About combined hormonal contraceptives
|Type of medicine||Combined hormonal contraceptive|
|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 vaginal ring:
NuvaRing® (ethinylestradiol with etonogestrel)
Elevin®, Levest®, Logynon®, Microgynon 30®, 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®, Katya® 30/75, Triadene®, Millinette® 30/75 (ethinylestradiol with gestodene)
Norinyl-1® (mestranol with norethisterone)
Qlaira® (estradiol with dienogest)
Evra® (ethinylestradiol with norelgestromin)
|Available as||Tablets, patches, and vaginal ring|
Combined hormonal contraception is the most effective method of contraception if taken correctly. Combined hormonal contraceptives contain two different female hormones: an oestrogen and a progestogen. The strength and type of oestrogen and progestogen varies from product to product. Examples of oestrogens contained in contraceptives are ethinylestradiol, mestranol and estradiol. Examples of progestogens are norethisterone, gestodene, desogestrel, drospirenone, levonorgestrel, norgestimate, dienogest, norelgestromin, and etonogestrel.
There are three ways of using combined hormonal contraception. You can take the combined oral contraceptive pill (often just called 'the pill'), apply skin patches, or insert a vaginal ring.
Preparations are called 'low-strength' or 'standard-strength' depending on how much oestrogen they contain. Your doctor will have discussed this with you and will have chosen the product most suitable for you. In some packs of pills there are two or even three different-strength tablets to take at different times during your cycle. In these packs, each strength of tablet is a different colour.
Most preparations are taken or used for 21 days of a menstrual cycle, leaving a seven-day treatment-free interval during which time your period occurs. If you find it difficult to remember which weeks to take your tablets, there are some pills which are taken each day of the month. Packs of these pills contain both active and inactive tablets and have the letters 'ED' after the brand name (for example, Femodene® ED).
Combined hormonal contraceptives prevent pregnancy in three ways:
- They change your body's hormonal balance so that your ovaries do not ovulate (produce an egg).
- They cause the mucus made by the neck of your womb to thicken and form a mucous plug. This makes it difficult for sperm to get through to fertilise an egg.
- They make the lining of your womb thinner. This makes it less likely that a fertilised egg will be able to attach to it.
Before taking combined hormonal contraceptives
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons before you start taking combined hormonal contraceptives, it is important that your doctor or pharmacist knows:
- If you are breast-feeding, or think you may be pregnant.
- If you or a close family member have ever had a blood clot, or circulation problems.
- If you have ever had a problem with your veins (such as superficial thrombophlebitis).
- If you smoke.
- If you have high blood pressure.
- If you have a breast lump or have had breast cancer.
- If you have liver problems or gallstones.
- If you have heart problems, migraine, or diabetes.
- If you have any vaginal bleeding other than your normal monthly period.
- If you are not fully mobile for any reason.
- If you have ever had depression.
- If you have had a transient ischaemic attack (TIA), sometimes called a 'mini-stroke'.
- If you or a close relative have ever had high blood levels of lipids (fats).
- If during a pregnancy you have had problems such as severe itching and blistering of your skin, jaundice, or any involuntary jerky movements.
- If you have been told you have high levels of prolactin.
- If you have an inflammatory bowel condition.
- If you have systemic lupus erythematosus (often called SLE).
- If you have sickle cell disease, porphyria, or if you have had haemolytic uraemic syndrome (these are blood disorders).
- If you have ever had an allergic reaction to this or to any other medicine.
- If you are taking any other medicines, including those available to buy without a prescription, herbal and complementary medicines. This is important because some medicines may stop combined hormonal contraceptives from working properly.
How to take combined hormonal contraceptives
If you are taking 'the pill':
- Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about the specific brand of pill you have been given, and a full list of possible side-effects from taking it.
- Take one tablet each day. Most pills are taken for 21 days of each menstrual cycle, leaving a seven-day pill-free interval. If you find it difficult to remember which weeks to take your tablets, your doctor may have given you the type of pill which is taken each day of the month (called 'ED'). If you are unsure how to take the tablets you have been given, ask your doctor or pharmacist for advice.
- You should take your pill at the same time each day. If you forget to take it on time, take it as soon as you remember, and then the next dose at your usual time (even if this means taking two pills together). (Note: if you are taking Qlaira® and you are more than 12 hours late taking a pill, your protection against pregnancy may be reduced and you may need to use additional precautions such as a condom. Follow the instructions on the 'missed pill chart' in the leaflet from your pack of Qlaira®, which tell you what you need to do, as the following points do not apply to you.)
- If you miss one dose (this means 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 two or more doses, the pill may not work and you may not be protected from becoming pregnant. As soon as you remember, take a pill and then continue taking the tablets as normal. In addition, for the following seven days you must either not have sex, or you 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 straightaway without any tablet-free days. This means you may not have a period until the end of the two packets. 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 miss two or more pills from the first seven tablets in the pack and you have had unprotected sex recently, ask your doctor or pharmacist for advice on what to do.
If you are using patches:
- Before you start using the patches, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about the patches and a full list of possible side-effects from using them.
- 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 seven patch-free days before beginning a new cycle.
- If a patch becomes detached and you notice this within 24 hours, reapply it to the same area or replace it with a new patch. Then continue as before, applying your next patch on your usual 'change day'.
