Which contraceptive pill is best?

The combined oral contraceptive or COC is an effective hormonal method of contraception often known as ‘the pill’. The pill contains synthetic versions of the natural female hormones oestrogen and progesterone.

There’s a wide range of combined oral contraceptive pills available. The experienced family-planning GPs at Virtually Healthcare can help you find the best formulation for your needs.

The combined oral contraceptive prevents pregnancy by stopping the ovaries from releasing an egg. It also thickens the mucous in the cervix so that it’s more difficult for the sperm to reach the egg and thins the womb lining, so a fertilised egg is less likely to implant in your womb.

When taken reliably according to instructions, the pill prevents more than 99% of pregnancies. Your doctor will advise you on how and when to take the pill, how soon it is effective and when you may need additional contraception.

The best contraceptive pill for you will depend on your health, your lifestyle and your preferences. Your family-planning doctor will take you through the options and help you find the right pill for your needs. Considerations include:

• Acne treatment: Certain combined contraceptive pills can reduce the effects of natural male hormones and prevent spots and acne. These pills, such as Dianette or Yasmin, may have an increased risk of thrombosis and should not be used for prolonged periods. Your doctor will carefully explain the pros and cons of treatment.
• Risk factors: If you smoke, are overweight or over 40, or suffer from migraines or hypertension, the combined oral contraceptive may not suit you. Talk to your family planning GP about your options. If you’d want an oral hormonal contraceptive, the mini or progesterone-only pill might be a safer option.
• Side effect problems:  Some people experience troublesome side effects on the pill. If you suffer from nausea, headaches or tender breasts, a lower dose pill could suit you more. Discuss the options with your doctor; they may recommend a pill with lower levels of oestrogen, such as Loestrin 20. Phasic pills have different amounts of hormones at different times in your cycle; an example is Logynon. Phasic pills have lower oestrogen and could potentially reduce side effects and unscheduled bleeding, although there is little strong evidence for this.
• Memory matters: If the pill-free break causes confusion and makes you forget to restart your pills after seven days, you may prefer a continuous or ‘every day pill. These types of COC include seven ‘dummy’ pills in the packet, so you take one pill every day. Every day pills need to be taken in the correct order, as marked on the packet. An example of an every day pill is Microgynon ED.

The specialist family planning GPs at Virtually Healthcare provide full and free contraceptive services. They will discuss your health, preferences, and pregnancy plans before suggesting contraceptive options to suit your lifestyle. These could include the contraceptive pill and other hormonal methods, including the mini-pill, contraceptive implants, injections or patches. They can also recommend barrier methods such as condoms and caps or insert coils or intrauterine systems like the Mirena device.

It’s perfectly safe to take two packets of pills consecutively with no break. The bleed you have when you’re on the pill is known as a ‘ withdrawal’ bleed. It happens because you stop taking the hormones in the pill. There is no disadvantage to missing a withdrawal bleed, and you will be protected from pregnancy throughout.

You can start the pill at any time during your menstrual cycle, but the time you start will affect the time before you are protected against pregnancy.

If you take the first pill on one of the first five days following the start of your period, the COC will prevent pregnancy immediately. If you start the pill later in your cycle, you should use additional protection for seven days.

If you’re healthy, a non-smoker, and have no medical reasons to prevent COC use, you can use the contraceptive pill until you reach 50 years. It may not be safe or healthy to use the contraceptive pill if:

• You may be pregnant.
• You’re over 35 and smoke or have given up smoking in the last year.
• You use drugs that can interact with the pill, such as epilepsy or anti-HIV medication.
• You have a history of cardiovascular disease, hypertension or stroke.
• You suffer from migraines with aura.

You have active liver or gallbladder disease.

You have breast cancer or have the BRCA gene.

You have a history of thrombosis or blood clots.

You have diabetes with complications.

You are a wheelchair user or have long periods of immobility.