The combined oral contraceptive pill (COC)
The combined oral contraceptive pill is a popular choice of contraceptive for women. The main types of combined contraceptive pill include standard strength oestrogen pills which can either be taken on a 21 or 28 day cycle and low oestrogen pills. Combined oral contraceptive pills contain both progesterone and oestrogen.
How do oral contraceptive pills work?
The pills contain hormones that prevent pregnancy by:
- Stopping ovulation
- Making it more difficult for sperm to travel up to the womb by thickening the mucus in the neck of the womb
- Making it more difficult for an egg to implant in the womb by making the lining of the womb thinner
The pill is one of the most effective forms of contraception currently available to patients.
Common COCs
There are a number of different contraceptive pills on offer; some are used to treat heavy and painful periods and acne, as well as providing contraception, so if you have either of these problems you may want to discuss this with your doctor.
Common brands of combined oral contraceptives are listed below:
Standard strength oestrogen (21 day cycle)
- Microgynon 30
- Yasmin
- Cilest
- Loestrin 30
- Dianette
Standard strength oestrogen (28 day cycle)
- Microgynon ED
- Logynon ED
- Femondene ED
Low strength oestrogen (21 day cycle)
- Mercilon
- Sunya 20/75
- Femodette
Is the pill suitable for everyone?
The pill can provide a very effective means of contraception for many people but it is not suitable for everyone. The pill should generally not be given to people who have more than one of the following risk factors:
- If you are over 35
- If you have a history of blood clots
- If you smoke
- If you are very overweight or obese
- If you suffer from migraines
- If you have high blood pressure
- If you have had a stroke in the past
- If you have family history of clotting
- If you have restricted mobility
There is evidence to suggest that women that take the pill are at a very slightly higher risk of developing breast cancer (the risk is increased from 5 in 2000 to 4 in 2000 by taking the contraceptive pill); research has also proven that taking the pill reduces the risk of suffering from endometrial and ovarian cancer.
Taking the pill
If you want to go on the pill you need to see your GP; they will work out which pill is best for you and check that you are safe to take the pill. If you decide to go ahead and go on the pill you will start taking the pill after your next menstrual cycle has started.
It is important to try and take your pill at roughly the same time each day; this will increase the efficacy of the pill. If you miss a pill, take it as soon as you realise and continue to take the rest of the pills as normal. As a general rule, missing less than three pills should have no effect; however, if you have missed more than three pills you should consider taking an emergency contraception pill and you should use additional contraception for the next 7 days. If you have any concerns about taking your pill or missing pills, talk to your GP. If you are sick or have severe diarrhoea shortly after taking your pill (within 2-3 hours), you should take another pill as the first one will not have had chance to be absorbed properly.
Taking other medications may affect your pill so it is best to use other forms of contraception if you are taking certain medications; you should ask your doctor about taking other medications with your pill. Your pill may also not work as effectively if you are suffering with illnesses such as colds or flu or gastroenteritis so you should consider using alternative forms of contraception for a period of 7 days.
Emergency contraceptive pill
The emergency contraceptive pill is commonly known as ‘the morning after pill’; it must be taken within 72 hours of having sexual intercourse to be effective. The pill is much more effective if it is taken within 24 hours of intercourse (the pill is effective in 95% of cases within 24 hours; the rate falls to 58% after 48 hours). There are currently two brands of emergency contraceptive pill available; these include Levonelle one step and Levonelle 1500.
Where can I get the emergency contraceptive pill?
The emergency contraceptive pill is available free of charge from GP surgeries and some family planning clinics. It is also available from some pharmacies, but they will charge in the region £26 per pill.
How does the pill work?
Both types of pill work in the same way. The pill works by:
- Stopping ovulation
- Thickening the mucus on the neck of the womb (which makes it more difficult for sperm to reach the womb)
- Thinning the lining of the womb (which makes it more difficult for the egg to implant)
Taking the pill
It is important to realise that the emergency contraceptive pill should not be used regularly as a form of contraception; it should be used in exceptional circumstances. Once you have taken the pill, continue to use contraception. Most people have a period at the normal time but some people may experience light bleeding after taking the emergency contraceptive pill. If your period is more than 7 days late you should see your GP as you may be pregnant.
Are there any side-effects?
Some people experience side-effects after taking the emergency contraceptive pill; common side-effects include:
- Abdominal pain
- Irregular menstruation (this includes bleeding between periods)
- Nausea
- Tiredness