What is the combined pill?
- The combined contraceptive pill (also called the pill) is a type of hormonal contraception. It contains the hormones oestrogen and progestogen.
- It prevents pregnancy by stopping the ovaries releasing an egg each month.
- The combined pill is not suitable for everyone.
- It’s over 99% effective if you use it correctly all the time. If not used correctly, for example missing a pill, it’s less effective.
- When you stop taking the pill, your fertility usually returns to previous levels after about a month.
- The pill can help with acne, heavy or painful periods, PMS (premenstrual syndrome) and endometriosis.
- You can compare different methods, including how well they work and side effects, when choosing a method of contraception.
The combined pill does not stop you getting and passing on sexually transmitted infections (STIs). Use a condom every time you have sex to protect you and your partner against STIs, including HIV.
Where to get the combined pill
Where can I get the combined pill?
Contraception services are free and confidential on the NHS.
You can get the combined pill from:
- sexual health clinics, also called family planning or contraception clinics
- GP surgeries
- some pharmacies
- some young people's services (call the national sexual health helpline on 0300 123 7123 for more information)
A pharmacist may be able to supply the combined pill for free without a prescription. Speak to a pharmacist for advice.
Getting contraception if you’re under 16
Contraception is free and confidential, including for young people under the age of 16.
The doctor or nurse will not tell anyone, including your parents or carer, unless they think you or someone else is at risk of harm.
Who can take the combined pill
Can I take the combined pill?
The combined contraceptive pill (also called the pill) is not suitable for everyone.
You may not be able to take it if you’re living with obesity, or you’re aged 35 or over and you smoke.
The pill may not be suitable if you have ever had:
- blood clots, or a family member had blood clots under the age of 45
- narrowed or blocked arteries, or a stroke
- a heart problem, heart disease, or high blood pressure
- migraines with warning signs called aura
- breast cancer
- gallbladder or bile duct problems
- liver cancer or severe cirrhosis
- complications due to diabetes
If any of these apply to you, talk to a doctor, nurse or pharmacist about whether it’s safe for you to take the pill.
Taking the combined pill for acne and heavy or painful periods
Taking the combined pill usually makes your periods regular, lighter and less painful.
The pill may also help the symptoms of:
If you have painful or heavy periods, or problem acne, ask a GP or pharmacist whether the pill could help with your symptoms.
Taking the combined pill after birth or when breastfeeding
If you have just had a baby and are not breastfeeding, you can usually start the pill on day 21 after the birth, but check with a midwife, health visitor, doctor, nurse or pharmacist first. You’ll need to use another type of contraception, such as condoms, for 7 days after you start taking the pill.
If you’re breastfeeding, you should wait 6 weeks after giving birth before you start taking the pill. You’ll need to use a different method of contraception, such as condoms, until then and for 7 days after you start taking the pill.
Taking the combined pill after a miscarriage or abortion
If you’re less than 24 weeks pregnant and have a miscarriage or abortion, you can start taking the pill straight away. If you start taking it within 5 days you’ll be protected from pregnancy immediately.
If you start the pill more than 5 days after a miscarriage or abortion, use another type of contraception, such as condoms, until you’ve taken the pill for 7 days.
If you’re more than 24 weeks pregnant and have a miscarriage, you can usually start the pill on day 21 after the miscarriage. Use another type of contraception, such as condoms, for 7 days after you start taking the pill.
How to take the combined pill
Different ways to take the combined pill
There are 2 main ways to take the combined pill (also called the pill).
Everyday (ED) pill
You take the everyday (ED) pill every day.
Each packet comes with dummy pills that do not contain any hormones. These are a different colour to the active pills. Some types have 7 dummy pills, while others have 2 or 4.
Follow the instructions in the leaflet that comes with your pills.
21-day pill
You take the 21-day pill for 21 days, then have a break (not taking a pill) for 7 days.
Follow the instructions in the leaflet that comes with your pills.
With both types of pill, you’ll usually have bleeding like a period when you take the dummy pills or have the 7-day break.
Tailored regimes
Some people taking the 21-day pill may choose to have a shorter break, fewer breaks or no break between pill packets. This is called a tailored regime and can reduce symptoms such as headaches and bleeding during pill breaks.
For more information about tailored regimes, speak to a doctor, nurse or pharmacist.
Starting the combined pill
If you’re taking the pill for the first time, you can usually start taking it at any point in your menstrual cycle. The advice may be different if you have a short menstrual cycle (less than 20 days).
There are separate instructions for the brands Zoely and Qlaira.
Read the information leaflet that comes with your pills. Speak to a doctor, nurse or pharmacist if you’re not sure when to start taking the pill.
Starting on day 1 to 5 of your menstrual cycle
If you start taking the pill in the first 5 days of your cycle (day 1 is the first day of your period), you will be protected from pregnancy straight away.
