Combined Oral Contraceptive Pill (COC)
You can now get the pill from a pharmacy in your local area without a prescription. Whether you're already taking the pill or looking for your first supply, you can arrange a confidential consultation at a local participating pharmacy. It's completely free for everyone and you don't need to be registered with a GP.
If 100 sexually active women don’t use any contraception, 80 to 90 will become pregnant in a year. If the pill is taken according to instructions it is over 99 per cent effective. This means that less than one woman in 100 will get pregnant in a year.
If the pill is not taken according to instructions, more women will become pregnant.
The main way the pill works is to stop the ovaries from releasing an egg each month (ovulation) and it also thickens the mucus from the cervix (making it difficult for sperm to move reach an egg) and it makes the lining of your uterus (womb) thinner so it is less likely to accept a fertilised egg.
There are lots of advantages of taking the COC, such as:
- Menstrual bleeds become regular, lighter and less painful
- May alleviate premenstrual symptoms
- Reduces the risk of some cancers such as ovarian, uterine and colon
- May reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease
- May improve acne
- Normal fertility returns immediately after stopping the COC.
- Temporary side-effects may last a few months and include headaches, nausea, breast tenderness and mood changes.
- Breakthrough bleeding (unexpected vaginal bleeding on pill taking days) is common when first starting the COC. It will improve, try and remember to take the pill at a set time of day. Missed a pill?
- The COC may increase your blood pressure
- The COC does not protect you against sexually transmitted infections, so you may need to use condoms
- The COC is not suitable for everyone so the doctor or nurse will ask about your own and your family’s medical history.
- The COC is not suitable for women who have had a thrombosis. The risk of venous thrombosis increases if you are overweight, a smoker, 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 increased if you smoke, are diabetic, have high blood pressure, 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 COC appear to have a very small increased risk of being diagnosed with breast cancer compared to non-users of hormonal contraception, but this reduces with time after stopping the COC.
- They are less effective than long-acting reversible methods of contraception
Research has shown that the COC does not cause weight gain.
If you are healthy, don’t smoke and there are no medical reasons, the COC can be used until you are 50 years old. You may then need to change to another method of contraception.
The COC needs to be stopped if you experience:
- 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
- A bad fainting attack or you collapse
- Unusual headaches or migraines that are worse than usual
- Sudden problems with your speech or eyesight
- Jaundice (yellowing skin or yellowing eyes).
Progestogen-only pill (POP)
The progestogen-only pill (POP) contains a progestogen hormone which is like the natural progesterone women produce in their ovaries. POP do not contain estrogen like the Combined Oral Contraceptive Pill (COC). POPs contain different types of progestogens. (POPs containing desogestrel will be named specifically where relevant on this page). If you are not sure what type of progestogen is in your POP, check the patient information leaflet inside your pack or ask your doctor or nurse.
If 100 sexually active women don’t use any contraception, 80 to 90 will become pregnant in a year. If taken according to instructions the POP is over 99 per cent effective. This means that less than one woman in 100 will get pregnant in a year.
If the POP is not taken according to instructions, more women will become pregnant.
POP need to be taken every day, even during times of vaginal bleeding (with no breaks).
POP need to be taken at a regular time of day either within a 12 hour time frame (window period) and some older type POP within a three hour time frame (e.g. if you take your older type POP at 8am every day, you would need to take it no later than 11am every day) Missed a pill?
The POP works by thickening the mucus from your cervix. This makes it difficult for sperm to move through it and reach an egg.
The newer type POP (containing the hormones desogestrel) sometimes stops your ovaries releasing an egg (ovulation).
The POP works by thickening the mucus from your cervix. This makes it difficult for sperm to move through it and reach an egg.
The newer type POP (containing the hormones desogestrel) sometimes stops your ovaries releasing an egg (ovulation).
- POP can be taken by most women
- Can be used whilst breastfeeding
- Can be used if contraception containing oestrogens, like those found in the combined pill (COC) or contraceptive patch are contraindicated
- Can be used at any age, weight and if you
- It is very effective when taken correctly.
- Sex need not be interrupted to use.
- It can be used when breastfeeding.
- It can be used by women for whom the combined oral contraceptive is not suitable.
- There is no evidence suggesting a delay in the return of fertility when the POP is stopped.
- The POP may help to alleviate painful periods.
Available evidence has not shown an increased risk of pregnancy in POP users with a heavier body weight or a higher body mass index (BMI).
- The POP must be taken daily with no pill-free interval.
- Adverse effects may occur, such as unscheduled bleeding and breast tenderness.
- Contraceptive efficacy is likely to be reduced in women using liver enzyme-inducing drugs.
- It does not protect against sexually transmitted infections (STIs).
Some women may develop small fluid-filled cysts on their ovaries. These cysts usually disappear without treatment.
I’ve missed a pill, what should I do?
This depends on a number of different factors; what pill you take, how many pills you’ve missed and where in your packet you are.
Take a pill and then take your next once at the usual time, taking two on the same day is fine. Carry on taking your pills as normal but use condoms for a week as you won’t be protected against pregnancy.
If you have only missed one pill, take that pill when you remember and finish the pack as normal. You will be protected against pregnancy
If two or more are missed, take your most recent pill when you remember and finish the pack as normal. You will not be protected against pregnancy and will need to use condoms for a week.
COC need to be taken every day, usually for 21 days followed by a seven day break.
Each packet of pills starts on the same day of the week (e.g. if you start your first packet on a Wednesday, every packet starts on a Wednesday).
Always start your next packet of pills, even if you are still bleeding or if you miss a bleed. The worst pills to miss are at the beginning of the packet.
COC need to be taken at a regular time of day within a 24 hour time frame (window period), for example, if you take your COC at 8am every day, you would need to take it no later than 8am the following day).
Emergency contraception may be needed if there has been unprotected sex around this time. This is available from GUM clinic up to five days after unprotected sex. If you are towards the end of your packet (less than seven pill), it needs finishing and then start the next packet without having the seven day break.
Pills missed anywhere else in the packet (more than seven pills left) take pills as normal with a seven day break.