Is the Pill popular?
If you’re thinking of going on the Pill, you’ll be joining a
band of about 100 million women worldwide who use this method.
| The Pill is a tablet containing two female hormones – an
oestrogen and a progestogen.
How many women take it in the UK?
In the UK, there are about 3.5 million women who take the Pill.
This is roughly one in three of all females of reproductive age.
The Pill has always been a bit controversial. Although it is now
55 years since it was first used (in Puerto Rico in 1956), there are still
occasional 'Pill scares' – when newspaper headlines trumpet the dangers of Pill
However, the fact that it remains so staggeringly popular does
indicate that for huge numbers of women, the slight risks are outweighed by the
Is the Pill safe?
Basically, yes. But very occasionally, it can have serious
Did you know?
More than 100 million women worldwide use the contraceptive
However, recent news about Pill safety has been remarkably
The Royal College of General Practitioners has produced (2010)
an important report, which revealed the fact that Pill-users have a 12 per cent
reduction in their risk of developing
The researchers studied 46,000 women over a period of 40 years
and found that those who had taken the Pill were less likely to die of cancer,
heart disease or
The report also found that
breast cancer rates
appeared to be the same in women who have used the Pill, and women who haven’t.
This finding goes some way towards diminishing previous fears about the Pill
and breast carcinoma.
Nevertheless, most doctors don’t think that the Pill should be
‘dished out’ to absolutely everyone, without any need for a preliminary chat.
Only a very tiny number of women should not take the Pill,
because they have serious medical conditions.
So when you want to start on the Pill, you should see a doctor
(or family planning nurse) and have a short check-up.
This is partly to see if you have any risk factors – especially
smoking – that would
make you more liable to
deep vein thrombosis
heart attacks or
Another important factor the doctor will be looking out for is
In May 2011, leading authority Anne Szarewski told a meeting of
GPs that being overweight is 'the single most significant risk factor' for
thrombosis on the Pill. She said that Pill-taking women whose
body mass index (BMI) is 30 or more
had almost 24 times the average risk of thrombosis.
At your first visit, quite apart from assessing risk factors,
the health professional can explain to you exactly how to take the Pill and can
answer any queries you've got.
Once you're on the Pill, what then?
You should return to the surgery or clinic for occasional 'Pill
checks'. In Britain, they are usually done at six-monthly or yearly intervals.
These visits are very brief, and generally all the nurse or
doctor does is ask you whether you’re having any problems with the Pill, ensure
that you haven’t developed any ‘risk factors’ in the last six months and check
blood pressure (and
possibly weigh you).
A lot of people still think that you have to have a vaginal
examination and a
smear test before
going on the Pill or at subsequent visits, but this is no longer true.
What is the Pill?
The Pill is a tablet containing two female hormones – an
oestrogen and a progestogen. This is why it's often called the combined Pill.
Various oestrogens and progestogens are used in the many
different types of Pill that are available.
There are currently 28 brands on the market in Britain. Six new ones have recently been introduced, and one of these is being marketed on the basis of its ability to shorten periods. However, this is actually a welcome property of nearly all combined Pills.
The two hormones stop you from ovulating (producing an egg) each
month. And if you don't ovulate, you won't get pregnant.
In addition, the hormones thicken the secretions round your
cervix, making it more difficult for sperm to get through. Also, they make the
lining of your womb thinner, so that it’s less receptive to an egg.
Is the Pill the same as the mini-Pill?
mini-Pill is not a
low-strength version of the ordinary combined Pill. It’s a completely different
product because it contains only one hormone instead of two. This makes it
'milder' and freer of side-effects, but also less effective.
Pill versus mini-Pill
The two are not at all the same. The Pill contains two
The mini-Pill has fewer side-effects but is also less effective.
Also, it doesn't control the periods in the same way that the
ordinary Pill does.
Adverse effects of the mini-Pill can include breast discomfort,
weight changes and spots on the skin.
For a full list, read the package leaflet, or talk to your nurse
However, it is a very good method – especially for
mothers, for over-35s, and for those who don't want to take (or can't take) the
How effective is the Pill?
