Combined pill (COC)

When you stop using the combined pill your fertility will return to normal. (Don’t worry if your periods don’t start immediately, for some women it can take a few months.)

The combined pill prevents ovulation and limits the build-up of the lining of the womb (endometrium) that is usually lost with your period. This results in a shorter, lighter and often less painful bleed.

It is not harmful to continue to take your next pack of pills without a 7 day break or miss out inactive (dummy) pills with EveryDay combined pills.

The Faculty of Sexual and Reproductive Healthcare has issued guidance supporting taking the combined pill without a monthly 7 day break:

(It is noted that these ways of taking the pill are ‘off licence’ use - this does not mean it is unsafe, but that taking the pill in this way is not within the UK product licence.)

• 'Tricycling' is taking a pill each day without any breaks for 3 continuous packs (9 weeks). Then stop for 4 or 7 days - during this time you may or may not bleed. Continue taking the pill in this manner (3 packs continuously followed by 4 or 7 days off).
• 'Extended pill taking' is taking a pill each day without any breaks, until you notice 3-4 days of continuous bleeding (where you need to use a tampon or pad). Stop taking the pill for the next 3-4 days, even if the bleeding stops. Then resume taking the pill every day, and when one pack is finished go straight on to the next pack. Don’t worry if you don't bleed, it doesn’t occur with everyone. When starting this method, you must take a pill for 21 consecutive days before taking a break.

Bleeding is common when you first start taking the combined pill. It can take up to 3 months to settle down, but it’s very important to keep taking the pills to the end of the pack, even if your bleeding is heavier than usual.

Once your body is used to the pill, your period should become regular, with bleeding during the pill-free week.

Bleeding can also be caused by not taking the pill correctly, or by a sexually transmitted infection or pregnancy. If the bleeding does not settle down, or if you are concerned, speak to your GP, sexual health clinic or call NHS 111 for advice.

If you vomit within 2 hours of taking the combined pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

If you continue to be sick, keep using another form of contraception while you're ill and for 7 days after recovering.

Very severe diarrhoea (6 to 8 watery stools in 24 hours) may also mean that the pill doesn't work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for 7 days after recovering.

Speak to your GP or contraception nurse or call NHS 111 for more information, or if your sickness or diarrhoea continues.

Research is ongoing into the link between breast cancer and the pill. Research suggests that users of all types of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with women who do not use them. However, 10 years after you stop taking the pill, your risk of breast cancer goes back to normal.

Research has also suggested a link between the pill and the risk of developing cervical cancer and a rare form of liver cancer. However, the pill does offer some protection against developing endometrium (lining of the womb) cancer, ovarian cancer and colon cancer.

The combined pill may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease.

Research has not shown that the combined pill leads to weight gain. Some women find that their weight changes due to fluid retention or an increase in appetite, but this should settle over time.

If you have missed one pill anywhere in the pack:

• Take the last pill you missed now and take the next pill at the normal time.
• Continue taking the rest of the pack as usual.
• You don’t need to use additional contraception, such as condoms.
• Take your 4 or 7 day pill-free break as normal.

If you have missed 2 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 2 pills in 1 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 7 days.
• Check how many pills you have left in your pack. If it is more than 7 pills then complete the pack as usual and take the 4 or 7 day break at the end of the packet. If you have less than 7 pills left in the pack, then miss the break at the end of this packet and start the new packet immediately without the 4 or 7 day pill free interval.
• You may need emergency contraception if you have had unprotected sex since missing the pills or in the 7 days before missing the pills.

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.

Taking the combined pill can increase your blood pressure. There is a small increased risk of some serious health conditions, such as thrombosis (blood clots) and breast cancer or cervical cancer. These risks reduce with time after stopping the pill.

Some medicines make the combined pill less effective (including those used to treat epilepsy, HIV and TB, and the herbal medicine St John’s Wort). Ask your GP, clinician or pharmacist and read the information that comes with your medicine.

The combined pill can cause temporary side effects, such as mood swings, when you start taking it. If these do not go away after a few months, speak to your GP or sexual health clinic about using a different form of contraception.

Most women can take the combined pill, but your GP or clinician will ask about your family and medical history to determine whether or not it is the best method for you.

The combined pill is not always suitable for women who:

• are pregnant;
• smoke (or stopped smoking less than a year ago) and are 35 or older;
• are very overweight;
• are over 50 years old.

It may also be unsuitable if you:

• take certain medicines (ask your GP about this);
• have or have had thrombosis;
• have or have had a heart abnormality or heart disease, including high blood pressure;
• have or have had severe migraines, especially with aura (disturbances of vision or sensation);
• have or have had breast cancer;
• have or have had disease of the gallbladder or liver;
• have or have had diabetes;
• are immobile for a long period of time or use a wheelchair;
• have systemic lupus erythematosus;
• have a family history of thrombosis;
• have a family history of cardiovascular problems at a young age.

This depends on when in your cycle you start taking it. If you start within the first 5 days of your menstrual cycle, then it will be effective immediately. If you start after the first 5 days of your cycle, then the combined pill will not be effective for 7 days. If you are switching from one method of contraception to another, then you should talk to your doctor or nurse about using additional contraception.

You may sometimes be provided or prescribed a different brand of pills, but the nurse or clinician will explain that the hormones and doses will be the same.

Some reports suggest that there may be a very small increased risk of breast cancer and cervical cancer, but the pill does help protect against other types of cancers such as ovarian, colon and uterine cancers.

There is no evidence to suggest the pill causes infertility. Most women, who have regular periods, will find that their normal cycle will return within 6 months. Some women find that their usual cycles begin again very quickly after stopping, but for others it can take longer.

The benefits of long-term use of the pill usually outweigh the risks.

See a doctor straight away if you have any of the following:

• 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).

It may reduce menopausal symptoms in some women but is not recommended for women over 50.

If you have just had a baby and are not breastfeeding, you can start the pill on day 21 after the birth. You will be protected against pregnancy straight away. If you start the pill later than 21 days after giving birth, you will need additional contraception (such as condoms) for the next 7 days.

If you are breastfeeding a baby less than 6 months old, taking the pill can reduce your flow of milk. It is recommended that you use a different method of contraception until you stop breastfeeding.

If you have had a miscarriage or abortion, you can start the pill up to 5 days after this and you will be protected from pregnancy straight away. If you start the pill more than 5 days after the miscarriage or abortion, you'll need to use additional contraception until you have taken the pill for 7 days.