The Pill (Combined Oral Contraceptive Pill)

What is the Pill?

The combined oral contraceptive pill, commonly referred to as the Pill, contains two artificial hormones, oestrogen and progestogen – these are similar to hormones naturally produced by the body. It is often taken to prevent pregnancy; however, there are other reasons why someone may decide to take it, such as to control periods or improve acne.

What types of the Pill are there?

There are many types of the Pill available; most come in a 28 day packet, containing hormone (active) pills, and up to 7 days of non-hormone (inactive) pills. When taking the inactive pills there is usually a withdrawal bleed, which is like a period.
Some Pill packing has a shorter 4 or 2 day window of inactive pills. There is also a Pill which is taken continuously for 84 days, followed by 7 days of very low dose active pills. There are different benefits and disadvantages to each type of Pill, and this can be discussed with a doctor or nurse before starting.

How does the Pill work?

The Pill works by:

• stopping the release of an egg by the ovary (ovulation)
• making the mucus (sticky fluid) at the opening of the uterus thicker so sperm can’t get through

How effective is the Pill?

The Pill is greater than 99% effective with perfect use, but with typical day-to-day use it is about 93% effective.

How do I get the Pill?

The Pill is available on prescription, which can be obtained from your doctor, SHINE SA clinics, community health clinics or youth health clinics.

How do I take the Pill?

It is usually advised to begin taking the Pill within the first 5 days of your period starting. If you start taking an active pill during this time frame then protection against pregnancy is considered immediate.

If you start after the first 5 days of your period, you need to use another form of contraception for 7 days before you will be protected from unplanned pregnancy.

If you are taking the multiphasic Pill ‘Qlaira’, then different rules apply for starting pills. You should check the information on the packet.

Take all the active pills in the packet until you reach the inactive pills. After you have finished taking the inactive pills you should start taking the active pills in your next packet. You should do this even if the withdrawal bleed hasn’t finished.

You may want to continue using condoms while using the Pill because they help to protect you from sexually transmitted infections (STIs) and provide back-up contraception, particularly if you miss a Pill.

Can I skip my period?

It is possible to skip the inactive pills and take the hormone pills continuously so that you should not get a bleed. It is safe to do this although some people may experience breakthrough bleeding. Talk to your doctor or nurse to get advice about the best way to do this.

When is the Pill not effective?

The Pill may not be effective if:

• two or more pills are missed (i.e. more than 48 hours since the last pill was taken)
• vomiting occurs within 3 hours of taking the hormone pill
• you have very severe diarrhoea

See Missed pills for instructions.

Always check with your doctor or contact the Sexual Healthline if you are taking other medications, as some drugs may stop the Pill from working (e.g. some anti-epileptic medication). This can also include herbal medicines like St John’s Wort. If you are taking one of these medications you will need to use other protection while taking the medication and for one month after stopping.

What are the benefits of taking the Pill?

• Periods usually become more regular, shorter, lighter and less painful.
• The timing of bleeding can be controlled.
• The Pill can reduce the chance of cancer of the uterus and ovaries, benign breast disease, endometriosis and ovarian cysts.
• The Pill usually improves acne.
• The Pill can be used as a treatment for pre-menstrual symptoms.
• It’s easily reversible and has no effect on future fertility.

What are the possible side effects?

The Pill has few side effects. Serious health problems caused by the Pill are rare; the most dangerous is blood clots, usually in the legs or lungs (called thrombosis).

You may notice:

• irregular bleeding
• headaches (more than normal)
• an increase in appetite
• nausea (feeling sick) – try taking the Pill with food or in the evening
• sore breasts (supportive bra can help)
• changes in mood, including feeling depressed

If you have any of these side effects continue taking the pills. They will mostly settle after 2–3 months of taking the Pill. If they persist or are very disruptive, see your doctor or SHINE SA clinic as a change of the type of Pill may help.
In some people the hormones in the Pill can cause patchy brown discolouration to appear on the face, especially if you spend a lot of time in the sun. If this happens when you are on the Pill you can try to limit your sun exposure and use sunscreen. The brown discolouration can take time to fade, even if you stop taking the Pill, and may require specialised treatment.

Who should not take the Pill?

The Pill is safe for most people. In particular, the risks of taking the Pill are less than the risks of being pregnant.

The Pill is not suitable for someone who:

• has had a stroke, heart attack or high blood pressure
• has a past or close family history of blood clots
• has certain types of migraine, diabetes or liver disease
• is over 35 years old and smokes
• has a body mass index >35

Tips for good Pill taking

• Take the Pill every day at a time that’s easy to remember.
• If you forget to take your pill you can take it up to 24 hours from the usual time to remain safe (up to 48 hours since your last pill), but it may cause irregular bleeding. See Missed pills for instructions.
• If you are taking the Pill to prevent pregnancy do not stop taking the Pill unless you want to get pregnant or have started another form of contraception.

Missed pills

It doesn’t matter if you forget to take your inactive pills.
If you are taking the multiphasic Pill ‘Qlaira’, then different rules apply for missed pills. You should check the information on the packet.

If you are worried about having missed a pill, contact a pharmacist, doctor or SHINE SA clinic.

If you are thinking about using Emergency Contraception (EC), it’s best taken as soon as possible, but can be taken up to 5 days after unprotected sex. The most effective EC is a copper IUD. There are 2 different Emergency Contraceptive Pills (ECP) available in Australia and your doctor or pharmacist can advise you which is the best one for you. For more information on EC see SHINE SA Fact Sheet.