Contraception The Pill

Overview

The pill is a daily tablet that a person takes to prevent pregnancy. There are two main kinds. The combined pill contains two hormones: one like the natural hormone oestrogen and one like progesterone. The progestogen-only pill contains just one hormone. Both work mainly by stopping the ovaries from releasing an egg each month. They also thicken the mucus at the neck of the womb (cervix), which makes it harder for sperm to get through. The pill is a medicine you take regularly, not a treatment for an illness. It does not protect against sexually transmitted infections (STIs), so condoms are still needed for that.

Very common. The pill is one of the most widely used types of contraception worldwide, and millions of people use it every day. It is also one of the most studied medicines in use, so there is a lot of evidence about how well it works and what the risks are.

Anyone who could become pregnant and does not want to be, from the teenage years through to the menopause. That includes people with long-term conditions, people who smoke, and people who take other medicines — all of which can affect which pill is suitable. Young people under 16 can get confidential contraception advice, and health professionals will usually encourage them to talk to a parent or trusted adult, but they can still be seen on their own.

Symptoms

Common symptoms

• Bleeding between periods (spotting), especially in the first few months
• Lighter, shorter or less painful periods
• Tender or enlarged breasts
• Headaches or mild migraines
• Feeling sick or bloated
• Mood changes or feeling more emotional than usual
• Skin changes — some people find their acne improves, others find it worsens
• A missed or very light period during the break week, which is common and not usually a sign of pregnancy if pills were taken correctly

Symptoms in children

• The pill is not normally needed before puberty, when pregnancy is not possible
• For teenagers, the side effects are the same as for adults, but young people may be more likely to stop and start, so a clear routine helps
• Teenagers can get confidential advice from a GP or sexual health service, and staff will not usually share information with parents without permission
• Some young people get dizzy or feel sick if they take the pill on an empty stomach — taking it with food or at bedtime can help

Symptoms in older adults

• From around age 35, the small risk of blood clots with the combined pill goes up, especially for people who smoke or have other risk factors
• Around the time of the menopause, periods become irregular anyway, so it can be harder to tell whether the pill is suiting you
• Most people need to switch from the combined pill to a progestogen-only method by around age 50 to 55 — your clinician will advise when
• Fertility drops with age, but pregnancy is still possible until periods have fully stopped, so contraception is still needed

Causes

Main causes

• The pill is not caused by an illness — it is a choice, so this section explains why people use it
• To prevent pregnancy when you do not want to be pregnant yet, or ever
• To make periods lighter, shorter or less painful
• To help with conditions such as acne, endometriosis or polycystic ovary syndrome symptoms
• To help with premenstrual symptoms or mood changes tied to the menstrual cycle
• To control the timing of periods, for example around exams, holidays or events

Risk factors

• Smoking, especially at age 35 or over — this is the biggest avoidable risk and raises the chance of blood clots
• Migraine with aura (a headache with flashing lights, blind spots or other warning signs before the pain)
• A previous blood clot, or a close family member who had one before age 45
• High blood pressure, high cholesterol, or diabetes with complications
• Being very overweight (a high body mass index, BMI)
• Some heart, liver or kidney conditions, or a history of breast cancer
• Taking certain other medicines, including some epilepsy medicines, some HIV medicines, and the herbal remedy St John's wort — these can stop the pill from working
• Vomiting or severe diarrhoea, which can mean the pill is not absorbed properly

When to see a doctor

See a doctor urgently if:

• Any of the emergency or urgent symptoms listed above — call your local emergency number for severe chest, leg or breathing symptoms
• You have missed pills and had unprotected sex — seek emergency contraception advice the same day, ideally within 5 days
• You think you might be pregnant
• You are having severe belly pain, heavy bleeding, or a headache that feels very different from usual
• You have new yellowing of the skin or eyes, or dark urine
• You have started a new medicine and are unsure whether it affects your pill

Book a routine appointment if:

