Everything you need to know about The Pill.

Approximately 100 million women worldwide take the pill, including one in three women of reproductive age in the UK. If you’re considering your contraception options and are thinking about going on the pill, here’s everything you’ll ever need to know, from how it works and how to take it, to advantages and side effects.

What is it?

Commonly known just as ‘the pill’, the combined oral contraceptive (COC) pill is one of the most widely prescribed drugs. After 50 years on the market it continues to meet the contraceptive needs of a wide variety of women.

The combined pill is named thus because it contains two hormones, Oestrogen and Progestrone. These are synthetic versions of the natural hormones involved in the menstrual cycle.

How does it work?

Contraception in its many forms is designed to prevent pregnancy, which occurs when sperm reaches an egg (ovum). The egg are stored in the ovaries and every month one is released (ovulation).

The pill works by preventing ovulation, therefore no egg is released. It also causes the mucus in the cervix to thicken. The cervix is the opening to the uterus and thickening here helps to prevent sperm entering the uterus. Thirdly it makes the womb lining thinner, which means it’s less likely to accept a fertilised egg.

Why are there so many types?

There are currently 28 brands of the COC pill on the market in UK. The choice can cause confusion, but all contain Oestrogen and Progesterone and work in the same way to prevent pregnancy. Talk to your doctor about which brand is right for you.

How effective is it?

The COC pill is extremely effective as a contraceptive method. If it is taken as recommended, estimates are almost 100%. It is thought to be the most preventative method, apart from sterilisation.

Certain factors can make the pill less effective, such as diarrhoea and vomiting, anti-epilepsy drugs, HIV medication, certain antibiotics and taking the morning-after pill. Consult your GP or family planning clinic for advice if you’re unsure, and use extra contraception until you’re confident you’re completely protected.

What are the benefits?

In addition to its effectiveness, the COC pill can help to relieve heavy or painful periods, meaning menstruation is light and regular with reduced premenstrual symptoms.

It has also been shown to reduce the risk of cancer of the ovary, womb and colon. A 2010 report from The Royal College of General Practitioners showed that Pill-users have a 12 per cent reduction in their risk of developing these cancers.

Additionally many couples prefer oral contraception as it doesn’t interrupt sex.

What are the risks?

It’s important to be aware that the pill won’t protect against sexually transmitted infections (STIs), including HIV.

During the first few months it’s also possible for women to experience minor side effects, such as headaches, nausea and spotting between periods. These symptoms should go away after the first few packs as your body adjusts. If discomfort persists consult your doctor about switching to another brand.

In addition there can be serious side effects, though these are less common. The COC can increase your blood pressure and there is evidence linking use to increased risk of blood clots (thrombosis) and breast cancer.

Who can use it?

Although widely prescribed, the pill isn’t suitable for all women. You shouldn’t take the pill if you’re pregnant, you smoke or stopped within the last year, are 35 or older or are seriously overweight.

Also the increased risk of blood clots means those with high blood pressure or heart disease, gallbladder or liver disease, diabetes or severe migraines (with aura), should avoid the pill.

How do you use it?

The most common type of COC pill is the monophasic 21-day. Each pack contains 21 pills with the same amount of hormone. One pill is taken daily, at the same time of day, for three weeks. No pills are taken for the next 7 days, which is when you will have your period. Phasic 21 day pills are similar but contain different amounts of hormone. These are in different coloured sections that must be taken in the correct order.

There are also every day (ED) pills. These include 21 active pills and seven inactive pills, which look different and need to be taken in the correct order. Some inactive pills have added iron, which can cause side effects in some women.

Most women can start taking the pill at any time during their menstrual cycle. Get advice if you’ve recently been pregnant. If taken on the first day of your period your will be protected immediately, otherwise you many need additional contraception for a short time.

What happens if I forget to take it?

It’s important to remember to regularly take your pills for complete protection.

Always consult the leaflet that comes with your medication for what to do in the event that you miss a pill. If you forget one pill, take it as soon as you remember, then ensure you take the next one on time (even if this means taking two at once). To be certain that you’re protected, you can take extra precautions for a few days. However, if you are more than 12 hours late taking a pill, avoid sex for 7 days or take extra precautions.

It can be particularly risky to miss more than one pill in a row, especially near the beginning or end of a packet. If you’re ever in doubt that you’re fully-protected don’t have sex or use condoms. Contact your family planning clinic for advice if you’re concerned.

Where can I get it?

To begin taking the pill you must go to see your GP, practice nurse, family planning clinic or sexual health clinic, to assess your risk factors and talk through your prescription. This is your chance to ask any questions.

Women can also obtain three-month supplies of their current contraceptive pill online. This service is only available to women who have been taking the same pill for the last year and have had a face-to-face check-up in that time.

For personal advice on the COC pill and its suitability for you, consult your GP or local family planning clinic.