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The Combined Oral Contraceptive Pill (COCP)

The combined pill is usually just called the pill. It contains two hormones, oestrogen and progestogen. These are similar to the natural hormones women produce in their ovaries. There are a number of different combined pills but all act in the same way.

How Effective is the Pill?

If the pill is taken according to instructions it is over 99% effective. This means that fewer than 1 woman in 100 will get pregnant in a year. However if the pill is not taken according to instructions, more women will become pregnant.

How Does the Pill Work?

The main way the pill works is to stop the ovaries from releasing an egg each month (ovulation). It also works by thickening the mucus from your cervix. This makes it difficult for sperm to move through the mucus and reach an egg. The pill also makes the lining of your womb thinner so it is less likely to accept a fertilised egg.

Can Anyone Use the Pill?

If you don’t smoke and there are no medical reasons for you not to take the pill, you can take it until your menopause. At the age of 50, if you are still having periods, you may be advised to change to a different method of contraception.

Not everyone can use the combined pill so your doctor will need to ask you about your medical history and your family history. The pill is unadvisable if:

  • You think you might already be pregnant
  • You are breastfeeding
  • You smoke and are 35 or older
  • You take certain medicines
  • You have had a thrombosis or there is a strong family history of thrombosis (blood clots) in any vein or artery
  • You have a heart abnormality or circulatory disease, including raised blood pressure
  • You get very severe migraines or migraines with aura
  • You have had breast cancer
  • You have a disease of the liver or gall bladder
  • You have diabetes with complications.

If you cannot use the combined pill, you may be able to use the progestogen-only pill (POP otherwise known as the mini-pill), or another progestogen-only method of contraception.

What are the Advantages of the Pill?

There are several other benefits of the pill, over and above its effectiveness as a contraceptive. These include:

  • It doesn’t interrupt sex
  • It is a treatment for heavy periods, irregular periods and painful periods
  • It can slow the progression of endometriosis and be used as a treatment
  • It may help with pre-menstrual syndrome
  • It reduces the risk of cancer of the ovary, womb and colon
  • It may protect against pelvic inflammatory disease
  • It may reduce the risk of fibroids, ovarian cysts and breast disease that is not cancer.

What are the disadvantages of the pill?

Rarely, there can be some serious side-effects:

  • Some women get temporary side-effects at first, including headaches, nausea, breast tenderness and mood changes. If these do not stop within a few months, changing type of pill to one with a different sort of progestogen may help
  • It is affected by taking other medicines such as antibiotics
  • The pill may increase blood pressure
  • The pill does not protect you against sexually transmitted infections, so you may need to use condoms as well
  • Breakthrough bleeding (unexpected bleeding on pill taking days) and spotting is common in the first few months of pill use
  • A very small number of women may develop a blood clot, which can block a vein (venous thrombosis) or an artery (arterial thrombosis or heart attack or stroke). If you have ever had a thrombosis, you should not use the pill. Some types of pill appear to be associated with a slightly higher risk of venous thrombosis
  • Research into the risk of breast cancer and hormonal contraception is complex and contradictory. Current research suggests that users of all hormonal contraception appear to have a small increase in risk of being diagnosed with breast cancer compared to non-users of hormonal contraception. Further research is ongoing
  • Research suggests that there is a small increase in risk of developing cervical cancer if the pill is used continuously for more than five years. This most likely due to sexual behaviour and the number of partners you have rather than the pill itself.


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