Starting after day 5 of your menstrual cycle
If you start taking the pill more than 5 days after the start of your period, you will not be protected from pregnancy straight away.
You’ll need to use another type of contraception, such as condoms, until you’ve taken the pill for 7 days.
Starting Zoely or Qlaira
If you start taking Zoely or Qlaira on the first day of your period, you’ll be protected from pregnancy straight away.
If you start taking it after day 1 of your period, use another type of contraception until you’ve been taking:
- Zoely pills for 7 days
- Qlaira pills for 9 days
If there’s a chance you could already be pregnant when you start taking the pill, take a pregnancy test 3 weeks after the last time you had unprotected sex.
How well the combined pill works
You need to take the combined pill at the same time every day for it to work properly.
When used correctly all the time, the pill is more than 99% effective.
If not used correctly, it’s 91% effective and about 9 in 100 women will get pregnant in a year. This is because things can go wrong, for example you might forget to take a pill.
Medicines and herbal remedies that affect the combined pill
Some medicines and herbal remedies can affect how the combined pill works. The pill may not work properly to stop you getting pregnant.
Ask a doctor or pharmacist for advice before taking the pill if you take medicine to treat TB (tuberculosis), epilepsy or HIV.
You should also ask for advice if you take griseofulvin (an antifungal medicine), lamotrigine (a mood stabiliser), or St John's wort (a herbal remedy).
You may need to use another type of contraception.
Side effects and risks of the combined pill
Common side effects of the combined pill
You may have some side effects when you first start taking the combined contraceptive pill (also called the pill).
Bleeding between periods (breakthrough bleeding) or changes to your periods are common in the first few months.
Taking the pill can cause high blood pressure in a small number of people.
Some people report headaches, feeling sick or dizzy, and sore breasts. But there is not enough evidence to say whether this is caused by taking the pill.
For some people the pill improves period pain and other symptoms linked to periods, such as headaches.
There is no evidence that taking the pill makes you put on weight or changes your sex drive.
If you still have side effects after 3 months and they’re a problem for you, speak to a pharmacist or doctor. It may help to change to a different pill, or to have a shorter pill-free break or no break between pills (a tailored regime).
Find out about choosing a method of contraception, including side effects and risks of different methods.
Risks of the combined pill
There are some other problems linked to taking the combined pill. But the chance of getting these is small.
Blood clots
The risk of getting a blood clot is very small and affects up to 1 in 1,000 people using combined hormonal contraception like the pill.
A doctor, nurse or pharmacist will check if you have certain risk factors before prescribing the pill.
There is a potential risk of:
- a blood clot in your leg or lung
- a blood clot causing a heart attack
- a blood clot causing a stroke
Find out more about blood clots, including symptoms and when to get help.
Cancer
Taking the pill can slightly increase your risk of getting:
But your risk of breast cancer and cervical cancer goes back to normal 10 years after you stop taking the pill.
Taking the pill can also lower your risk of getting:
More information
Cancer Research UK: does the contraceptive pill increase cancer risk?
What to do if you miss a combined pill or take an extra one
What to do if you miss a combined pill
If you forget to take your pills, or you’re late taking a pill, what you need to do next depends on:
- what type of combined pill you’re on
- how many pills you’ve missed
- where you are in the pack (day and week)
Talk to a pharmacist to find out what to do, or read the information leaflet that comes in your pill pack.
You may need emergency contraception.
Emergency contraception
Speak to a pharmacist, sexual health clinic or GP or call 111, as the combined pill can affect how some emergency contraception works.
What to do if you take an extra combined pill
Taking more than one contraceptive pill is unlikely to harm you.
However, it may make you:
- feel sick or be sick (vomit)
- have some vaginal bleeding
Speak to a doctor or pharmacist if you get any of these symptoms.
What to do if you’re sick or have diarrhoea when taking the combined pill
If you’re sick (vomit) less than 3 hours after taking the combined pill (or up to 4 hours after taking the Qlaira or Zoely pill), take another pill straight away and then take the next one at the usual time.
If you’re still being sick, use another type of contraception, such as condoms, until you’ve taken the pill for 7 days without being sick.
If you have diarrhoea for more than 24 hours, keep taking your pill as normal. Use another type of contraception, such as condoms, until 7 days after your diarrhoea has stopped.
Vomiting or diarrhoea before your pill-free break
If you’re sick (vomit) or have diarrhoea for more than 24 hours while taking the last 7 pills before your pill-free break or before the dummy pills in the pack (pills 15 to 21), take the 7 pills as normal then start your next pack straight away. Do not have a pill-free break, and do not take the dummy pills.
Use another type of contraception, such as condoms, until you’ve taken the pill for 7 days without being sick or having diarrhoea.