- If a patch has been detached for more than 24 hours or if you do not know when it came off, 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 following seven 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. If this happens, apply a 'Day 1' patch as soon as you remember and use another method of contraception such as a condom during the following seven days. If you have had sex during the time when you were not wearing a patch, speak with your doctor or pharmacist for advice.
- If you forget to change your patch on Day 8 or Day 15 but you remember when it is less than 48 hours overdue, change to a new patch straightaway and then remember to change it again on your usual change day.
- If you forget to change a patch on Day 8 or Day 15 and you only remember when it is more than 48 hours overdue, you may not be protected. Remove the old patch and apply a new patch straightaway. You will also need to use another method of contraception such as a condom during the following seven days. The 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 remove the patch at the end of a cycle (that is, on Day 22), remove it as soon as you remember and start your next cycle on your usual 'change day'.
If you are using the vaginal ring:
- Before you insert the ring, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about the vaginal ring, how to insert it correctly, and a full list of possible side-effects from using it.
- Insert one ring into your vagina on Day 1 of your cycle and then remove it on Day 22. Check the ring regularly to make sure it is still correctly in place.
- If your vaginal ring comes out but it is for less than three hours, rinse it in cool water and reinsert it straightaway.
- If your vaginal ring comes out for more than three hours (or of you do not know when it came out), you may not be protected. If this happens during week 1 or 2 of your cycle, rinse the ring with cool water and reinsert it. You will also need to use another method of contraception such as a condom during the following seven days. If this happens during week 3 of your cycle, you can either start a new cycle by inserting a new ring, or (providing the ring has been used continuously for at least seven days before this happens) you can allow your period to occur and then insert a new ring within seven days.
- If your ring breaks, remove it and insert a new ring straightaway. Use another method of contraception such as a condom during the following seven days.
- If you forget to insert a new ring at the start of a new cycle, you will not be protected. If this happens, insert a new ring as soon as you remember and use another method of contraception such as a condom during the following seven days. If you have had sex during the time when you were not using a ring, speak with your doctor or pharmacist for advice.
- If you forget to remove the ring at the end of a cycle, remove it as soon as you remember and leave seven ring-free days. After the seven ring-free days start another cycle. If you are more than a week late in removing the ring, you may no longer be protected. If this happens, speak with your doctor or pharmacist for advice.
- The vaginal ring can occasionally be felt by sexual partners, although this is usually not a problem. If you choose to remove the ring before intercourse, make sure that you replace it again within three hours so that the contraceptive effect is retained.
Getting the most from your treatment
- Try to keep your regular appointments with your doctor or clinic. This is so your doctor can check on your progress. You will need to have your blood pressure checked every six months.
- If you suspect at any time that you may be pregnant, stop using hormonal contraception and see your doctor or pharmacist for a pregnancy test straightaway.
- Important: if you vomit or have diarrhoea, it can reduce the effectiveness of the pill. If you are sick within two hours of taking a pill, take another pill as soon as possible. If the sickness continues or if you have severe diarrhoea lasting for more than 24 hours, you must use additional contraceptive precautions such as a condom during and for seven days after your recovery (nine days if you are taking Qlaira®). If the sickness and diarrhoea occur during the last week of your tablets, miss out the seven pill-free days and start a new pack of oral contraceptives straightaway. 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.
- There is a slight increased risk of thromboembolism (blood clot) with combined hormonal contraceptives. Your doctor will discuss this with you and choose a preparation most suitable for you. Travelling that involves long periods of sitting still (for example, flying for more than five hours) can increase the risk of this. Wearing flight socks and remembering to exercise your feet and ankles regularly can help to reduce this risk.
- Before having any kind of surgery, you must tell your doctor or surgeon that you are using combined hormonal contraception. This is because your doctor may decide that you need to stop taking hormonal contraception for a period of time to reduce your risk of unwanted blood clots.
- Combined hormonal contraceptives do not protect you from sexually transmitted diseases or HIV infection. If you are concerned about either of these, ask your pharmacist or doctor for advice on safe sex.
Can combined hormonal contraceptives cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.
|Common side-effects||What can I do if I experience this?|
|Feeling sick||Eat simple or bland meals - avoid rich and spicy food. If you are sick within 2 hours of taking a pill, take another tablet as soon as possible (see also the information above on vomiting)|
|Headache||Ask your pharmacist to recommend a suitable painkiller. If the headache continues or is sudden and severe, contact your doctor for advice|
|Breast tenderness, increased weight, fluid retention, mood changes, change in sex drive, breakthrough bleeding, changes in vaginal discharge, vaginal fungal infection, feeling tired, and skin changes such as acne||If any of these become troublesome, speak with your doctor|
Important: if you experience any of the following serious symptoms, contact your doctor for advice straightaway:
- Any sudden or severe chest pain.
- Any sudden breathlessness, or if you cough up any blood.
- Any swelling or pain in a leg.
- Severe stomach pain
- An unusually painful or severe headache, or any loss of your sight or hearing, or any difficulty swallowing.
- A bad fainting attack, a fit, or any numbness on one side of your body,
- Any jaundice (yellowing of your skin or whites of your eyes).
If you experience any other symptoms which you think may be due to this medicine, discuss them with your doctor or pharmacist.
How to store combined hormonal contraceptives
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Further reading & references
- British National Formulary; 62nd Edition (Sep 2011) British Medical Association and Royal Pharmaceutical Society of Great Britain, London
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Helen Huins