How to take the combined contraceptive pill

There are a variety of different ways you can take the combined contraceptive pill. This depends on the brand of combined contraceptive pill you have and if you would like to skip your period or not. 

In this article we’ll be talking about the combined contraceptive pill only, but if you would like information about the progestogen only pill (sometimes known as the mini pill) click here. Please note, if you’re taking the combined pills Qlaira or Zoely the information below may not apply to you. 

What is the combined pill?

The combined contraceptive pill combines 2 hormones (hence the name), oestrogen and progestogen. These are similar to the hormones produced by the ovaries and work to both prevent an egg being released and thin the lining of the womb. Both these actions make it harder for an egg to be fertilised and implant in the lining of the womb. 

The combined pill, when taken correctly, is 99% effective at preventing pregnancy. 

When should I start taking the pill?

As long as you’re sure you’re not pregnant, you can start taking the combined contraceptive pill at any point in your menstrual cycle. Depending on when you start you’re likely to have different levels of protection against pregnancy.

You’ll be protected from pregnancy:

• immediately - if you start the combined pill on the first day of your period
• immediately - if you start the combined pill on up to and including the fifth day of your period, as long as you do not have a very short cycle or a cycle that changes.
• after 7 days - if you start the combined pill at any other time during your menstrual cycle. You’ll need to use another form of contraception, such as a condom, if you have sex in those 7 days. 

Don’t forget, taking the pill only protects against pregnancy, and not sexually transmitted infections (STIs). The only form of contraception which will also protect against STIs are condoms. Find out more about getting an STI test or STI treatments.

Different types of combined contraceptive pill

There are 3 main types of combined contraceptive pill:

• Monophasic: this type of pill is typically taken for 21 days in a row and then no pills are taken for 7 days. This is the most common type of combined contraceptive pill and popular brands include Microgynon, Rigevidon, Lucette, Brevinor, Gedarel 30 and Cilest. 
• Everyday: these packs contain 21 active pills (with hormones) and then 7 inactive pills (placebo or dummy, without hormones). These must be taken in the correct order and are taken for the 28 days without a break. Popular brands include Microgynon ED and Femodene ED.
• Phasic: each pack of phasic pills will contain 2 or 3 different coloured sections. Each of these sections contain different levels of hormones and must be taken in the correct order. After 21 days the pack comes to an end and typically you have a 7 day break. A common brand of this type of pill is Logynon. 

All of these are designed to give you a withdrawal bleed, which is like a period but is not a period. This bleed is caused by the break in the hormones during the pill-free or placebo week. 

How do I take the pill?

There are different ways to take the combined pill. How this is done depends on the type of pill and if you want to miss your withdrawal bleed or not.

Monophasic pills

• Take the pills for 21 days and then have a 7 day break. This is the typical way to take this type of pill and means you’ll usually have a withdrawal bleed. Start the pack again on the eighth day, even if you’re still bleeding.
• Take the pills for 21 days and then have a 4 day break. This means you’ll usually have a withdrawal bleed. Start the pack again on the fifth day, even if you’re still bleeding.
• Take the pill everyday for 9 weeks (three packs of pills) and then a break for either 7 or 4 days. You’ll usually have a withdrawal bleed in this break but should start the next pack on the fifth or eighth day, even if you’re still bleeding. 
• Take the pills every day with no break. You won’t have a withdrawal bleed but you’re likely to get some bleeding/spotting on occasion. 
• Take the pill everyday for at least 21 days. If the breakthrough bleeding is too much for you, you can then take a break from the pill for 4 days to help manage this bleeding. Restart the pill on the correct day and keep taking them for at least another 21 days. 

Everyday pills

• Take the pills in the correct order continuously. You will usually have a withdrawal bleed during the time you’re taking the placebo pills. Once the pack is finished you start the next one straight away, even if you’re still bleeding. 
• Take the pills for the first 21 days and then skip the placebo pills to start the next pack. This means you’ll avoid the withdrawal bleed.

Phasic pills

• Take the pills in the correct order for 21 days and then have a 7 day break. You will usually have a withdrawal bleed during your break but you should start the next pack on the eighth day even if you’re still bleeding. 
• If you want to avoid 1 or more withdrawal bleed on the phasic pill, you should discuss this with your doctor or nurse to check the safest way to go about this. 

Am I protected against pregnancy during the pill-free week or placebo week?

Provided you’ve taken your pills correctly, start the next pack at the right time and nothing else has happened (such as sickness or diarrhoea), you should be protected during this week. 

Sickness and diarrhoea

If you’re sick within 3 hours of taking a pill, it might not have been absorbed by your body. As long as no more pills are missed (i.e. you’re not sick again the following day after taking your pill), you'll be protected from pregnancy.

If you have severe diarrhoea which lasts more than 24 hours, this could make your pill less effective. But you should treat each day with severe diarrhoea as if you’ve missed a pill. 

Missing a pill

If you’ve missed a pill, the best thing to do is look at the instructions on the Patient Information Leaflet, contained in the packaging of the pill. Different combined pills may have different guidance on what to do when missing a pill, depending on how many pills have been missed and the time that has passed. 

You can visit our contraception clinic to get more information about the different types of contraception. Start a free consultation to get the advice and support of our clinicians to help you choose the right contraception for you. 

Sources
https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/