Combined Oral Contraceptive Pill

If it is your first time taking the combined contraceptive pill or you are restarting:

• Start it on days 1-5 of your next period and you will have full contraceptive cover immediately.
• If you have not been sexually active since your last period, you can start it at any time of your cycle. If taken correctly, you will have full contraceptive cover after 7 days of pill-taking. You should use additional contraception during this 7-day lead-in time.
• If you are changing from another pill/ form of contraception, please contact us via your patient record for specific instructions.

Each combined contraceptive pill packet contains 21 pills which are labelled 1-21. Traditionally, combined contraceptive pills are taken for 21 days with a 7-day break, and this cycle is then repeated.

It is important that you take your pill at the same time every day.

Tailored Pill-Taking

There is no medical reason to have a 7-day pill-free break. It is now recommended that contraceptive pills can be used in cycles as follows if preferred, to provide more reliable contraceptive cover and better bleeding control:

1. 21-day use with a 4-day break (most pill-free intervals should now be 4 days).
2. 3 packets together with no break and then a 4-day break.
3. Continuous use of the pill until spotting for 2 days, then a 4-day break and then restart the pill and continue until spotting occurs again.

If you follow a set pattern and have a planned break, you will usually bleed during this time. Make sure you start the next pill packet after the recommended pill-free break, regardless of your bleeding pattern.

It is essential that you take your pill around the same time every day.

These are examples of ‘off-licence’ pill prescribing. This means they are being used in a different way than that detailed on the product licence by the drug company. These methods of pill use are supported by the Faculty of Sexual and Reproductive Health. They are considered to be safe.

We can offer you advice on this, just send us a message via your account when you have completed the request questionnaire.

Occasionally skin changes, such as acne, decreased libido (sex drive), altered mood, and fatigue are reported.

If you develop any of these symptoms and they are persisting or you are concerned, please speak with your doctor. There are many alternative combined pill options to consider.

Combined oral contraceptive pills can cause increases in blood pressure. It is not medically safe to take this pill if you have high blood pressure. A blood pressure check should be performed every 6 months to monitor for this as you are unlikely to have any symptoms.

For full details of the potential birth control side effects of these medications, please ensure you read the patient information leaflet that comes with your medication before you start to use it.

Yes, taking a combined contraceptive pill increases your risk of developing potentially harmful blood clots, compared to non-users. The overall risk of a blood clot is very small and is significantly lower than if you were pregnant or during the postpartum period. Blood clots are potentially very serious and in very rare cases can be fatal.

You should see a doctor immediately if you develop any of the following symptoms when taking the combined oral contraceptive pill:

• Pain or swelling in the legs
• Severe chest pain
• Breathlessness or coughing up blood
• Bad fainting attack or collapse 
• Unusual headaches or difficulty with speech or sight
• Numbness or weakness of a limb

Some combined contraceptive pills have a higher risk profile than some other combined contraceptive pills.

• If a blood clot develops in the leg, it can cause deep vein thrombosis (DVT)
• If it travels to the lung, it can cause a pulmonary embolism (PE)
• If it travels to the heart, it can cause a heart attack
• If it travels to the brain, it can cause a stroke

The risk of developing a blood clot is greatest in the months immediately after starting the combined contraceptive pill or when restarting after a break of at least one month. This risk reduces over the first year of use and then remains stable. It is for this reason that frequent starting and stopping of the combined oral contraceptive pill should be avoided.

Other things that can increase your risk of developing a blood clot when taking the combined contraceptive pill include:

• Being overweight
• Smoking
• Increasing age (from 35 years and older)
• Having a family member with a blood clot aged <45 years
• Postpartum (6-12 weeks post-delivery)
• Reduced mobility (even temporarily)

The more of these risk factors that apply to you, the greater your risk.

Seek additional advice if you are:

• Having a procedure or surgery (of any type)
• Planning a long-haul flight
• Planning a holiday to an area of high altitude
• Immobilised for a prolonged period of time

Further information about blood clot risk is detailed in the leaflet that comes with your medication. Please read this before you start the combined contraceptive pill.

If you are taking the combined contraceptive pill regularly, you can delay or prevent your period by skipping your pill-free break. You do this by running 2 pill packets together without a break (42 pills). You can run up to 3 pill packets together at a time (63 pills) and then you should have a pill-free break (ideally 4 days, but no more than 7 days). 

This is a form of tailored pill-taking, as discussed above in the second section of the Important Medical Information – “How do you take the combined oral contraceptive pill?”

Some people will experience breakthrough bleeding when taking pill packets back-to-back though.

Please note, this advice applies to traditional pill-taking (21 pills then a 7-day break).

• If your missed pill is less than 12 hours late:
  • Take the missed pill as soon as you remember and continue with your pill packet as usual.
  • You will have full contraceptive cover and do not need to use additional contraception.

• If your missed pill is more than 12 hours late, or you have missed more than one pill:
  • Take the missed pill as soon as you remember and carry on with your pill packet as usual. You may need to take 2 pills together (do not take more than one missed pill).
  • Use additional precautions for the next 7 days.
  • If you have more than 7 days left in your pill packet, then take your break as usual.
  • If you have less than 7 days remaining in your pill packet, do not take a break and start your next pill packet. If you do not have a bleed at the end of the second packet, you should do a pregnancy test.
• If your missed pill was in the first week of your cycle and you had unprotected sex, then you should speak with a healthcare professional as you may need emergency contraception.

• If you start your new pill packet more than one day late, you will need to use additional contraceptive protection for 7 days.

• If you have unprotected sex during the 7 days you are not fully covered for contraception, you should speak with a doctor via online video consultation as you may need emergency contraception.

If you have any questions or concerns about this, or you are using a tailored pill-taking regime, please speak to a healthcare professional.

If you are using combination pills for reasons other than contraception, then missing a very occasional pill is of no significant consequence.
If you have any vomiting or watery diarrhoea, you must use extra precautions during the illness and for seven days after the illness ends.

Some medications (prescribed and over the counter), herbal remedies and supplements can interact with the pill. This can cause contraceptive failure and increase the possibility of potential side effects.

Please seek advice from a healthcare professional (e.g. doctor, pharmacist or nurse):

• Before starting any new medications, herbal remedies or supplements if you are taking the combined oral contraceptive pill.
• If you are taking regular medication and are planning to restart using combined contraceptive pills (or any contraceptive).

Examples of medications that can interact with combined birth control pills include emergency contraceptive pills, St John’s wort, antiviral medications used to treat HIV/ AIDs, certain epilepsy medications, some antifungal medications, and some antibiotic medications.