• You want to start the pill, or you want to talk through which contraception might suit you best
• You are due your yearly blood pressure and review check
• You are getting side effects that bother you — there is often another pill or method that suits you better
• You are about to turn 35 and smoke, or you are nearing the menopause
• Your periods have changed, or your bleeding pattern is unusual for you
• You are thinking about stopping the pill or planning a pregnancy
• You are taking antibiotics or other medicines and want to check whether they affect your pill

Diagnosis

There is no test to 'diagnose' taking the pill. Instead, a health professional works out whether a particular pill is safe and suitable for you. This is a short conversation rather than an examination in most cases. They ask about your periods, your health, your family history, any medicines you take, whether you smoke, and what you want from contraception. They may take your blood pressure and your weight. If something needs checking — such as a family history of blood clots — they may suggest a blood test or refer you on before prescribing.

Tests that may be done

• Blood pressure check, usually at the first appointment and at reviews
• Height and weight, to work out body mass index
• A chat about your medical history and your family's medical history
• A discussion about migraines, including whether you get warning signs (aura)
• Sometimes a blood test or a blood clotting check, if there is a family history of clots
• A pregnancy test if there is any chance you could already be pregnant
• A cervical screening (smear) test is not needed to start the pill — but do keep up with invitations when they come

What to expect at your appointment

Appointments are usually short and confidential. You can bring someone with you. The clinician will explain the options, including how well each one works, the side effects, and how it fits with your health. You can ask about any method — long-acting options such as an implant or coil, the patch, the vaginal ring, the injection, condoms, or the pill. You do not have to decide on the day, and you can change your mind later. If you are starting the pill, you will be told when it becomes effective and whether you need extra protection (like condoms) for the first few days.

Treatment

Here 'treatment' means your contraception choice and how to use it well. The pill is highly effective when taken as directed, and there are many options, so the aim is to find a method that suits your body, your health and your daily routine. Your clinician will help you weigh up the combined pill, the progestogen-only pill, and other methods. Whichever you choose, knowing what to do about missed pills and when you need backup protection matters as much as the prescription itself.

Self-care at home

• Take your pill at roughly the same time each day — the progestogen-only pill is more time-sensitive, so setting a phone alarm helps
• Keep the information leaflet and know what to do if you miss a pill; the rules differ between the two main types, so check the leaflet or ask a pharmacist
• If you are sick or have severe diarrhoea, follow the 'missed pill' advice for your type until you have been well for a couple of days
• Use condoms as backup when you start, when you miss pills, and whenever you want protection from STIs
• Tell any doctor, nurse, dentist or pharmacist that you take the pill when they prescribe anything new
• Do not stop the pill suddenly partway through a pack without a plan — stopping mid-pack can leave you unprotected
• Keep a spare pack so you do not run out, and order your repeat in good time
• If you smoke, getting support to stop is one of the most effective things you can do for your health on the pill

Medical treatments

The two main types are the combined pill, which contains two hormones and is usually taken for three weeks with a week's break (or continuously in some versions), and the progestogen-only pill, which contains one hormone and is taken every day with no break. Within each type there are several versions with different balances of hormones, so if one causes side effects another may suit you better. Some combined pills are also used to help with heavy or painful periods, acne, and symptoms of conditions like endometriosis or polycystic ovary syndrome. Other methods your clinician may discuss include the contraceptive implant, hormonal and copper coils (IUDs), the injection, the patch, the vaginal ring, internal and external condoms, and fertility awareness methods. Each has different effectiveness, side effects, and how often you need to think about it. Your clinician will match the options to your health history, particularly migraines, blood pressure, smoking and clot risk.

When is surgery considered?

Surgery is not a treatment for contraception needs in most cases, but permanent options exist. Sterilisation — for example, tubal ligation ('having your tubes tied') or vasectomy for a partner — is a permanent procedure and is usually chosen by people who are certain they do not want children, now or in the future. These procedures are done in hospital or a clinic setting and are generally very effective, but reversal is not always possible. Your clinician can talk you through the benefits, the risks and the alternatives before you decide.

