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The Pill (or Combined Oral Contraceptive Pill)

What is the pill?

The pill is a tablet that is taken daily as a form of female contraception. The pill usually refers to the Combine Oral Contraceptive Pill (COCP).

What is in the COCP?

The COCP contains two hormones called oestrogen and progesterone. The type of oestrogen and progesterone depends on the specific formulation. The dose of each medications within a pill also varies between the different formulations.

How does it work?

The COCP works primarily as a contraceptive by inhibiting ovulation. It also can change the thickness of the cervical mucus to prevent sperm from passing through the cervix and it can also interfere with implantation of a fertilised egg.

How effective is the COCP?

The pill is about 99% effectively if correctly taken.

How is the pill taken?

The COCP is taken as a single tablet each day. In a typical pill packet there are 28 tablets. Twenty one of these tablets contain hormone and are called active pills, the other 7 tablets contain no hormone, only a simple sugar, and are called inactive tablets. Whilst a person is taking the active tablets, the COCP will be working, though this might not happen straight away (see below). Whilst a person takes the inactive tablets a withdrawl bleed (a bleed like a period) is brought on as the hormones are not being taken, and the lining of the uterus will be shed.

The COCP should be taken at the same time each day. Establishing a routine is the best solution.

How do I start taking the COCP?

This may vary depending on the specific product. Usually a person should commence taking an active tablet during the first two days of a period bleed. This should provide contraception very quickly.

Do I need to take the inactive tablets and have a withdrawal bleed each month?

Whilst there is the possibility of increased side effects from taking continuous active pills, it is generally thought acceptable to take continuous active pills for up to four cycles before having a withdrawal bleed (taking the inactive pills). Some people will develop some irregular spotting and other side effects if this method is chosen.

What are the side effects?

There are a range of side effects. These can include the following;
  • Headaches
  • Nausea
  • Breast tederness
  • Acne
  • Changes in mood
  • Chloasma – brown patches on the face
  • Increased vaginal discharge

What are the risks associated with taking the COCP?

There are a number of risks associated with taking the COCP. These include;
  • Increased risk of breast cancer by 24% whilst on the COCP
  • Small increased risk of cervical cancer
  • Increased risk of benign adenoma or hemartoma of liver but this is rare
  • Some of the newer types of progestogens have shown an increased risk of venous thromboembolism, compared to the older type of progestogens, but the data is not all together clear
  • Increased risk of ischaemic stroke (worse when certain other conditions are present)

What are the non-contraceptive benefits of taking the COCP?

  • Cancer of the ovary and uterus are less common
  • Colorectal cancer is probably less common
  • Reduce most menstrual cycle disorders
  • Fewer functional ovarian cysts
  • Fewer ectopic pregnancies
  • Reduced pelvic inflammatory disease
  • Reduction in benign breast disease
  • Fewer symptomatic fibroids
  • Probable reduction in thyroid disease
  • Probably reduction in rheumatoid arthritis
  • Fewer sebaceous disorders

Are there any medical conditions that would prevent me from taking the COCP?

There are many medical conditions that represent contra-indications to using the COCP. Some of these include;
  • Women over the age of 35 years who smoke should not take the COCP
  • Past or present circulatory diseases such as blood clots, high blood pressure, migraines
  • Liver disease
  • History of serious conditions affected by sex steroids
  • Pregnancy
  • Undiagnosed genital tract bleeding
  • Oestrogen dependent cancers
  • Allergy to COCP

Are there any drug interactions will the COCP?

There are many drugs which can interact.

A common drug that may interfere with the effectiveness of the COCP is an antibiotic. Though the chance is low, it is best to use alternate contraception (like condoms) whilst taking antibiotics and for 7 days afterwards.

What should I do if I miss a pill?

There are international guidelines to give us advice here

One tablet missed for up o 24 hours
  • No special action needed
  • Take the delayed pill and the next one on time
Anything more than one tablet missed
  • Use condoms for the next seven days
  • PLUS
    • In the third active pill week, if any pill was completely (>24hr) late, at the end of the packet run onto the next pack (skip th inactive pills)
    • In the first pill week, emergency contraception (Morning After Pill) is recommended if with sexual exposure since the last pack, the COCP user is a late restarter by >2 days or >2 pills are missed. This would be followed next day by recommencing pill taking with the appropriate day’s tablet
All of the information contained in this leaflet is designed to provide basic level education. It does not represent medical advice and no action should be taken as a result of the information contained within without discussing it with a doctor. Medical information changes rapidly and this content may be out of date and therefore incorrect. The content has been written with the intention of helping those who read it and specific medical terminology, complex and detailed information has been purposefully omitted. The author holds no responsibility for any action taken as a result of reading this information. The content of this leaflet remains the property of Two One Five Melbourne Street Medical Practice and any usage, apart from personal use, must receive the authority of the owner.
©2016 Two One Five Melbourne Street Medical Practice