Contraception – the combined pill

About the pill

There are 2 types of oral contraception available in Australia – the combined pill (oftencalled ‘the pill’), and the progestogen only pill. Both are taken daily, and are available on prescription.

The combined pill contains two hormones: oestrogen and progestogen. These are similar to hormones that are naturally produced by the body. It is commonly used to prevent pregnancy, but can also be used to regulate periods, reduce period pain or improve acne.

There are many different brands of the pill. Most come in a 28-day pack that includes both hormone (active) and sugar (inactive) pills. Each pill has its own benefits and possible side-effects - speak to your doctor or nurse for advice about which type is most suitable for you.

Effectiveness of the pill

If used correctly the pill is more than 99% effective at preventing pregnancy. Allowing for mistakes (like missing a pill), it is about 93% effective.

How the pill works

The pill works by:

• stopping the ovaries from releasing an egg each month thickening the fluid at the opening to the uterus to prevent the sperm from entering.

What stops the pill from working?

The pill may not work if:

• you miss a pill or it is taken more than 24 hours late
• you vomit within 3 hours of taking it
• you have very severe diarrhoea
• you are taking some medications or natural remedies. (Check with your doctor, nurse or pharmacist).

How to take the pill

Swallow one pill around the same time every day, regardless of how often you have sex. It does not matter if you take it before or after food When you start the pill for the first time, or after a break from the pill, it may not work straight away. This depends on your menstrual cycle, and whether you start with the hormone pill or sugar pill:

• If you start with a hormone (active) pill within the first 5 days of a normal period (counted from when bleeding starts), the pill is immediately effective at preventing pregnancy.
• In most other situations it will take 7 days of taking active pills until you are protected from pregnancy. You will need to use another form of contraception until the pill is working.
• Some pills have different instructions for starting – always check with your doctor and the information on the packet.

Speak with a doctor, nurse or pharmacist about the best way to start taking the pill.

When you have the sugar (inactive) pills you will usually have a withdrawal bleed, which is like a period. After you have finished the sugar pills you should start taking the active pills in the next packet, even if your bleeding hasn’t finished. You can skip this bleed by missing the sugar pills and continuing to take the hormone pills each day.

Where to get the pill

Your doctor or nurse practitioner can provide a script for the pill which you can take to the pharmacy.

Some brands may be more expensive than other brands. Some brands will be cheaper if you have a healthcare card.

Benefits of the pill

The pill can:

• be used to skip your period
• make your periods become lighter, more regular, and less painful
• improve acne
• reduce your chance of getting cancer of the uterus (womb), ovaries and bowel
• help with symptoms of polycystic ovary syndrome (PCOS) and endometriosis

Once you stop taking the pill your fertility quickly returns to normal.

Side effects from taking the pill

Possible side effects for a small number of people who take the pill can include:

• irregular vaginal bleeding
• nausea
• sore or tender breasts
• headaches
• bloating
• changes to your skin
• mood changes.

These side effects often settle with time. The pill has not been shown to cause weight gain.

Serious health problems and the pill

The pill causes a very small increase in your risk of deep vein thrombosis (blood clot), heart attack or stroke. It may also lead to a tiny increase in your risk of breast cancer. The risk of developing breast cancer due to vaginal ring or pill use in people aged under 35 years is 1 in 50,000 per year.

When the pill is not a good option

The pill may not be a good option for you if you:

• don’t think you would remember a daily tablet
• have certain types of migraine
• are very overweight
• have a history of deep vein thrombosis in yourself or a close family member
• are taking other medication which might stop the pill from working (check with your doctor, nurse or pharmacist)
• have health conditions such as high blood pressure, , heart or liver disease, or had a stroke in the past(check with your doctor, nurse or pharmacist)
• are over 35 years and smoke
• have been treated for breast cancer
• are unable to move around for a long time (for example, because of surgery or disability).

If you miss a pill

Take the next pill as soon as you notice (this may mean taking 2 pills on the same day). If the missed pill is less than 24 hours late (less than 48 hours since the last pill taken) it will continue to work and no additional precautions are necessary. It does not matter if you miss a sugar (inactive) pill.

If you miss a pill by more than 24 hours:

• Take the missed pill as soon as you notice (this may mean taking 2 pills on the same day).
• Continue to take hormone (active) pills as normal. If you are due to take sugar (inactive) pills in the next 7 days, skip these and continue taking active pills from the next packet.
• Use condoms for the next 7 days.
• If you have taken less than 7 active pills since your last hormone-free break and had sex without a condom in the 5 days before missing a pill, you may need emergency contraception Check with your doctor, nurse or pharmacist.

There are some pills that have different rules for missed pills than those listed above: if in doubt, check with your pharmacist or the instructions in the pill packet.

If you get pregnant while taking the pill

The pill won’t harm the pregnancy. It is safe to continue the pregnancy (and stop the pill) or to have an abortion.

Taking the pill after having a baby

If you are breastfeeding, do not use the pill until your baby is 6 weeks old, as it may reduce your supply of breast milk and may increase your risk of thrombosis. After 6 weeks you can use the pill but other types of contraception might be better choices (check with your doctor, nurse or pharmacist).

If you are not breastfeeding, you can start using the pill once your baby is 3 to 6 weeks old (check with your doctor, nurse or pharmacist).

Taking the pill and pregnancy

You can stop the pill at any time and your fertility will quickly return.

Further information about the pill

The pill:

• does not protect you from sexually transmissible infections (STIs). The best way to lessen the risk of STIs is to use barrier protection such as internal and external condoms with all new sexual partners
• can sometimes be supplied in small quantities by your pharmacist, without a prescription. If you run out of pills and cannot see a doctor for a new script, speak to a pharmacist. They can often give you a small supply of pills without a script. If possible show them your old pill packet.

Where to get help

• 1800 My Options Tel. 1800 696 784 – for information about contraception, pregnancy options and sexual health in Victoria
• Your GP (doctor)
• Pharmacist
• Chemist Care Now allows Victorians to receive some treatments at a local chemist without needing to see a doctor to get a prescription first. You can attend a participating chemist for resupply of some types of hormonal contraceptives without needing a prescription.
• Many community health services and some public hospitals will have a family planning clinic, a sexual health clinic or a women’s health clinic
• Sexual Health Victoria (SHV) – book an appointment online or call our clinic at Box Hill: 03 9527 0100 or (free call): 1800 013 952. These services are youth friendly
• The Virtual Women’s Health Clinic can help you with contraception advice and prescriptions including long-acting reversible contraception (LARC) options such as intrauterine devices (IUDs).
• Women’s Health Clinics can help you with contraception advice and services, including long-acting reversible contraception (LARC) options such as intrauterine devices (IUDs).
• The Aboriginal Women’s Health Clinic is a dedicated health service for Aboriginal and Torres Strait Islander women in Victoria. The clinic provides advice on contraception options.
• The Mobile Women’s Health Clinic can help you with contraception advice and services, including prescriptions and long-acting reversible contraception (LARC) options.