Combined hormonal contraceptives

Carefully read and follow the printed information leaflet that comes with your tablets or patches.

About combined hormonal contraceptives

Type of medicine	Combined hormonal contraceptives
Used for	Contraception Menstrual disorders
Also called	Low strength tablets: Loestrin 20® (ethinylestradiol with norethisterone acetate) Mercilon®, Gedarel 20/150® (ethinylestradiol with desogestrel) Femodette®, Sunya 20/75®, Millinette 20/75® (ethinylestradiol with gestodene) Low strength patch: Evra® (ethinylestradiol with norelgestromin) Standard strength tablets: Levest®, Logynon®, Logynon ED®, Microgynon 30®, Microgynon 30 ED®, Ovranette®, Rigevidon®, TriRegol® (ethinylestradiol with levonorgestrel) BiNovum®, Brevinor®, Loestrin 30®, Norimin®, Ovysmen®, Synphase®, TriNovum® (ethinylestradiol with norethisterone) Cilest® (ethinylestradiol with norgestimate) Marvelon®, Gedarel 30/150® (ethinylestradiol with desogestrel) Yasmin® (ethinylestradiol with drospirenone) Femodene®, Femodene ED®, Katya 30/75®, Triadene®, Millinette 30/75® (ethinylestradiol with gestodene) Norinyl-1® (mestranol with norethisterone) Qlaira® (estradiol with dienogest)
Available as	Tablets and patches

Combined hormonal contraceptives tablets (sometimes called 'the pill') and combined hormonal contraceptive patches, contain two different hormones: an oestrogen and a progestogen.

The strengths and types of oestrogen and progestogen vary from product to product. Preparations are called low strength or standard strength depending on how much oestrogen they contain. Your doctor will have chosen the product most suitable for you. In some products there will be two or even three different strength tablets to take at different times during your cycle.

Combined hormonal contraceptives may be used to treat menstrual problems as well as to prevent pregnancy.

Combined hormonal contraceptives prevent pregnancy in three ways:

by stopping you from ovulating (producing an egg)
by thickening secretions round your cervix (making it harder for sperm to get through)
by making the lining of the womb thinner (therefore less welcoming to the egg).

Before taking combined hormonal contraceptives

Before taking combined hormonal contraceptives make sure your doctor or pharmacist knows:

If you are breast feeding or think you may be pregnant.
If you suffer from thrombosis (blood clots) or arterial disease, or if you or a close relative have a history of these conditions.
If you suffer from heart disease, migraine, high blood pressure, porphyria (blood disorder) or systemic lupus erythematosus (arthritis affecting skin, joints & internal organs).
If you suffer from liver problems, gallstones or diabetes mellitus.
If you have just been treated for trophoblastic disease (an abnormal growth formed in the womb in pregnancy).
If you suffered from itching, jaundice (yellowing of the skin and whites of the eyes), chorea (jerky involuntary movements) or pemphigoid gestation (severe itchy, blistering disorder) while you were pregnant.
If you have a breast lump, have had breast cancer, or if there is a history of breast cancer in your family.
If you suffer from vaginal bleeding other than your normal monthly period.
If you are not fully mobile.
If you are obese, smoke, or are over 35 years of age.
If you have a history of depression.
If you have had a transient ischaemic attack (TIA), sometimes called a 'mini-stroke'.
If you or a close relative have ever had hypertriglyceridaemia (high levels of lipids in blood).
If you suffer from hyperprolactinaemia (excess prolactin), haemolytic uraemic syndrome (a blood disorder), sickle cell disease (an inherited blood disorder affecting red blood cells), inflammatory bowel disease or varicose veins.
If you have ever had an allergic reaction to this or any other medicine.
If you are taking any other medicines, including those available to buy without a prescription, herbal or complementary medicines. Some medicines may stop the combined oral contraceptive from working properly.

How to take combined hormonal contraceptives

If you are taking this contraceptive for the first time, read the manufacturer's printed leaflet carefully which will tell you when and how to start it.

If you are taking tablets:

You must take your pill at the same time each day. If however your forget to take it on time, take it as soon as you remember, and the next dose at your usual time (even if this means taking two pills together).
If you miss 1 dose (that is, you are 24 or more hours late taking a dose) take a pill as soon as you remember and then take the next dose at your usual time.
If you miss 2 or more doses (especially at the beginning of the packet) the pill may not work. As soon as you remember you must continue taking the tablets as normal. As you may not be protected for the next seven days you must either not have sexual intercourse or must use another method of contraception, such as a condom. If these seven days run beyond the end of your packet, start the next packet at once when you have finished the present one. This means you will not have a break between the packets and you may not have a period until the end of two packets, but this will do you no harm. Nor does it matter if you see some bleeding on the tablet taking days. If you are using an everyday (ED) pill, miss out the seven inactive pills (the pills you take while you are having a period). If you are not sure which these are or if you are unsure about the advice, speak with your doctor or pharmacist.
Important: If you have had unprotected intercourse whilst having missed 2 or more pills, speak to your doctor or pharmacist for advice on what to do.

