Oestrogen and progestogen together. Highly effective, and there is one question that must always be asked before prescribing.
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The combined pill contains an oestrogen and a progestogen. It works chiefly by preventing ovulation, and also by thickening cervical mucus and thinning the womb lining.
Used perfectly it is over 99% effective. In real use — accounting for missed and late pills — effectiveness is around 91%, and that gap is worth knowing when choosing between methods.
The progestogen-only pill is a different medicine with a different risk profile, and is often the right answer where the combined pill is not suitable.
One tablet daily. Traditionally 21 days followed by a 7-day break, though continuous or extended regimens — taking packs back to back, or shortening the break to four days — are now recognised as safe and often preferable, because the withdrawal bleed is not medically necessary and shorter breaks reduce the risk of escaping ovulation.
Take it at roughly the same time each day.
If you miss one pill, take it as soon as you remember and carry on — you remain protected. Two or more missed pills requires additional precautions for seven days, and emergency contraception may be needed depending on where you are in the pack.
Vomiting within a few hours, or severe diarrhoea, means the pill may not have been absorbed — treat it as a missed pill.
Early and usually settling within three months: nausea, breast tenderness, headaches, mood changes, and breakthrough bleeding.
Longer term: some women report mood change or reduced libido, both of which are legitimate reasons to switch preparation rather than persevere.
The risks in proper context:
Seek urgent assessment for severe calf pain or swelling, chest pain, breathlessness, severe headache with visual change, or weakness on one side.
BMI, age, family history of clots and blood pressure all feed into the assessment rather than being absolute bars.
Enzyme-inducing drugs reduce effectiveness — some anti-epileptics, rifampicin, and St John's Wort, which people frequently do not mention because it is herbal. Alternative contraception is usually needed.
GLP-1 medicines such as semaglutide and tirzepatide delay stomach emptying and can affect absorption — which matters a great deal given those drugs must not be taken in pregnancy.
Most antibiotics do not reduce effectiveness. This changed years ago and the old advice persists stubbornly. Only enzyme-inducing antibiotics such as rifampicin are an issue.
Monitoring: blood pressure and weight before starting and at review, then annually. No routine blood tests are needed.
Yes. Contraception is well suited to remote consultation — the assessment is a structured history and a blood pressure reading.
What that involves: a full history against UK Medical Eligibility Criteria, always including the migraine-with-aura question, your blood pressure, BMI, smoking status, family history of clots, and a discussion of what you actually want from a method.
What we would also raise: the combined pill is not the most effective method available. The implant and the coil are considerably more effective in real use because they remove the possibility of missing a dose — and we would say so even though we cannot fit them ourselves. If a long-acting method suits you better, we will refer you rather than prescribe something less effective.
You will need your blood pressure measured. If you do not have a monitor, we will tell you where to get a reading before we prescribe rather than skipping it.
This page is information, not an offer to supply.
Contraception is free on the NHS across the whole UK — no prescription charge, in England as well as Wales. That includes the combined pill.
You can get it free from your GP surgery or from a sexual health clinic, and sexual health clinics generally do not require you to be registered with them. Many take self-referrals and offer walk-in or online ordering.
We would rather tell you that than take a fee. If the free route works for you, use it.
Two brands containing the same hormones at the same doses can differ several-fold in price. If you are paying, ask the pharmacy what the equivalent generic costs.
A 12-month supply is now recommended practice rather than three months at a time, and it is reasonable to ask for it.
The combined pill can be stopped at any point without tapering. There is no withdrawal.
Fertility returns quickly — often within the first cycle, and certainly within a few months. The idea that it takes a long time to "get out of your system" is not supported.
If you are stopping and do not want to conceive, you need alternative contraception immediately, not after a break.
Whatever the pill was masking. Heavy or painful periods, acne, and irregular cycles typically return over a few months.
That is not the pill having caused a problem — it is the underlying pattern reappearing, and it is worth investigating if it is severe.
Changing brand or to a progestogen-only method is straightforward but timing matters, and getting it wrong leaves a gap in cover. Ask rather than assume — the rules differ depending on what you are switching to.
No. There is no medical benefit to a break, and stopping and restarting increases both pregnancy risk and, marginally, clot risk.
The idea persists anyway, and it causes unplanned pregnancies.
No. The monthly bleed on the pill is a withdrawal bleed, not a real period, and there is no health reason to have one.
Continuous or extended regimens are now standard practice and are particularly useful for painful periods, endometriosis and migraine.
Often within the first cycle. There is no prolonged delay.
Use another method straight away if you are not trying to conceive.
The evidence does not support meaningful weight gain from the combined pill. Some people notice fluid retention early on which settles.
That said, if you feel worse on it, that matters — a different preparation is a reasonable thing to try.
Stop it and get advice. Aura — visual zigzags, blind spots, or numbness before the headache — combined with the pill raises stroke risk, and it is an absolute reason to change method.
This is the single most important question on this page.
One missed pill: take it as soon as you remember and carry on. No extra precautions needed.
Two or more missed, or missed in the first week: use condoms for seven days and consider emergency contraception if you have had sex. Check the leaflet or ask — the rules depend on where in the pack you are.
Most antibiotics do not. That advice changed years ago and is still repeated.
Rifampicin and rifabutin do, and vomiting or severe diarrhoea reduces absorption regardless of the cause.
No, not at all. Only condoms do that.
A small increase in breast and cervical cancer risk while taking it, which falls after stopping, set against a substantial and long-lasting reduction in ovarian and womb cancer risk.
The overall balance is generally favourable, which is rarely explained.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 24, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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