Combined hormonal contraceptives

About combined hormonal contraceptives

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:

1. by stopping you from ovulating (producing an egg)
   
   
2. by thickening secretions round your cervix (making it harder for sperm to get through)
   
   
3. 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.
  
  

• 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.
  
  

• 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.
• Important: Oral contraceptives can be less effective when taken with short courses of antibiotics. To prevent an unwanted pregnancy you should use a barrier method of contraception such as a condom while you are taking antibiotics and for at least 7 days after the course of treatment has ended. If the week following the antibiotic course runs into your pill free week, the next pack of oral contraceptives should be started immediately, without a break. If you are taking the form of contraceptive pill which is taken every day (ED) miss out the seven inactive pills (the pills you take while you are having a period). 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.

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