combined oral contraceptive pills may not be the recommended contraceptive method. It’s essential to have a thorough discussion with your healthcare provider to assess your individual health risks and determine the most suitable contraception option for you.

Conclusion

Combined oral contraceptive pills are a popular and effective method of birth control that offers additional benefits beyond contraception. They work by preventing ovulation and altering the uterine environment to make it less favorable for fertilization and implantation. However, it’s important to understand the potential risks and side effects associated with the use of combined oral contraceptive pills.

You can speak to a GP, family planning nurse, or a healthcare provider at sexual health clinic who can evaluate your medical history, discuss potential risks, and provide personalized recommendations. They will help you choose the most appropriate type of combined oral contraceptive pill and guide you on how to take it correctly for optimal effectiveness.

Remember, combined oral contraceptive pills do not protect against sexually transmitted infections (STIs) if you have unprotected sex. If STI protection is needed, it’s important to use additional contraception, such as condoms, in combination with the pill.

By understanding the benefits, risks, and proper use of combined oral contraceptive pills, you can make an informed decision about your contraceptive needs and take control of your reproductive health. Always consult with your healthcare provider for personalized advice and guidance tailored to your specific circumstances.

Sources

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NowPatient has taken all reasonable steps to ensure that all material is factually accurate, complete, and current. However, the knowledge and experience of a qualified healthcare professional should always be sought after instead of using the information in this page. Before taking any drug, you should always speak to your doctor or another qualified healthcare provider.

The information provided here about medications is subject to change and is not meant to include all uses, precautions, warnings, directions, drug interactions, allergic reactions, or negative effects. The absence of warnings or other information for a particular medication does not imply that the medication or medication combination is appropriate for all patients or for all possible purposes.

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