The combined pill

This article explores the combined pill, its advantages, disadvantages, side effects. How does the combined pill work? Will it be suitable for you?

What is the combined pill

The combined pill is a combination of two hormones, progesterone and oestrogen. These pills are usually taken for 21 days and then you have a break of 7 days, during which time you will experience a light vaginal bleed (like a period).

How does it work?

Each month your ovaries in your pelvis produce an egg, ready for fertilization by sperm, during sexual intercourse.

This combination of two hormones prevents your body from producing an egg. Therefore, if taken reliably it is very unlikely you will get pregnant.

Where can you get combined pill from?

The combined pill is available on prescription form the Family Planning Centre (FPC) or your family doctor. However, your doctor may not think the combined pill is suitable for you, as there are certain risks – see below.

What types of combined pill are available?

There are many brands of combined pills available and your doctor will discuss which would be most suitable for you. For example if you also have acne or painful periods then some hormone combinations will be more effective than others.

How much does the combined pill cost?

A prescription for the combined pill for under 22 year olds will cost $3. For 22 year olds Andover, you prescription charges will vary according to your age and whether or not you have a Community Service Card.

What is the success rate of the combined pill?

In preventing pregnancy the combined pill is 99% effective if taken correctly. Therefore if 100 women took the pill for 1 year, one would get pregnant.

Each packet has precise instructions relating to that particular pill.

If not taken correctly (for example, pills are forgotten) it is only 97% effective in preventing pregnancy.

The combined pill is not effective in preventing STIs and needs to be used in conjunction with condoms and lubricant.

What are the risks in taking the combined pill?

The combined pill has received much press in the last 40 years, regarding side effects.

Research has shown there are side effects, but remember that the side effects of the pill are much worse in an unplanned pregnancy – for example, blood clots in the leg are much more common in pregnancy than while taking the combined pill.

The greatest risks of taking the pill are when this is combined with smoking cigarettes. Smoking related diseases are the greatest killers of young women. When this is combined with taking the combined contraceptive pill, these risks of blood clots and strokes are increased further.

Risks of cancer of the breast and the cervix are increased by taking the combined pill

The pill is unsuitable for the following groups of women –

• Those over 35 who smoke
• Those who are immobile for a period of time, due to a broken leg, for example
• Women who are overweight
• Women with a family history (parent, brother, sister) of blood clot (deep vein thrombosis), heart attack or stroke.

What are the pros?

The pill does not interrupt love making – but remember it is only suitable to prevent pregnancy, not sexually transmitted diseases!

If taken correctly, it is highly effective in preventing pregnancy.

The combined pill can reduce acne

If you are healthy, a non smoker and the pill is working well for you, you can take it successfully for many years.

The pill does not affect your chance of getting pregnant, once you stop taking it. Most women get pregnant within a few months of stopping the combined pill – remember that 1 in 10 women will have problems conceiving, whether they have been on the pill or not.

If you have experienced heavy and painful periods, the pill may help prevent this, as periods are usually light whilst you are on the pill.

Cancer of the ovary and the endometrium (lining of the womb) are reduced by 50%.

What are the cons?

Some women will experience uncomfortable symptoms to begin with, while taking the pill.

• Nausea and appetite changes
• Irregular bleeding or spotting
• Breast tenderness
• Headaches
• Weight changes
• Mood changes
• Skin changes – some women notice acne worsening on the pill.

Sometimes these settle after a few months, but sometimes you may need to return to your doctor or FPC to try a different brand or combination.

The combined pill is unsuitable during breastfeeding, as it affects milk supply to the baby. However, the progesterone pill (or mini pill) can be taken during breast feeding.

The combined pill is not suitable for people with a poor memory. The pill needs to be taken every day without fail.

What to do if you forget your pill?

If you forget one pill, take it as soon as you remember. 

If you forget 2 pills within 7 days then you will need to use another form of contraceptive until you have taken the pill correctly for 7 days in a row. Otherwise your body may release an egg, ready for fertilization and pregnancy.

Follow this 7 day rule of using another contraceptive also (such as a condom) if you have diarrhoea and vomiting, or you are taking a medicine with affects the combined pill, such as antibiotics.

Always inform your doctor/pharmacist that you are taking the combined pill, before you accept any other medicine.

Useful websites and articles

Remember that the combined pill does not prevent you getting STIs. Visit our article Condoms for more information on condoms and lubricants.

To find your local Family Planning Centre visit-

www.fpanz.org.nz