If you are using patches:

Apply a patch on the first day of your period, 'Day 1', and then change it for a fresh patch each week on the same day of the week for two further weeks (that is on 'Day 8' and 'Day 15' of your cycle). On 'Day 22' remove the patch and follow it with 7 patch-free days before beginning a new cycle. If a patch becomes detached or unstuck, replace it with a new patch. Do not hold it in place with bandages or plasters.
If a patch becomes detached for less than 24 hours, reapply it (or replace it with a new patch) to the same site. Then continue as before, applying the next patch on the usual change day.
If the patch has been detached for more than 24 hours, stop the current cycle and start a new cycle by applying a new patch. You will also need to use another method of contraception such as a condom during the next 7 days. This new patch is now your 'Day 1' patch and you must remember to change your patches on this same day of the week from now on.
If you forget to apply a patch at the start of a new cycle, you will not be protected. You must apply a 'Day 1' patch as soon as you remember and use another method of contraception such as a condom during the next 7 days. If you have had intercourse during the period where no patch was applied, speak with your doctor or pharmacist for advice.
If you forget to change a patch during the 4-week cycle and it is less than 48 hours overdue, change to a new patch immediately and remember to change it on your usual change day (that is, your change day remains the same).
If you forget to change a patch during a 4-week cycle and it is more than 48 hours overdue, you may not be protected. Remove the old patch and start a new cycle applying a 'Day 1' patch and use another method of contraception such as a condom during the first 7 days of this new cycle.
If you forget to remove the patch at the end of a cycle (that is on Day 22), remove it as soon as you remember and start the next cycle on your usual 'change day'.

Getting the most from your treatment

You must keep your regular appointments with the doctor or clinic and your smear tests.
If you suspect that you may be pregnant, stop using at once and consult your doctor as soon as possible.
Important: If you are sick (vomit) within 2 hours of taking your contraceptive pill, take another pill as soon as possible. If the vomiting continues or you have severe diarrhoea lasting more than 24 hours, this can affect the absorption of the pill. You must use additional precautions such as a condom, during and for seven days after your recovery. If the sickness and diarrhoea occurs during the last seven tablets, miss out the 7 pill-free days and start a new pack of oral contraceptives straight away. If you are taking the everyday (ED) pill, miss out the seven inactive pills (the pills you take while you are having a period). If you are not sure which these are or if you are unsure about the advice, speak with your doctor or pharmacist.
If you are prescribed an antibiotic for an infection while you are taking an oral hormonal contraceptive, the current advice (January 2011) is that additional contraceptive precautions (such as condoms) are not required unless you are sick or have diarrhoea. If you need further advice, speak to your doctor or pharmacist.
Before having any kind of surgery, including dental and emergency treatment you must tell the doctor, dentist or surgeon that you are using combined hormonal contraception.
Travelling that involves long periods of immobility (more than five hours) can increase the risk of serious side effects affecting the blood circulation and in rare cases may lead to blood clots. Taking appropriate exercise during the journey and possibly wearing elastic hosiery can reduce this risk. If you are concerned, speak to your doctor or pharmacist.
Combined hormonal contraceptives do not protect from sexually transmitted diseases or HIV infection. Ask your pharmacist or doctor for advice on safe sex.

Can combined hormonal contraceptives cause problems

Along with their useful effects all medicines can cause unwanted side effects, which usually improve as your body adjusts to the new medicine. Speak with your doctor or pharmacist if any of the following side effects continue or become troublesome.

Common side-effects - these affect less than 1 in 10 people who take this medicine	What can I do if I experience this
Feeling or being sick, stomach cramps	Eat little and often and stick to simple foods
Headache	Ask your pharmacist to recommend a suitable pain killer. If the headache continues or is sudden and severe, contact your doctor
Dry eyes	If you wear contact lenses ask your optician for advice
High blood pressure, breast enlargement or tenderness, changes in body weight, fluid retention, irritability, changes in sex drive, low mood, breakthrough bleeding, absence of bleeding on pill withdrawal, changes in vaginal discharge, leg cramps, jerky movements, brown patches on skin.	If troublesome, speak to your doctor

Important: If you experience sudden severe chest pain, breathlessness, unexplained swelling or pain in the lower leg, stomach pain, unusually severe headache, collapse or fainting, fits or numbness of one side of the body, jaundice (yellowing of the skin and whites of the eyes), loss of vision or hearing, or you become unable to swallow, contact your doctor immediately.

If you experience any other symptoms which you think may be due to this medicine, let your doctor know.

How to store combined hormonal contraceptives

Keep all medicines out of the reach of children.
Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

Keep all medicines out of the sight and reach of children.
Make sure that the person prescribing this medicine knows about any other medicines that you are taking. This includes medicines you buy and herbal and homeopathic medicines.
If you buy any medicines check with a pharmacist that they are safe to take with your other medicines.
Before taking this medicine tell your doctor if you have ever had an allergic reaction after taking any medicine.
Never take more than the prescribed dose. If you suspect that you or someone else has taken an overdose of this medicine go to the accident and emergency department of your local hospital at once. Always take the container with you, if possible, even if it is empty.
If you are having any treatment like an operation or dental treatment tell the person carrying out the treatment which medicines you are taking.
Always read the printed information leaflet that comes with your medicine.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Never keep out of date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.