Living with this condition

Most people fit the pill into daily life easily once it becomes a habit — beside the toothbrush, in a phone reminder, or with breakfast. The main things to keep an eye on are missed pills, running out of supplies, and new medicines that might interact. It is also worth noting changes in your bleeding pattern, mood or headaches so you can mention them at your next review. Reviews are usually once a year, and they are a good chance to ask questions or change method.

Lifestyle tips

• Do not smoke — smoking while on the combined pill is the single biggest avoidable risk, especially from age 35
• Keep up with your yearly review so blood pressure and risk factors can be checked
• Use condoms for STI protection, and consider regular sexual health checks if you have new or multiple partners
• Be careful with alcohol and recreational drugs, which can make you more likely to forget pills
• Tell your clinician about any new medicine, including anything bought over the counter or herbal
• If you travel, take enough packs with you and keep them in your hand luggage; time zones can affect when you take your pill

Diet and exercise

There is no special diet needed on the pill. A balanced, varied diet and regular movement are good for general health, mood and weight, which in turn affects some risk factors. If you are sick or have severe diarrhoea, the pill may not be absorbed properly — follow the missed-pill advice in your leaflet. Some hormonal methods can affect appetite or fluid retention; if you notice weight changes that bother you, mention it at your review rather than stopping suddenly. Exercise is safe on the pill, and there is no need to avoid it.

Mental health and emotional wellbeing

Some people notice mood changes on the pill — feeling more tearful, flat, irritable or anxious. For many, these settle within a few months, and for some there is no change at all. Others find their mood is better because their periods are lighter or less painful. If low mood, anxiety, or thoughts of harming yourself appear or get worse, please speak to a healthcare professional — this matters and deserves support. If you ever have thoughts of ending your life or of seriously harming yourself, contact your local emergency number or a crisis line in your country straight away, or go to the nearest emergency department. You do not have to cope alone, and help is available at any hour.

Prevention

The pill is not a condition, so it cannot be 'prevented'. Instead, think about preventing unwanted pregnancy and reducing the small risks of the pill. Use contraception consistently and correctly, have a backup plan (condoms, or emergency contraception if something goes wrong), and reduce clot risk by not smoking and keeping blood pressure in a healthy range. If you want a method you do not have to think about every day, long-acting options such as an implant or coil are more effective than the pill.

Vaccines

No vaccines are relevant to using the pill. Do keep up with your routine vaccinations and any offered by your local health service.

Screening programmes

Regular blood pressure checks and a yearly contraception review are the main monitoring while on the pill. Cervical screening (smear tests) is offered on a schedule to everyone with a cervix, whether or not they take the pill, and the pill does not change your screening results. Sexual health screening for STIs is recommended if you have new or multiple partners.

Complications

If left untreated

• If you stop the pill without another method in place, you can become pregnant — this is the main 'complication' and it is entirely manageable with planning
• Unintended pregnancy is more likely when pills are missed, and the chance rises the more pills are missed in a row
• Blood clots in the leg or lung are a rare but serious risk, mostly with the combined pill and mostly in people with added risk factors like smoking or a family history
• A small rise in blood pressure can happen with the combined pill and is picked up at reviews
• Rarely, the combined pill is linked to a small increase in the risk of some cancers, while it lowers the risk of cancer of the ovary and womb — the overall picture is complex and your clinician can explain it
• If pregnancy happens on the progestogen-only pill, there is a slightly higher chance it is outside the womb (ectopic), so tell a doctor early if you have pain or bleeding

Long-term outlook

For most healthy people, the pill is a safe, well-understood and very effective choice, and any side effects are usually mild and settle within a few months. Serious problems are rare, and reviews are designed to catch risk factors early. There are many methods available, so if the pill does not suit you there are good alternatives — and switching is a normal, everyday conversation with your clinician. Whatever you decide, you deserve clear information and support to feel confident about your choice.

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