They’re pills that combine two types of hormone: oestrogen and progesterone. These hormones affect how and when your body prepares for pregnancy.
There are several different types of combined birth control pill and they’re all just about equally effective at preventing pregnancy. However, some contain higher doses of hormones than others, or use different types of progestin and oestrogen. This means one pill might be ideal for easing specific PMS symptoms, while another pill works great for women who are extra-sensitive to hormones.
It can feel a bit overwhelming, so we’re here to help.
How does the combination pill work?
The combined pill works in three ways to prevent pregnancy. Here’s the big one: it stops ovulation. That’s when your ovary releases an egg, and it happens once a month. Each egg has the chance to become fertilised, leading to pregnancy. If fertilisation doesn’t happen, the lining of your womb breaks down and the whole thing happens again next cycle (lots of fun, we know).
Because the combined birth control pill stops ovulation, your chances of becoming pregnant are significantly reduced.
The combined birth control pill also protects you by making the mucus in your cervix thicker. “Thick mucus” isn’t something you normally want to hear but in this case, it’s great news. When it’s thicker, sperm have a much harder time reaching the egg.
The pill also makes your uterine lining thinner. This lining builds throughout the month and then breaks down during your period. When you’re using birth control, the lining doesn’t build in the same way. And so the period you have while taking the pill should be shorter, lighter and more predictable.
Which contraceptive pills are combination pills?
Any that contain two active ingredients, a progesterone and an oestrogen. To find out if your pill is a combined pill, just check the active ingredients.
In the leaflet that comes with your pill, the ingredients should be clearly listed at the top underneath the name of the drug. For combined pills you should see two ingredients, front and center, that are progestin and oestrogen.
With Loestrin, for example, the active ingredients are norethindrone acetate and ethinyl estradiol. This pill is clearly stated as a progestin-oestrogen combination.
We offer a range of combined birth control pills, so there’s plenty of choice for you. But if you can’t take combination pills, for any reason, it’s important to share this with us for your safety.
When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.
How effective are combined birth control pills?
There are two ways of measuring how effective pills are at preventing pregnancy. One way is according to perfect use. This means you take the pill exactly as you should, every day, without making a mistake. The level of effectiveness of the combined oral contraceptive pill when taken like this is over 99%. So in a whole year, fewer than 1 in 100 women taking the combined birth control in that time will become pregnant.
The other way is typical use. This is when you take the pill but make realistic errors, such as forgetting the occasional pill or taking it late. It’s 91% effective when taken like this, which means about 9 in 100 women taking it over a year will become pregnant.
The best way to make sure the pill is effective then is to follow the instructions as closely as you can when you take it.
When to start taking the combined pill
It depends on whether you’re taking the pill for the first time, coming back after a break, or switching from a different type of birth control. If you’re using the pill for the first time, you can start on any day.
When you start using the pill on the first day of your period, you’re protected from becoming pregnant immediately — so you don’t need to worry about using a condom. You’ll also be protected immediately if you start taking the pill before the fifth day of your period.
If you start using the pill after the fifth day of your cycle, you won’t be protected right away. Use a back-up birth control method (like condoms) for seven days while the pill starts to work.
Another option is the Sunday start approach. If you start taking the pill on the first Sunday after your period begins, you avoid withdrawal bleeding on a weekend (if you want to skip having your period on a weekend, this is the way to go).
When to start the combined pill if you’re already on birth control
You shouldn’t leave a gap when you’re switching from one birth control method to the combined pill. If you’re already taking a hormonal birth control pill, start your new prescription the day after you finish your last pill.
If you’re using a transdermal patch like Evra, start the pill a day before you’re due to take off the patch. If you’re using the vaginal ring, start the pill a day before you’re set to take out the ring.
If you normally have the Depo-Provera injection, you can start taking your pill up to 15 weeks after your last shot.
And if you have an IUD (copper or hormonal), you should begin your combined birth control pill pack a week before having your IUD removed.
Are all combination pills the same?
No. Whilst all contraceptive pills have the same effectiveness (so over 99% when they’re used correctly), some pills contain variations of the same hormone, or higher or lower doses of hormones than others. It may be that you’re more sensitive to progestin (or oestrogen) in the combined pill for instance, and so you’ll be better off taking a particular pill that restricts the number of side effects you get. If you’re more sensitive to progestin for example, combined pills like Microgynon, Levest and Ovranette are the safest, and the least likely to trigger side effects. And if you’re more sensitive to oestrogen, combination pills such as Lucette, Yasmin and Yacella should offer you the best protection from side effects.
How do I know which is the best combined pill for me?
