Hormonal contraceptives are grouped by the type and number of hormones in them. There are two main groups:
- One group contains two types of hormone – oestrogen and progesterone – and these are known as combined hormonal contraceptives (CHC). These include tablets, the contraceptive patch and the vaginal ring.
- The other group contains just the hormone progesterone. This group includes progesterone only tablets (which are also often called the ‘mini pill’), the depo injection, the contraceptive implant and the hormonal coil.
This summary is about combined hormonal contraceptives often referred to as ‘the pill’.
‘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.’ (NHS Choices 2015). However average use of the pill has a 9% failure rate (Centre for Disease Control 2015).
Combined hormonal contraceptive methods work by stopping the ovaries releasing an egg every month. This means that the woman’s own natural cycle of egg release and periods is switched off. If a woman wants to have a regular bleed every month then she can stop the hormones for 7 days every 4 weeks to create a ‘withdrawal bleed’. To do this the user takes her pills daily for 3 weeks (or uses the contraceptive patch or ring for 3 weeks) then has a week off to create a bleed, then they repeat the cycle. If she wants fewer bleeds than this, she can run packets of pills, patches or rings together without a break. A doctor or nurse can explain how to do this. It’s not how these products were originally designed to be used but is safe and effective and preferred by an increasing number of women.
The ‘withdrawal bleed’, that most women get when they take a week’s break between packets of the combined pill, is lighter and shorter than a woman’s usual period. For this reason some young women take the combined pill to help with heavy or painful periods even before they need contraception (see ‘Living with periods‘). Pre-menstrual symptoms like mood changes can also be helped and the combined pill can help with acne (spots) for some users.
Indicates that her experience on the pill has been very positive. (Actor)
Women described liking ‘the pill’ because it’s easy to use, is reliable, and under their control. The women we spoke to said that taking the pill shows a responsible attitude to contraception and means that sex can be more spontaneous.
Says she is quite happy on the pill and has no plans to change to another method of contraception…
It is important to know that some medications (for example some HIV medications, or epilepsy medicines) can interact with hormonal contraception, and so this needs to be considered before choosing what type of contraception is right for someone (for more information on epilepsy and contraception see our Epilepsy section).
Most women take contraceptive pills without problems. However, the combined pill has possible side effects which include nausea, vomiting, rises in blood pressure, headaches, and effects on mood and libido (sex drive). These are only some examples and it is important to read the product information and talk to a health professional. Many women won’t get any of these side effects.
Using the combined pill or combined hormonal contraceptives can increase the risk of developing some serious conditions such as: venous thromboses (blood clots) and circulation problems including, very rarely, strokes. It is because of these possible risks that health professionals will need to check whether a person has other risk factors for blood clots or circulation problems, such as smoking, high blood pressure, increased weight (high body mass index), diabetes, and whether anyone in the close family has had these illnesses or difficulties. Some women with migraine headaches should not take combine hormonal contraceptives. If they have warning symptoms (aura) before the headache, such as a blurred patch of vision, changes in speech or numbness, progesterone only methods are a safer alternative.
Talks about the different oral contraceptives she has tried.
If women start a new tablet and develop new symptoms such as headaches (or their blood pressure goes up), it is important they get advice straight away. Sometimes this means changing the method of contraception for a more suitable one, or in rare cases it may even need assessment in hospital e.g. for cases of suspected blood clots.
Describes how one GP mistakenly gave her the combined pill despite a history of headaches and migraines and how another GP stopped her taking it (Actor)
Stopped using oral contraceptives because her blood pressure is high. (Actor)
Explains that she has had two incidences of suspected blood clots but that oral contraceptives do…
Some of the women we talked to stopped taking the pill due to worries over the side effects of taking hormones. Some weren’t very good at remembering to take it every day – in which case they often switched to the contraceptive injection or implants.
Talks about her concerns regarding the possible side-effects of the combined pill.
There are pros and cons of taking the pill, and some of the women we spoke to had been put off by friends and family, or had read negative stories in the media. Others didn’t like the idea of taking hormones, although many felt that, for them, it was better to take the pill than risk an unwanted pregnancy.
One woman said that she understands why clinics have ‘a bit of an agenda’ but feels that women are sometimes under pressure to go on the pill.
Felt under pressure by the family planning service to use the contraceptive pill. (Actor)
Frequently women find men don’t know much about the pill. Some women wish their partners would learn more, or they teach them about the pill themselves.
Talks about the need to ‘educate boyfriends about the pill. (Actor)
For women who find it difficult to swallow pills or have sensitive stomachs there are two other forms of CHC contraception available. These are based on the same hormones as the combined oral contraceptive pill, and come in the form of contraceptive patches, or a vaginal ring which delivers the pill hormones vaginally.