5.1 Combined Oral Contraceptive Review

For most women the combined contraceptive pill is a safe and effective form of contraception. In some women it can increase the risk of developing serious health problems. Your health care team need to check that it is still safe to prescribe the pill for you.

If you have a home blood pressure monitor you can use this to record your reading. You can purchase these from most pharmacies or alternatively source online. Alternatively you can visit our health check room at the surgery and ask to use our machine. You could also check your weight at the same time if you do not have scales at home.

You still need barrier contraception to protect yourself from sexually transmitted infections

Not everyone can use the combined pill so your doctor or nurse will need to ask you about your own and your family’s medical history. Do mention any illness or operations you’ve had. Some of the conditions which may mean you shouldn’t use the combined pill are:

• you think you might already be pregnant
• you smoke and are 35 years old or over
• you’re 35 years old or over and stopped smoking less than a year ago
• you’re very overweight
• you take certain medicines
• you’re breastfeeding a baby less than 6 weeks old

You have now or had in the past:

• thrombosis (blood clots) in any vein or artery or a member of your immediate family had thrombosis before they were 45 years old heart disease or a stroke
• systemic lupus erythematosus with positive antiphospholipid antibodies
• a heart abnormality or circulatory disease, including hypertension (raised blood pressure)
• migraines with aura
• breast cancer or you have the gene that’s associated with breast cancer
• active disease of the liver or gall bladder
• diabetes with complications
• you’re immobile for a long period of time or use a wheelchair
• you’re at high altitude (more than 4,500m) for more than a week

If you’re healthy, don’t smoke and there are no medical reasons for you not to take the pill, you can use it until you’re 50 years old. You’ll then need to change to another method of contraception.

Yes. You’re protected if:

• you’ve taken all the pills correctly and
• you start the next pack on time and
• nothing else has happened that might make the pill less effective.

Some of the advantages of the pill are, it:

• usually makes your bleeds regular, lighter and less painful
• may help with premenstrual symptoms
• reduces the risk of cancer of the ovary, uterus  and colon
• improves acne in some people
• may reduce menopausal symptoms
• may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease

What are the disadvantages of the COCP?

• There are some serious side effects ( see what are the risks FAQ )

In addition:

• you may get temporary side effects at first
  including headaches, nausea, breast tenderness
  and mood changes. If these don’t stop within a
  few months, changing the type of pill may help
• the pill may increase your blood pressure O the pill doesn’t protect you against sexually
  transmitted infections, so you may need to use
  condoms as well
• breakthrough bleeding (unexpected vaginal
  bleeding on pill taking days) and spotting is
  common in the first few months of use

The pill can have some serious side effects, but these aren’t common. For most people the benefits of the pill outweigh the possible risks. All risks and benefits should be discussed with your doctor or nurse.

• A very small number of pill users may develop venous thrombosis, arterial thrombosis, heart attack or stroke. If you’ve ever had thrombosis, you should not use the pill. Some types of pill appear to be associated with a slightly higher risk of venous thrombosis. The risk of venous thrombosis is greatest during the first year that you take the pill and if any of the following apply to you: you smoke, you’re very overweight, are immobile for a long period of time or use a wheelchair, or a member of your immediate family had venous thrombosis before they were 45 years old. The risk of arterial thrombosis is greatest if any of the following apply to you: you smoke, are diabetic, have hypertension, are very overweight, have migraines with aura, or a member of your immediate family had a heart attack or stroke before they were 45 years old.
• Research suggests that users of the pill appear to have a small increased risk of being diagnosed with breast cancer compared to non-users of hormonal contraception, which reduces with time after stopping the pill.
• Research suggests that there’s a small increase in the risk of developing cervical cancer with longer use of estrogen and progestogen hormonal contraception.

See a doctor straight away if you have any of the following:

• pain in the chest, including any sharp pain which is worse when you breathe in breathlessness  you cough up blood  painful swelling in your leg(s)
• weakness, numbness, or bad ‘pins and needles’ in an arm or leg severe stomach pains
• bad fainting attack or you collapse
• unusual headaches or migraines that are worse than usual sudden problems with your speech or eyesight O
• jaundice (yellowing skin or yellowing eyes).

If you go into hospital for an operation or have  an accident which affects the movement of your legs, tell the doctor you’re taking the combined pill. You may need to stop taking the pill or need other treatme

Research hasn’t shown that the pill causes weight gain. You may find that your weight changes throughout your cycle due to fluid retention.

Missing pills or starting the pack late may make the pill less effective. The chance of pregnancy after missing pills depends on:

• when pills are missed
• how many pills are missed.

Missing one pill anywhere in your pack or starting the new pack one day late isn’t a problem. You’ll still have contraceptive cover.

Missing two or more pills or starting the pack two or more days late may affect your contraceptive cover.

Use the chart on pages 12–13 of the FPA information leaflet to check. You can obtain this from the download section. If you are ever unsure  use extra protection and contact your health care professional for advice.

If you vomit within two hours of taking a pill, it won’t have been absorbed by your body. Take another pill as soon as you feel well enough. As long as you’re not sick again your contraception won’t be affected. Take your next pill at the normal time. If you continue to be sick, seek advice. If you have very severe diarrhoea that continues for more than 24 hours, this may make the pill less effective. Keep taking your pill at the normal time, but treat each day that you have severe diarrhoea as if you’d missed a pill and follow the missed pill instructions on pages 12–13 of the FPA information leaflet ( accessed via the download section )

If you’ve had sex without contraception, or think your method might’ve failed, there are different types of emergency contraception you can use.

• An IUD is the most effective option. It can be fitted up to five days after sex, or up to five days after the earliest time you could’ve ovulated (released an egg).
• An emergency contraceptive pill with the active ingredient ulipristal acetate can be taken up to five days (120 hours) after sex. It’s available with a prescription or to buy from a pharmacy. ellaOne is the only brand in the UK.
• An emergency contraceptive pill with the hormone levonorgestrel can be taken up to three days (72 hours) after sex. It’s more effective the earlier it’s taken after sex. It’s available with a prescription or to buy from a pharmacy. There are different brands. Emergency pills are available for free from some pharmacies. Age restrictions may apply.