Combined pill, patches and ring

Hormonal contraceptives are grouped by the type and number of hormones in them. There are two main groups:

  • One group contains two types of hormone – oestrogen and progesterone – and these are known as combined hormonal contraceptives (CHC). These include tablets, the contraceptive patch and the vaginal ring.
  • The other group contains just the hormone progesterone. This group includes progesterone only tablets (which are also often called the ‘mini pill’), the depo injection, the contraceptive implant and the hormonal coil.

This summary is about combined hormonal contraceptives often referred to as ‘the pill’.

‘When taken correctly, the pill is over 99% effective at preventing pregnancy. This means that fewer than one woman in 100 who use the combined pill as contraception will get pregnant in one year.’ (NHS Choices 2015). However average use of the pill has a 9% failure rate (Centre for Disease Control 2015).

Combined hormonal contraceptive methods work by stopping the ovaries releasing an egg every month. This means that the woman’s own natural cycle of egg release and periods is switched off. If a woman wants to have a regular bleed every month then she can stop the hormones for 7 days every 4 weeks to create a ‘withdrawal bleed’. To do this the user takes her pills daily for 3 weeks (or uses the contraceptive patch or ring for 3 weeks) then has a week off to create a bleed, then they repeat the cycle. If she wants fewer bleeds than this, she can run packets of pills, patches or rings together without a break. A doctor or nurse can explain how to do this. It’s not how these products were originally designed to be used but is safe and effective and preferred by an increasing number of women.

The ‘withdrawal bleed’, that most women get when they take a week’s break between packets of the combined pill, is lighter and shorter than a woman’s usual period. For this reason some young women take the combined pill to help with heavy or painful periods even before they need contraception (see ‘Living with periods‘). Pre-menstrual symptoms like mood changes can also be helped and the combined pill can help with acne (spots) for some users.

Indicates that her experience on the pill has been very positive. (Actor)

Age at interview 20

Gender Female

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(The accompanying video and audio clips are played by an actor)

Are your periods regular or irregular?

When I first started my period they were regular, sort of 28 days on, 7 days off, then when, it was around my GCSE and A level time, it was pretty stressful and my eating habits were pretty poor, so my periods became very irregular, which was not brilliant.

Later on I think when I was 19, they became too regular every sort of 15 to 18 days I’d come on, which was really annoying. Then when I was about 20, they just became really, really painful, so I went to the doctors and decided to go on the pill, which was mainly for contraceptive reasons as well but it did help with the pain.

Which pill are you taking?

Marvelon, it’s 21 days on and 7 days off.

Are you quite happy with the pill?

Yeah, very, I wouldn’t change it.

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Women described liking ‘the pill’ because it’s easy to use, is reliable, and under their control. The women we spoke to said that taking the pill shows a responsible attitude to contraception and means that sex can be more spontaneous.

Says she is quite happy on the pill and has no plans to change to another method of contraception…

Age at interview 24

Gender Female

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(The accompanying video and audio clips are played by an actor)

Well no, I’m quite happy with the pill, so I don’t think I’d try any others.

Okay.

Well I can’t say never, I don’t know how I’ll feel in the future, but for the time being I’m quite happy with the pill.

Oh, when I first came here, the nurse I saw, she recommended it. She was telling me about different kinds of contraception and she recommended the pill, told me about the different types of pill. She recommended the combined one which is what I’ve always taken.

And are you quite systematic at taking the pill? You’ve never missed pills or.?

Oh yeah sometimes I miss, yeah. But on the whole, quite good.

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It is important to know that some medications (for example some HIV medications, or epilepsy medicines) can interact with hormonal contraception, and so this needs to be considered before choosing what type of contraception is right for someone (for more information on epilepsy and contraception see our Epilepsy section).

Most women take contraceptive pills without problems. However, the combined pill has possible side effects which include nausea, vomiting, rises in blood pressure, headaches, and effects on mood and libido (sex drive). These are only some examples and it is important to read the product information and talk to a health professional. Many women won’t get any of these side effects.

