Oral Contraceptive Pill (the pill) Online Private prescription service

This popular hormonal form of female contraception is commonly referred to as ‘the Pill’. At the moment, 23 brands are available in Britain containing various kinds of estrogens and progestogens, synthetic female sex hormones.

There essentially are two different types of the Pill that need to be distinguished from one another, the combined oral contraceptive pill (COCP), which contains an estrogen and a progestin compound and the so-called mini pill, a progestin (progestogen) only tablet.

The COCP pill is taken for either 21 or 28 days with the hormone dosage being either constant (monophasic) or changing (multiphasic) from one week to the next.

Apart from offering a very high protection against unwanted pregnancy, the Pill is sometimes prescribed to treat acne, endiometriosis, polycystic ovary syndrome, painful, irregular or heavy periods as well as vaginal dryness or painful intercourse due to a decrease in natural estrogen secretion as experienced during the menopause.

One particular combined pill, sold under the brand name Dianette (active ingredient co-cyprindiol) can be prescribed to women suffering from severe acne or hirsutism (excessive hair growth in women) seeking contraception at the same time. It should not be given merely for contraception.

The Pill

How popular is the pill?

The oral birth-control pill is used by approximately 100 million women worldwide. In the UK, 3.5 million females rely on this convenient means of contraception, which equals about one third of all women of reproductive age nationwide.

How does the pill work?

The synthetic hormones in the pill trick the body into believing you are pregnant by altering the naturally changing hormone balance, which suppresses the monthly release of an egg (ovulation). Furthermore, they cause a thinning of the womb lining making it more difficult for a fertilised egg to nest as well as a thickening of the mucus in the cervix (neck of the womb) which makes it harder for sperm to get to an egg.

How effective is the pill?

If taken correctly, the pill offers 99% protection against unwanted pregnancy, which means that each year statistically less than 1 out of 100 women will become pregnant despite correctly taking the pill. Correct Pill use is defined as not missing any dosages and relying on additional contraceptive precautions such as condoms if the effectiveness of the Pill is knowingly impaired.

If you initially start taking the combined Pill within 5 days of the beginning of your period, protection is immediate. If you start the Pill at any other day during your cycle, it will take 7 days before its effect kicks in, so you must use alternative contraception during this time.

How do I take the pill?

Dosaging regimes differ depending on what type of pill you take. The minipill is taken without any breaks and comes in packs of 28 tablets which you will need to take back to back. You will most likely experience light withdrawal bleeding after about 21 days, however many women do not get any ‘periods’ while on the minipill. As the hormone dose is very low, it is crucial that you take your pill at exactly the same hour, or within 3 hours of the same hour every day to achieve maximum effectiveness.

The combined pill is taken for either 21 days or 28 days in a row. Please take the tablet at exactly the same hour each day. If you forgot one dosage, you have got a 12 hour window to make up for this and take your tablet without the contraceptive effect being impaired.

If your pill blister contains 21 tablets, take one pill each day for 3 weeks. After finishing all the pills in the blister, you will have a pill-free break of 7 days during which you will experience a withdrawal bleed. Start with a new pack of tablets on the 8th day and take the first pill at your usual time of day. For your convenience, most pills have the days of the week printed on the blister to make it easy for you to remember when to take your tablet.

If your pill blister contains 28 tablets, you will take one tablet for 4 weeks and immediately start a new pack afterwards, which means you’ll take one tablet every day continuously. Many women find this a convenient way of remembering to take their pill. Only 21 of these tablets contain hormones whereas the remaining 7 tablets are inactive placebo or sugar pills. This means that you will experience a withdrawal bleeding during the last week of your pill cycle.

Regardless of whether you follow a 21 scheme followed by a 7 day break or a 28 tablet dosaging regime, you will be protected from unwanted pregnancy throughout your cycle provided that you have taken your medication correctly.

What if I miss a dosage?

It is essential that you take your Pill religiously every day as indicated and preferrably at the same time. Try to adopt a routine that will make it easy for you to remember to take your Pill, such as a reminder on your mobile set to go off daily at the same hour.

If you forget to take your Pill for one reason or another but manage to remember and take it within 3 hours (minipill) or 12 hours (COCP) respectively after your usual time, protection will be ongoing and you do not need to take any further action. Otherwise please refer to the patient leaflet of your Pill to find out how to proceed and when and for how long it will be necessary to temporarily revert to other means of contraception. It is a good idea to keep the patient leaflet handy so you know where to find it easily when you need it.

If you vomit or have diarrhoea within 2 to 3 hours after taking your Pill, take another one provided that you are well enough as the first dosage will not have been absorbed. Then continue your dosaging regime as normal bearing in mind that your cycle will be shortened by one day.

Can I delay my period with the Pill?

Many women wrongly assume that the bleeding experienced during the 7 day active Pill break is a period. In fact, this so-called withdrawal bleeding is very similar to a period however it is often much lighter and shorter, which is why the Pill is beneficial to women suffering from very heavy or painful periods. It is triggered by the sudden drop of hormones. It should also be noted that the hormones administered in the Pill are very different from a woman’s natural hormonal balance which changes at various stages throughout the monthly cycle.

Most women would find it somewhat unnatural to not have any periods anymore at all, which is why the Pill dosaging regime has been designed to mimick the natural menstrual cycle lasting 28 days on average. Some women also like the added reassurance of having physical confirmation that they are not pregnant so to speak.

