When taken correctly, the pill is over 99% effective at preventing pregnancy. This means that fewer than one woman in 100 who use the combined pill as contraception will get pregnant in one year.
You need to take the pill every day for 21 days, then stop for seven days, and during this week you have a period-type bleed. You start taking the pill again after seven days.
You need to take the pill at the same time every day. You could get pregnant if you don't do this, or if you miss a pill, or vomit or have severe diarrhoea.
If you have heavy periods or painful periods, the combined pill can help.
Minor side effects include mood swings, breast tenderness and headaches.
There is no evidence that the pill makes women gain weight.
There's a very low risk of serious side effects such as blood clots and cervical cancer.
The combined pill is not suitable for women over 35 who smoke, or women with certain medical conditions.
The pill does not protect against sexually transmitted infections (STIs), so using a condom as well will help to protect you against STIs.
Monophasic 21-day pills
This is the most common type. Each pill has the same amount of hormone in it. One pill is taken each day for 21 days and then no pills are taken for the next seven days. Microgynon, Brevinor and Cilest are examples of this type of pill.
Phasic 21-day pills
Phasic pills contain two or three sections of different coloured pills in a pack. Each section contains a different amount of hormones. One pill is taken each day for 21 days and then no pills are taken for the next seven days. Phasic pills need to be taken in the right order. Binovum and Logynon are examples of this type of pill.
Every day (ED) pills
There are 21 active pills and seven inactive (dummy) pills in a pack. The two types of pill look different. One pill is taken each day for 28 days with no break between packets of pills. Every day pills need to be taken in the right order. Microgynon ED and Logynon ED are examples of this type of pill.
Follow the instructions that come with your packet. If you have any questions about how to take the pill, ask your GP, practice nurse or pharmacist. It's important to take the pills as instructed because missing pills or taking them at the same time as certain medicines may make them less effective.
How to take 21-day pills
Take your first pill from the packet marked with the correct day of the week, or the first pill of the first colour (phasic pills).
Continue to take a pill at the same time each day until the pack is finished.
Stop taking pills for seven days (during these seven days you will get a bleed).
Start your next pack of pills on the eighth day, whether you are still bleeding or not. This should be the same day of the week as when you took your first pill.
How to take every day pills
Take the first pill from the section of the packet marked ‘start’. This will be an active pill.
Continue to take a pill every day, in the correct order and preferably at the same time each day, until the pack is finished (28 days).
During the seven days of taking the inactive pills you will get a bleed.
Start your next pack of pills after you have finished the first, whether you are still bleeding or not.
Starting the combined pill
Most women can start the pill at any time in their menstrual cycle. There is special guidance if you have just had a baby, abortion or miscarriage. You may need to use additional contraception during your first days on the pill – this depends on when in your menstrual cycle you start taking it.
If you start the combined pill on the first day of your period (day one of your menstrual cycle) you will be protected from pregnancy straight away. You will not need additional contraception.
If you start the pill on the fifth day of your period or before you will still be protected from pregnancy straight away, unless you have a short menstrual cycle (your period is every 23 days or less). If you have a short menstrual cycle you will need additional contraception, such as condoms, until you have taken the pill for seven days.
If you start the pill on any other day of your cycle you will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for seven days.
Taking pill packs back to back
For monophasic combined pills (pills all the same colour and with the same level of hormones), it is normally fine to start a new pack of pills straight after your last one, for example if you want to delay your period for a holiday.
However, avoid taking more than two packs together unless advised to by a doctor or nurse. This is because you may have breakthrough bleeding as the womb lining sheds slightly. Also, some women find they feel bloated if they run several packs of the pill together.
What to do if you miss a pill
If you miss a pill or pills, or you start a pack late, this can make the pill less effective at preventing pregnancy. The chance of getting pregnant after missing a pill or pills depends on:
when the pills are missed
how many pills are missed
A pill is late when you have forgotten to take it at your usual time. You have missed a pill when it is more than 24 hours since the time you should have taken it. Missing one pill anywhere in your pack or starting the new pack one day late isn’t a problem as you will still be protected against pregnancy (known as having contraceptive cover).
However, missing two or more pills or starting the pack two or more days late (more than 48 hours late) may affect your contraceptive cover. In particular, if you make the seven-day pill-free break longer by forgetting two or more pills, your ovaries might release an egg and there is a risk of getting pregnant. This is because your ovaries are not getting any effect from the pill during the seven-day break.
If you miss a pill, follow the advice below. If you are not sure what to do, continue to take your pill and use another method of contraception, such as condoms, and seek advice as soon as possible.
If you have missed one pill, anywhere in the pack:
take the last pill you missed now, even if it means taking two pills in one day
continue taking the rest of the pack as usual
you don’t need to use additional contraception, such as condoms
take your seven-day pill-free break as normal
If you have missed two or more pills (you are taking your pill more than 48 hours late) anywhere in the pack:
take the last pill you missed now, even if it means taking two pills in one day
leave any earlier missed pills
continue taking the rest of the pack as usual and use an extra method of contraception for the next seven days
you may need emergency contraception
you may need to start the next pack of pills without a break (see Starting the next pack after missing two or more pills)
You may need emergency contraception if you have had unprotected sex in the previous seven days and have missed two or more pills (you are taking your pill more than 48 hours late) in the first week of a pack.
Get advice from your contraception clinic, doctor or pharmacist about this. You can also call NHS Direct on 0845 46 47 (24 hours a day).
Starting the next pack after missing two or more pills
If there are seven or more pills left in the pack after the last missed pill:
finish the pack
have the usual seven-day break
If there are fewer than seven pills left in the pack after the last missed pill:
finish the pack and start the new one the next day, without having a break
Advantages and disadvantages
Some advantages of the pill include:
it does not interrupt sex
it usually makes your bleeds regular, lighter and less painful
it reduces your risk of cancer of the ovaries, womb and colon
it can reduce symptoms of premenstrual syndrome
it can sometimes reduce acne
it may protect against pelvic inflammatory disease
it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease
Some disadvantages of the pill include:
it can cause temporary side effects at first, such as headaches, nausea, breast tenderness and mood swings – if these do not go after a few months, it may help to change to a different pill
it can increase your blood pressure
it does not protect you against sexually transmitted infections
breakthrough bleeding and spotting is common in the first few months of using the pill
it has been linked to an increased risk of some serious health conditions such as thrombosis (blood clots) and breast cancer
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