It's very effective indeed, which is why so many millions of
women rely on it.
If you take it exactly as prescribed, its effectiveness is
likely to be almost 100 per cent.
Put it another way: let’s say that 100 women use the Pill for a
year and that all of them never forget to take a tablet. It’s likely that not a
single one of them will get pregnant.
In contrast, if they were all relying on the
probably about two to five of them would become pregnant. And if they used no
contraception at all, perhaps 20 to 40 of them would fall
So the Pill is just about the most effective method of
contraception there is, apart from
How do you take it?
In the UK, you’re given a pack that usually contains 21 pills,
and you take one every day for three weeks. At the end of those three weeks,
you break for a week. During those seven days, you'll have your
If you wish, you can take seven 'dummy' tablets during the
week's break. Brands that have seven dummy tablets are called 'ED' ones. ('ED'
just means 'every day'.)
It's stopping the Pill at the end of the 21-day pack that brings
on the period.
After the week's break, you start on your next packet. So it's
'three weeks on and one week off' throughout the year.
If you want to, you can set your mobile phone so that it beeps
at the same time every day, to remind you to take your Pill.
Note: one newly-introduced Pill, called
different from all the rest because the makers have decided that you should
have hormones on 26 out of the 28 days of your cycle (and then two dummy
But how do I get started?
Go to a GP or a family planning clinic to see the doctor or
nurse, and discuss risk factors and possible side-effects and get a
In Britain, it's now the practice to take your first-ever Pill
on the first day of your period.
If you do this, you should be protected immediately – so you can
have sex whenever you like.
Practices vary in other countries, and their Pill packs may
contain more than 21.
In the USA, it's extremely common for women to be given packs
containing 28 tablets – but seven of which are 'dummies'.
What are the good points about the Pill?
The Pill has now been shown to have certain major health
Because of this, you are less likely to become
it usually abolishes
it makes periods shorter
it makes them lighter.
If you have
acne, the Pill should
usually improve it – but not always.
The Pill is useful if you want to delay having a period for a
special occasion, such as a holiday. By taking two packets back-to-back without
a week's break, you can avoid having your period at an inconvenient
In addition, it decreases your chances of getting certain
cancers (though it increases the risk of others).
But can't it give you a lot of side-effects when you
Yes. During the first few packs of the Pill, many women get
minor, passing side-effects, such as:
These side-effects usually go away after the first few packs. If
they don’t, it's easy to get rid of them by simply switching to another brand.
slight weight gain
slight 'spotting' of blood between the periods.
What about serious side-effects?
There's no doubt at all that the Pill can occasionally cause
serious problems like:
Fortunately, these events are rare. But they are much more
likely to happen if you have certain 'risk factors', which include:
deep vein thrombosis (DVT) or clotting (this is now thought to
be slightly more common in women who are taking Pills containing the
progestogens desogestrel and gestodene)
There are other risk factors, for instance making a very long
journey in a plane or a cramped car seat. Your doctor or family planning nurse
can give you more details.
having a family history of thrombosis or some similar illness
(say, if your mother had a heart attack or a deep vein thrombosis at
quite a few non-smoking diabetics do use the Pill, under careful
high cholesterol level
having a past history of phlebitis (vein inflammation) or
being immobile for a while (especially when having a surgical
The risk is now known to be greater in the first year of taking
the Pill. But it also increases a little as you get older, which is why many
women come off the Pill some time after the age of 35.
Family Planning Association
(FPA) is currently stating that women without risk factors can take the
Pill up to age 50.
Many people have the idea that 'you can't take the Pill if you
varicose veins'. This
However, in recent years it has become clear that severe
problems with varicose veins are a contraindication to the Pill.
But if you just have mild and superficial varicose veins, it's
quite likely that your doctor will be willing to prescribe a low-dose Pill for
you – provided that you have no other risk factors.
Familial blood factors
It's now clear that certain blood-clotting abnormalities that
run in many families make you more liable to clotting.