The following information refers to the most common type of Pill, the COCP. If you wish to delay withdrawal bleeding with any other type of pill, please read the patient leaflet or consult your doctor or family planning nurse.

When you go on holiday or have a special event coming up, you might find it inconvenient to have a period. In this case you could delay your monthly bleeding by skipping the 7 day break and start with a new Pill pack straight away. You might experience some spotting or slight breakthrough bleeding as the womb lining will continue to build up during this time and shed slightly.

In some women, tricycling might be indicated, which means that you will use 3 blisters in a row without any breaks. This can be beneficial to women suffering from a particular type of migraine or endiometriosis. For further information or if you would like to consider this option and reduce the number of withdrawal bleeds per year, please consult your prescribing doctor for advice on whether this is suitable for you and if it is feasible with the Pill you take. It is possible to tricycle both with monophasic and multiphasic pills.

Benefits of the Pill

Millions of women in the UK opt for the pill and find it a very convenient, easy and reversible means of contraception. It is highly effective and does not interfere with sex. Barrier methods such as condoms can sometimes be bothersome, which is why many men and women are reluctant to use them. While the Pill alters your hormonal balance for as long as you take it, it does not impair your fertility and if you are planning on having children, your fertility should be back to normal within a few months of stopping the Pill.

The Pill

Women affected by acne often find that the Pill clears up their condition. Acne is due to an excess of male sex hormones which is balanced out by the synthetic hormones in the Pill. Furthermore, scientific research suggests that the contraceptive Pill protects against certain types of cancer such as ovarian, uterine or colon cancer.

The Pill can also potentially improve the following conditions or make them less painful:

• Endiometriosis
• Painful, heavy periods
• Prementrual Syndrome
• Anaemia
• Polycystic Ovary Syndrome (PCOS)

Risks of the Pill

The contraceptive Pill has a very well established and remarkably good safety profile and the majority of women do not experience any problems while taking it. Like every medication, the Pill can however rarely have serious side effects and certain patient groups are more at risks at others, which is why it is essential that you provide your prescriber with full details about your past and present medical condition before you obtain a prescription for the Pill.

The medicine increases the risk of Deep Vein Thrombosis (DVT), commonly known as blood clotting, which can be potentially fatal. Women who knowingly are at increased risk of DVT, stroke or heart attack because these conditions run within the family should not take the Pill. Some scientific evidence also suggests that, while the Pill may well protect against certain cancers, it also favours some cancers such as breast or cervical cancer.

For most women, the beneficial aspects outweigh the potential risks and if you are concerned at all, you should discuss your worries with your prescribing doctor to put your mind at ease.

Side effects of the pill

The Pill is mostly well tolerated and the majority of women taking it do not experience any unpleasant or adverse side effects. Some women report nausea, headaches or tender breasts for a few weeks after initially starting to take the Pill. These symptoms usually subside once your body is used to the new medication. For full information about the side effects reported to dat, please refer to the patient leaflet of your Pill.

The contraceptive Pill may cause:

• Fatigue
• Change in sex drive (increased or decreased libido)
• Hypertension
• Headaches
• Weight gain/water retention
• Depression/Mood swings
• Migraine

Please note that this list is not exhaustive. As the Pill can alter blood pressure, it is important that you have your blood pressure monitored regularly while you take the Pill. Please have a check up with yout prescribing doctor every 6 weeks to spot any changes.

Which medications interact with the Pill?

Some medicines interact with the Pill which is why you need to tell your doctor about all medications you take before going on the Pill. Some broad spectrm antibiotics can make the Pill less effective. These are:

• amoxicillin
• ampicillin
• azithromycin
• cefadroxil
• cefixime
• cefradine
• cefalexin
• cefpodoxime
• clarithromycin
• co-amoxiclav
• co-fluampicil
• doxycycline
• erythromycin
• metronidazole
• minocycline
• oxytetracycline
• tetracycline
• tinidazole

If you are required to complete a course of any of these drugs, tell your doctor that you are on the Pill. You will need to use additional contraception during your antibiotic treatment and for 7 days thereafter.

Certain medicines affect how quickly estrogens and progestogens are broken down by the liver, which again makes the Pill less effective. These medicines include:

• aprepitant
• bosentan
• carbamazepine
• griseofulvin
• modafinil
• nelfinavir
• nevirapine
• oxcarbazepine
• phenytoin
• phenobarbital
• primidone
• rifabutin
• rifampicin
• ritonavir
• rufinamide
• St John's Wort (Hypericum)
• topiramate

If you need to take any of these medicines at the long term, you might have to consider switching to a different method of contraception.

Who should not take the Pill/Precautions

The Pill increases the risk of a blood clot such as in the legs (Deep Vein Thrombosis), lungs (Pulmonary Embolism), a stroke or heart attack.

Your risk for this kind of potentially fatal complication is increased if you:

• Smoke
• Are overweight with a BMI above 35
• Are over 35 years of age
• Suffer from migraines with aura
• Have high blood pressure
• Have had a blood clot in the past or if the condition runs within your family
• You are unable to move for an extended period of time, for example following an accident or if you are otherwise bedbound

The Pill does not offer any protection against sexually transmitted infections such as Chlamydia, Gonorrhoea, HIV or Syphilis. Especially if you have several or frequently changing sexual partners, you should use an effective barrier method such as male condoms. If you think you are pregnant, stop taking the Pill and consult a doctor or family planning nurse to arrange for a test and further advice.

The Pill