Using the combined pill or combined hormonal contraceptives can increase the risk of developing some serious conditions such as: venous thromboses (blood clots) and circulation problems including, very rarely, strokes. It is because of these possible risks that health professionals will need to check whether a person has other risk factors for blood clots or circulation problems, such as smoking, high blood pressure, increased weight (high body mass index), diabetes, and whether anyone in the close family has had these illnesses or difficulties. Some women with migraine headaches should not take combine hormonal contraceptives. If they have warning symptoms (aura) before the headache, such as a blurred patch of vision, changes in speech or numbness, progesterone only methods are a safer alternative.

Talks about the different oral contraceptives she has tried.

Age at interview 22

Gender Female

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I was offered ‘ I was talking to the nurse, I’ve had ‘ with the Pill I go on, and it’ll cure up my PMS for a while, and then I found that after, like, sort of a few months, if I’m not on the right one, it’ll come back again. So I went to see ‘ when I first went on them, I changed it quite a few times.

How old were you when you started?

I think I was 17.

Can you remember the name of the Pill?

Yeah, I started on the Microgynon ED , because it was the first one I went on, and it was what the doctors started everybody on at my surgery, because it’s the one with the 21 active, and the seven inactive pills, so that you get used to taking it every day. And then, erm, because I had quite bad acne, I went on to Dianette, which is for the ‘ obviously, for that.

And that didn’t agree with me. So then I went on to Cilest , which I stuck with for a while, but then my symptoms came back, so they tried me on ‘ Trinordiol, which is a triphasic one, and I’ve just recently changed to Brevinor, but I really don’t like that, and I’m going to try and get back on the Trinordiol.

Why don’t you like that?

Because I’ve got such problems with my breasts, I’ve got to the stage I can hardly bear my boyfriend to touch them, and even walking up and down stairs, it hurts. So I’m going to go back to the doctor and say, ‘I don’t get on with this one.

I don’t mind taking a pill every day, I just want something that’s ‘ a different one. So were going through the ‘ it was really funny, I was going through the BNF with the doctor, trying to find one in the glossary that I hadn’t tried. Hes like, ‘You’ve been on everything!’ .

So your breasts are very sensitive ‘?

Yeah, and they’re really tender and swollen and ‘ and hurt when I walk, and when people touch them. And because of the job I do as well, I work in a bowling alley, so obviously theres always a lot of people about, and you’ve got to ‘ like, lots of lifting when you’re carrying glasses and stuff, and it’s like I can’t do my job properly, because my breasts hurt, which seems really silly.

So when did this start to ‘?

About a month ago, which is why I’m fairly certain it’s the new Pill, because I’ve only been on it for two months.

And you haven’t had this problem before?

No. I never had a problem with my breasts before, so that’s why I’m fairly certain it’s the new Pill, so I’m going to go back and get it changed.

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If women start a new tablet and develop new symptoms such as headaches (or their blood pressure goes up), it is important they get advice straight away. Sometimes this means changing the method of contraception for a more suitable one, or in rare cases it may even need assessment in hospital e.g. for cases of suspected blood clots.

Describes how one GP mistakenly gave her the combined pill despite a history of headaches and migraines and how another GP stopped her taking it (Actor)

Age at interview 21

Gender Female

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(The accompanying video clips are played by an actor)

Something like Microgynon 30. I think I took that one for about a year and then I was getting severe headaches and stuff, so they told me to come off the pill and, so I came off the pill and they told me just to use condoms, but I never and that’s when I fell pregnant with my daughter

Well I’ve only been on it for the past month, just over a month, but its like I’m meant to be on and I’d get like a spotting of blood, then I’d use something and then it’d disappear and it’s all gone, so you don’t put anything there ‘cos you think its stopped again and it starts again.

Do you have any concerns about the health affect of any of the contraceptive methods?

No not really. Well they put me on the combined pill, well my doctor put me on the combined pill after I’d had my son ‘cos I wanted to go back on the pill, and I actually went to the Family Planning and I said can I have some more of these and they said ‘well if we had given them to you we could just give you some more, but I had to see the doctor.

I said OK, so I saw the doctor and she looked at my records and she said ‘why was you on the mini pill before you fell pregnant with your son’ and I said well I got severe headaches and she said ‘who gave you this combined pill I said my doctor and she said ‘you shouldn’t be on it’, because where I got real bad headaches like when I was 18 I went sort of like numb down one side of my body with it. She said being on the combined pill could cause me to have a stroke, so she quickly took me off it and put me onto the mini pill that’s what I’m on now.

