Contraceptive Pill, Patch or Ring

There are two types of oral contraceptive pills; combined pills and progesterone-only pills (“mini pills”). They both contain synthetic versions of natural female hormones, but they differ in the type of hormone they contain and the way they work. If taken correctly, both types of pill are over 99% effective at preventing pregnancy. Ideally, you should take your pill at the same time every day.

The Combined Contraceptive Pill:
This pill contains two hormones; oestrogen and progesterone. There are many different brands of combined pill – they all work in the same way but contain varying amounts and types of oestrogen and progesterone. In some individuals, depending on the type you are taking, a variation in side effects from person to person can occur.

Traditionally, the pill was taken for 21 days with a 7 day break, and this cycle was then repeated. However, it is now recommended that these pills are taken as follows to provide more reliable contraceptive cover:

1. 21-day use with a 4-day break (most pill-free intervals should now be 4 days).
2. 3 packets together with no break and then a 4-day break.
3. Continuous use of the pill until spotting for 2 days, then a 4-day break and then restart pill and continue until spotting occurs again.

We can offer you advice on this, just send us a message via your account when you have completed the request questionnaire.

Here is some important information on the combined pill.

The Progesterone Only Pill:
This pill only contains progesterone and is sometimes referred to as the “mini-pill”. It is an excellent pill, with less risk factors than the combined pill. However, it does NOT have the same cycle control.

This pill is taken every day without any break. Sometimes irregular bleeding/ spotting can occur for the first 2-3 cycles. After this many women settle into a bleeding pattern, which can be no periods for months on end.

Here is some important information on the progesterone-only pill.

The contraceptive patch contains oestrogen and progesterone (like the combined contraceptive pill) and the hormones are absorbed through the skin. You stick a new patch to your skin every week for 3 weeks, take a break (no patch) for 4 days and continue to repeat this cycle.

Its advantages are that it is unaffected by vomiting or diarrhoea and you do not have to remember daily pills.

When used correctly, the patch is up to 99% effective at preventing pregnancy.

Here is some important information on the contraceptive patch.

The contraceptive ring is a small, soft, silicone ring that contains both oestrogen and progesterone. A new ring is inserted into the vagina every month. It remains in place for 21 days during which the hormones are released slowly into your bloodstream through the vaginal wall, and then it is removed.

You have a 4 day break and then you repeat this cycle again. As it is very small and usually not felt, it does not interfere with sexual activity.

Here is some important information on the vaginal ring.

Each of these hormones may cause different side effects. If these occur, they can be more or less pronounced depending on the dose and type of hormone, and the delivery mechanism eg tablet, patch or ring.

Below are some of the common side effects of combined hormonal contraceptives and progesterone only contraceptives that might occur.

Oestrogen & Progesterone:

• Vaginal bleeding/ spotting in the early months.
• Transient Breast tenderness is very common early on but usually settles after the first 2-4 weeks.
• Bloating.
• Headaches & migraine: This would need to be reviewed if NEW migraine starts on this pill.
• Nausea, in the early stages of pill taking.
• Increased blood pressure: This is why a reading is essential every 6 months.
• Blood clots (very rare but potentially fatal).

Progesterone:

• Irregular vaginal bleeding/ spotting (very common).
• Transient Breast tenderness.
• Headaches.
• Nausea.
• Low mood & low libido: Progesterone only pills are not thought to be causative of this though.
• Acne: This can improve, stay neutral or disimprove.

For full details of the potential side effects of these medications, please ensure that you read the patient information leaflet that comes with your medication before you start to use it.

No, these types of contraception do not protect against STIs. The best way to reduce your risk of catching an STI when having sex (vaginal, anal or oral) is to use a condom.

Yes, some medications can make these methods of contraception less effective and increase the risk of pregnancy. It is important that you tell us about all the medication/ treatments you are taking, including any use of the morning after pill /emergency contraception so we can advise you safely and appropriately.

It is also essential that you tell any other doctor treating you that you are using these medications.

Key safety information for combined hormonal contraceptives
All combined contraceptives (contain oestrogen and progesterone hormones) increase the risk of thromboembolism (potentially dangerous blood clots which can develop within blood vessels). Some combined contraceptives have a slightly higher associated risk than others. The overall risk of a blood clot is very small.
However you should see a doctor immediately if you develop any of the following symptoms when taking the combined pill:

• • Pain or swelling in the legs.
  • Severe chest pain.
  • Breathlessness or coughing up blood.
  • Bad fainting attack or collapse.
  • Unusual headaches or difficulty with speech or sight.
  • Numbness or weakness of a limb.

If a blood clot:

• Develops in the leg, it can cause a deep vein thrombosis (DVT).
• If it travels to the lung, it can cause a pulmonary embolism (PE).
• If it travels to the heart, it can cause a heart attack.
• If it travels to the brain, it can cause a stroke.

It is very important that you recognize when you might be at greater risk of a blood clot, what signs and symptoms you need to look out for, and what action you need to take.
In which situations is the risk of a blood clot highest?

• In the first year of use.
• If you are very overweight.
• If you are a smoker.
• If you are older than 35 years.
• If you have a family member who has had a blood clot at a relatively young age (eg. below 45).
• If you have given birth in the previous 6-12 weeks. There is also some evidence that the risk is higher if you are restarting use after a break of 4 weeks or more.