Unless you’ve tried a few different pills and found one that works well for you, there’s a good chance that you won’t know which is the best option. Finding the right combination pill for you can involve some trial and error. And our bodies can change over time, so what was effective before might not suit you as well now. A consultation with our clinician will help you to narrow down your options. Besides your sensitivity to hormones in pills and whether you’re prone to certain side effects, there are other factors that may play a role in identifying the right pill for you too. If you’re looking for a pill that can also help with acne, for example, the likes of Yasmin (or the generic version, Lucette) are thought to be particularly strong choices. But at the same time, you may be at a slightly higher risk of getting a blood clot with these treatments, so the pros and cons of specific pills also need to be taken into account.In short then, we can help you to pick out the best (and safest) combination pills for you by weighing these things up, using your health background as the basis.
FAQ: Combined pill
Have something specific you want to know? Search our info below, or ask our experts a question if you can’t find what you’re looking for.
What side effects can I get on the combination pill?
Most women don’t get any side effects but some of the most common side effects when you start using the pill include nausea, headaches, tender breasts, changes to your mood, bloating and breakthrough bleeding.
A lot of the time, these side effects are pretty mild and will normally go away as you continue using the pill, usually after the first two to three months.
But if you get any side effects that concern you, or don’t go away after a couple of months of use, tell us. Our clinician may suggest moving you on to a different pill.
Serious side effects like allergic reactions or blood clots are rare, but you should go to your nearest hospital right away if you get any signs of these.
Can I take combined pills with other medications?
Combined pills can interact with other medications, so it’s important for you to let us know if you’re currently taking medication for any health issues.
For the most part, antibiotics are safe to take when you’re on the pill — except for rifampin, which is used to treat tuberculosis. These antibiotics can affect your periods, making them irregular, so your chances of becoming pregnant increase.
Let us know if you’re currently taking medication to treat HIV, as some of these treatments can impact your pill. Medications like Darunavir, Efavirenz and Nevirapine all interfere with the combined birth control pill, so another birth control option may be better for you.
Anti-fungal medications used to treat skin conditions like jock itch may interfere with your pill, as can anti-seizure drugs. Drugs like carbamazepine, phenobarbital and primidone can affect how the hormones in birth control are broken down. If you’re using these treatments, another birth control option should be used instead of the combined birth control pill.
Modafinil (you may know this under the name Provigil) is used to treat sleep issues like narcolepsy and shift work sleep disorder. It can reduce the effectiveness of your pill, so you shouldn’t use a combined birth control method if you’re taking this medication.
Be mindful of herbal remedies too, because they can have an impact on your pill. St John’s Wort (used to treat mild depression or sleep disorders) can affect how oestrogen is broken down, so the pill may not work as well and the chances of breakthrough bleeding increase.
Saw palmetto (used for hair loss), alfalfa (for kidney or bladder problems), garlic pills (taken for heart and blood diseases) and flaxseed (for digestion problems) can all impact the effectiveness of your pill. Combined birth control pills will probably not be a good fit for you if you’re using any of these treatments.
Who can’t use combined birth control pills?
As we’ve mentioned, combined birth control pills aren’t suitable for all women to use. That’s why it’s important to share any health problems with our clinician. You should not use combined birth control pills if you:
have uncontrolled high blood pressure
are in the first month of breastfeeding your baby
currently have, or have a history of deep vein thrombosis or pulmonary embolism
have a history of stroke or heart disease
you smoke and are older than 35 years of age
are older than 50
get migraines with aura (you might see flashing lights just before the migraine begins)
have liver complications
have unexplained vaginal bleeding
What is a generic birth control pill?
A lot of the birth control pills you know will probably be branded versions. You’ll know them by name, they’re popular choices and you know what’s in them and what to expect.
But there are also “generic” versions of those pills.
Generic versions have the same ingredients and are tested in the same way as their branded counterparts. So while their name may be different, these options are completely safe for you to use.
The main difference is the company that makes them. For instance, there may be several names for a specific formulation of a pill, in a specific dose, because multiple companies make that pill.
So if we use Levest as an example, it contains 0.15mg levonorgestrel and 0.03mg ethinyl estradiol. Rigevidon, Maexeni and a number of other pills contain exactly the same hormones in the same amounts, but may look slightly different and come in different packaging. But there shouldn’t be any real difference in how they work. In some cases, one version of a pill may be cheaper than the other, because different companies make and market them.
How much do combined pills cost?
There isn’t a single price for combined birth control pills. Because they’re made by different pharma companies, the price of the pill can vary. But at Treated, we have a number of options at different prices, so you can find a pill that suits you and fits within your budget.
Why should I buy combination pills with Treated?
We like to keep ‘the pill’ simple. Consult with our clinicians about your health, and they’ll advise you on suitable (and safe) combination pill options.
Once you’ve chosen your pill, and let us know how often you’d like us to deliver it to you (and in what quantity), we’ll ship your medication to you.
We’ll reach out to you regularly to find out how you’re getting on with your pill. So if you have any questions about your treatment, or if you’d like to make any changes (or both), our medical experts will be at hand to help you.
Change, pause or cancel your plan whenever you like.
Disclaimer: The information provided on this page is not a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns about your health, please talk to a doctor.
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