So you went to your GP?

And he gave me the combined pill.

Did he know about your history?

Yeah hed been my doctor all my life, my whole life. I said to him that I wanted to go back on the pill and he was like well here you are, just gave me that one. He done my blood pressure and everything that was about it really, just gave me the prescription for one of the combination pills.

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Stopped using oral contraceptives because her blood pressure is high. (Actor)

Age at interview 25

Gender Female

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(The accompanying video and audio clips are played by an actor)

Well basically I came off the pill about 4 years into the 6 year relationship because, yes I came off the pill. I just found that I was really hungry all the time which was okay, I didn’t put on any weight or anything but I didn’t really like it.

And also I didn’t feel much like sex when I was on the pill, I found that. So I came off the pill and obviously I was worried about pregnancy and I knew someone else, vaguely, who wed discussed, and they had a diaphragm, I hadn’t really thought about that as a form of contraception before. But I used that for a while in conjunction with condoms.

Do you have any concerns about the health effect of any of the contraceptive methods?

I found when I came off the pill it took a long time to get my period back and that was, I don’t think that’s typical of everyone but that was my experience and that was why I was off the pill for so long. And after that I didn’t really feel like going back on the pill.

It took nearly 2 years for my period to come back regularly and I think there could be other factors but I think that’s a hassle because you don’t know every month. I don’t know, could I be pregnant? And I just don’t know because my period isn’t regular, things like that. I mean I don’t think that’s dangerous or anything, I wasn’t worried that it was something dangerous but it was just a bit annoying.

I don’t particularly want to use a contraceptive pill again. My blood pressure is quite high in the family anyway and so that’s something which, I know when you get older as well is not so advisable. So the doctor thought that that might be quite a good method for me.

So were you taking your blood pressure regularly when you were on the pill?

Not that regularly but I went, I mean they check it and it was fairly high. Not dangerously high but probably in the longer term, but that’s just something in my family. I mean my mother has got high blood pressure so…

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Explains that she has had two incidences of suspected blood clots but that oral contraceptives do…

Age at interview 23

Gender Female

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I stayed on it until, oh for a long time, for years. Years and years I was, I stayed on it and then, I can’t remember when it was, it was when, well not long before my dad left, which would be August four years, so whenever that was, Yeah.

I had my, I was working in a hotel and my leg blew up one day, went bright red, boiling hot to touch and they thought I had deep vein thrombosis so they took me off of the pill straight away then.

And they said, well they never found anything, it just went down and they don’t know if I was, I’d pulled, you know, strained something that just flared up or something like that but they never actually, I had all the scans and everything, they never actually found a clot so they took me off of the pill then and they weren’t very keen for me to go on it for a while just to make sure that everything had settled.

And then they put me on the it’s Trinordiol, it’s called, it’s all, the three different colours hormonal things on, and then I’ve been on those ever since apart from my two pregnancies… Yeah. So they took me off of this, off of the micro-something or other and put me on this other combined thing, different colours. I don’t know why, they never really explained to me but they said it was a safer, for you. And ‘

And how have you been feeling since?

Yeah. Fine, apart from when I was pregnant with [daughter] I had another suspected blood clot on my lung and, turned very, well they keep saying, well after I had [daughter] I had the injection, contraceptive injection which I quite hated and they gave, every time I’d go and see the doctor I, she always, I have quite regular pill checks now, to check that everythings because obviously I’ve been, they never found a blood clot on my lung either but they never know because they put me on Heparin.

I went in on a Friday night and they put me on Heparin and they didn’t actually scan me for a blood test for the blood clot until the Tuesday, so the Heparin could have dis, might have been a minute one and the Heparin dispersed it, so well never know.

So obviously I’ve got on my records two suspected blood clots now so they’re not that thrilled about me being on the pill but there isn’t really anything else. If I come off of the pill then I’ll start with these horrendous periods again which I really don’t want to be doing. And though that what, and I never want that injection again either because it made me so ill.

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Some of the women we talked to stopped taking the pill due to worries over the side effects of taking hormones. Some weren’t very good at remembering to take it every day – in which case they often switched to the contraceptive injection or implants.