The best-known of these is
Factor V Leiden. If
you have this, we suggest you go for another form of contraception.
In the last few years, it's become evident that a lot of women
have something called Hughes' syndrome (anti-phospholipid syndrome, or
This blood disorder predisposes them to serious blood clotting.
If you have Hughes' syndrome, you should definitely not go on the
In the early part of this century, new research showed that
women who have severe
migraine and use the
Pill run an unacceptable risk of having a stroke.
Official advice in the 2011 edition of the British National
Formulary (BNF) is that you can use the Pill 'with caution' if you have
But if you have migraine with 'aura' (which means odd 'warning'
symptoms in any part of the body), you should avoid the contraceptive Pill
The BNF also states that women who have any increase of headache
frequency on the Pill should tell their doctors.
Whether or not you have migraine, if you develop symptoms, such
as severe headache, eye disturbances, numbness, paralysis, deafness, speech
difficulties or fits while on the Pill, you should STOP taking it immediately,
and ask your doctor to refer you to a neurology expert.
Fortunately, such alarming occurrences are rare.
Does age make a difference?
Yes. The Pill is extraordinarily safe for young women in their
teens or 20s who have no risk factors (such as smoking). But when you get to
the age of 35 or 40, the chances of having a thrombosis (clot) are starting to
In practice, there are some women in their 40s who take the
Pill, and the FPA currently believes this to be safe.
But as the years go by, there's more and more reason to switch
to the mini-Pill or to some other
contraception, such as sterilisation or
vasectomy for your
What about cancer?
The Pill does affect your risk of certain types of cancer – and
when you first decide to go on it, you should be told about this.
Did you know?
The Pill can increase the risk of some cancers and reduce the
risk of others. Ask your doctor for advice.
But it's important for you to realise that the Pill actually
reduces your chances of getting some cancers – while it increases the risk of
As far as we know, the Pill reduces your chance of
The Pill slightly increases your risk of getting:
cancer of the
cancer of the womb
bowel cancer – a 60
per cent reduction in risk has been claimed, though this is still not
Be 'breast aware'
Check your breasts regularly for lumps or anything odd,
particularly as you approach middle age, which is when breast cancer starts
cancer of the
a very rare form of liver cancer
possibly breast cancer – but see above.
Does anything make the Pill less likely to work?
Yes. These things make it less effective:
You used to be advised to use extra precautions, such as a
condom, if you were prescribed a course of antibiotics like tetracyclines and
forgetting Pills – especially at the beginning or end of a
vomiting (a common holiday risk)
taking certain anti-epilepsy drugs, including phenytoin (eg
Tegretol). It has
been agreed that the Pill should NOT be taken by women who are on the
taking the antibiotics rifampicin (,
(TB) or other infections.
taking certain anti-HIV medicines, including ritonavir (egNorvir)
taking the morning-after pill called
acetate). You'd be wise to use extra precautions for two weeks if you
are prescribed this as emergency contraception, for example if you've missed
Pills. (The emergency contraceptive called
Levonelle that you
can buy over the counter contains a different ingredient and doesn't make the
Pill less effective.)
taking the popular herbal remedy
St John's wort while you are taking
the Pill. It reduces the effectiveness of the oral contraceptive, and you may
get 'spotting' of blood.
This was because there was a theory that antibiotics could
interfere with the Pill. But there has never been any clear evidence of
In February 2011, the Faculty of Sexual and Reproductive
Healthcare of the Royal College of Obstetricians and Gynaecologists issued new
guidance about taking ordinary antibiotics while on the Pill.
They stated that 'additional precautions' (such as condoms) are
no longer considered necessary because the latest evidence suggests that
ordinary antibiotics do NOT reduce the effectiveness of the oral
During 2011, this new advice has been resisted
by some GPs, who have written in to medical publications claiming that they
remembered cases in which women became pregnant when taking antibiotics while
on the Pill.
So at present, you might still find that your family doctor
wants you to use extra precautions while you are using an antibiotic.
It's generally agreed that if a course of antibiotics gives you
diarrhoea or makes you sick, you do need to use extra precautions. Follow the
instructions for diarrhoea and vomiting in the leaflet that comes with your
If a doctor wants to prescribe any drug of any kind for you,
always tell him or her that you're on the Pill.
What if I miss a Pill?
Try not to! Of course people do inevitably miss Pills; it's
only human nature.
If you miss only one Pill, you'll probably be
OK. Take it as soon as you remember – and then take the next one on time (even
if that means you’re taking the two of them at the same time).
If you want to be super careful, you could avoid sex for the
next seven days – or take extra precautions.
However, if you're more than 12 hours late in taking the Pill,
avoid sex for the next seven days – or take extra precautions. And consider taking the 'emergency contraceptive' – see below.
Missing more than one Pill is quite risky –
particularly near the beginning or end of a packet. To avoid pregnancy, follow
the advice on the pack leaflet strictly.
To be frank, the 'missed Pill advice' in these leaflets is
pretty complicated. If you're in doubt:
call a family planning clinic for personal advice
emergency contraception (the
don't have sex until you're sure you're fully
Does the Pill reduce sexual desire?
Many experts believe that any reduction of desire is likely to
be psychological in origin, and perhaps attributable to the woman being with
the wrong partner – or at least a partner who does not make proper efforts to
romance her and to give her adequate foreplay.
However, it does seem that a few women may have a reduction of
desire because of their reaction to the hormones in the Pill.
In 2010, a study from the University of Heidelberg claimed that
lack of libido is
more common in women who are on the Pill than in those who use other methods.
In practice, many family planning doctors report that women who
are on the Pill become more relaxed about sex, because they've been relieved of
the fear of unwanted pregnancy.
So which Pill should I choose?
Regrettably, very few women do actually choose their own brand
The choosing is mainly done by doctors or nurses. (The main
exception to this occurs when a woman asks to go 'on the same Pill as my
friend' – or 'the same as my Mum'.)
Unfortunately, some doctors who don't know much about
contraception do tend to pick Pills more or less at random.
If you want a more informed choice, go to a doctor who has
training in family planning.
I think you should ask for:
The reason for preferring a second-generation Pill is that the
ones that came immediately after them in the late 1980s ( third-generation
Pills) carry a minutely increased risk of thrombosis.
a low-dose Pill
a 'second-generation' Pill.
Also, at the end of April 2011, the British Medical Journal
published research which suggested that Pills that contain the progestogen
called drospirenone carry a slightly higher risk of clotting in the veins.
However, statistically that risk remains low.
At present, the only contraceptive Pill available in Britain
which contains drospirenone is Yasmin. But very popular through much of the
world is a brand called Yaz. It's similar to Yasmin, but it contains less
In September 2011, the respected US health watchdog called the Food and Drug Administration (FDA) warned that there might be an increased risk of blood clots with Pill brands that contain drospirenone.
Nevertheless, the danger of vein thrombosis for women who are on low-dose Pills and have no other risk factors is small.
To put it into context:
Clearly with all types of Pill the annual risk is less than the risk of getting a thrombosis while you're pregnant.
Every year around 60 out of every 100,000 women who are pregnant will have a blood clot.
In women taking a 'second-generation' Pill, such as one containing levonorgestrel, a clot may occur in around 15 women out of every 100,000 each year.
In women taking a 'third-generation' Pill containing desogestrel or gestodene the risk is around 25 in every 100,000 women.
Pills containing drospirenone probably have a similar risk to these.
I strongly advise you not to pay any attention to newspaper stories or broadcasts that suggest any particular brand of Pill is wonderful' or ‘better than all the rest'. These tales usually originate from the PR companies employed by the manufacturers.
Useful numbers for Pill information
England, Scotland & Wales:
Family Planning Association
(FPA) helpline: 0845 122 8690.
Northern Ireland: FPA helpline: 0845 122 8687.
If you're under 25:
Centres: 0808 802 1234.
To find a family planning clinic, call NHS Direct on 0845
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