Talks about her concerns regarding the possible side-effects of the combined pill.

Age at interview 21

Gender Female

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I was on that for about 5 years.

OK

When me and my boyfriend split up, my ex-boyfriend, I stopped taking it, ‘cos I weren’t gonna be sleeping with anyone. I knew that and they say that they were worried about the cancer scare, and getting blood clots and such. I’m a really quite paranoid person about my health in general, so I thought I don’t, theres no, I don’t really need to take it, so I will stop, and I did.

What do you use now?

I use condoms. If I sleep with someone, I use a condom.

And that’s the only method?

Yeah.

Do you have any concerns about the health effect of any of the contraceptive methods?

Pill, ‘cos you hear a lot about it in the paper about you get blood clots and it leads to cancer and things like that

Some of my friends suffer from the, the combined pill. They say they get pains in their legs and things like that. But I was fine on it. I never has no problem whatsoever. Every couple, ‘cos it gives me three to six months supply, then after that check my blood pressure, check my weight and they, he said I was fine. I didn’t have no affects from it at all.

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There are pros and cons of taking the pill, and some of the women we spoke to had been put off by friends and family, or had read negative stories in the media. Others didn’t like the idea of taking hormones, although many felt that, for them, it was better to take the pill than risk an unwanted pregnancy.

One woman said that she understands why clinics have ‘a bit of an agenda’ but feels that women are sometimes under pressure to go on the pill.

Felt under pressure by the family planning service to use the contraceptive pill. (Actor)

Age at interview 25

Gender Female

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(The accompanying video and audio clips are played by an actor)

I think quite good. I don’t know, the last time I went I sort of felt a bit under pressure from them to go back on the pill and I can understand it because I’d gone to get the morning-after pill because, you know, I hadn’t been consistent in using condoms. And I can see why, from their point of view that I should be on a more reliable form of contraception.

But I’ve got my reasons for not wanting to go back on the pill and it’s not that, you know, it’s not that I’m thinking of using the IUD because I don’t want to have an effective method of contraception. I felt a bit under pressure from them to go back on the pill.

Did they sort of talk to you explicitly about… did they ask you?

Yes, they sort of said why don’t you have the contraceptive injection because, that’s another one that I forgot about! Because of not being reliable in taking pills. I had sort of already explained that that isn’t the reason that I don’t want to go back on the pill. And then they were sort of saying, well you know you could go on the mini-pill. But I think they were just sort of making me aware of more options.

It wasn’t a negative experience, I just felt that they’d got a bit of an agenda! But that’s their job so it’s fair enough.

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Frequently women find men don’t know much about the pill. Some women wish their partners would learn more, or they teach them about the pill themselves.

Talks about the need to ‘educate boyfriends about the pill. (Actor)

Age at interview 20

Gender Female

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(The accompanying video and audio clips are played by an actor)

Yeah I actually think that we need to educate men more, I mean there is a lot of pressure on girls

You say educate the men, about what specifically?

Well I think that men should probably know what their girlfriends need to know. Especially about like the contraceptive Pill. Like their girlfriend knows that if they miss a pill and take it 12 hours, more than 12 hours late then they should not have sex for a week and guys need to know that too. It would take some of the pressure off the girls having to remember it every day if the guy could share that.

And I guess they should know when to take the after-sex pill, that you can take it up to 72 hours afterwards. And maybe the different safety risks for using the condom and the Pill and sexually transmitted diseases and the symptoms that go with those. If they just knew a bit more then it would take the pressure off the girl.

So do you think you could start educating your boyfriend?

Yeah, well I think I already have. Like sometimes he reminds me to take a Pill when I’ve forgotten and so that’s quite nice and it just makes me feel like hes taking part in the contraceptive side of our sex life as well, so that’s good.

Practically, hes more involved?

Yeah he knows more about it and that’s really helpful and so yeah, I do try to educate him.

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For women who find it difficult to swallow pills or have sensitive stomachs there are two other forms of CHC contraception available. These are based on the same hormones as the combined oral contraceptive pill, and come in the form of contraceptive patches, or a vaginal ring which delivers the pill hormones vaginally.

Condoms

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