Combined Oral Contraceptive Pill: Uses, Benefits and Risks

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The combined oral contraceptive pill (COCP), commonly called “the pill,” is a popular method of preventing pregnancy. It contains two hormones, estrogen and progestin, which work mainly by stopping ovulation. The pill also thickens the mucus around the cervix, making it harder for sperm to reach an egg.

For many women, the pill offers benefits beyond contraception. It can make periods more predictable, reduce menstrual cramps and heavy bleeding, and may also help with acne. However, the combined pill is not suitable for everyone. Your doctor will consider your health history, age, blood pressure, medications, and other risk factors before recommending it.

What is the Combined Oral Contraceptive Pill?

The combined oral contraceptive pill contains two hormones: estrogen and progestin. These hormones mainly prevent pregnancy by stopping the release of an egg from the ovaries.

The pill also thickens cervical mucus, which makes it more difficult for sperm to enter the uterus. It also changes the lining of the uterus.

Different combined pills contain different types and amounts of estrogen and progestin. Your doctor can help you choose an option that suits your health and contraceptive needs.

The combined pill does not protect against sexually transmitted infections (STIs). Condoms are still needed if STI protection is required.

Types of Combined Oral Contraceptive Pills

Combined pills are available in different formulations. They can be grouped according to the amount of hormones they contain and how the active pills are arranged in the pack.

Monophasic Pills

Monophasic pills contain the same amount of estrogen and progestin in each active pill. They are one of the commonly used types of combined oral contraceptives.

Exact ingredients and hormone doses vary by brand and country.

Biphasic and Triphasic Pills

Biphasic and triphasic pills contain different amounts of hormones in the active pills at different points in the pack.

The hormone levels change during the cycle, depending on the formulation. These pills are less commonly prescribed in some places, but they may still be an option for certain women.

Extended-Cycle Pills

Extended-cycle pills allow you to take active hormone pills for longer before having a hormone-free interval. This means you may have fewer withdrawal bleeds during the year.

The exact schedule depends on the product. Some extended-cycle regimens are designed to result in only a few withdrawal bleeds each year.

How to Choose the Best Combined Oral Contraceptive Pill

No single combined pill is best for every woman. The right choice depends on your health, lifestyle, preferences, and any other medicines you take.

Medical History

Your medical history is an important part of choosing a contraceptive pill. Your doctor may ask whether you have had blood clots, high blood pressure, migraine with aura, heart disease, stroke, liver disease, or certain types of cancer.

Your doctor may also check your blood pressure before prescribing a combined pill.

Lifestyle

Your age and smoking habits can affect whether a combined pill is suitable for you. Smoking while using estrogen-containing contraception can increase the risk of serious cardiovascular problems, particularly in women aged 35 and older.

It is also worth considering whether taking a pill every day fits comfortably into your routine. If remembering a daily pill is difficult, another contraceptive method may be more suitable.

Side Effects

Some women notice mild side effects when they first start taking the pill. These may include nausea, breast tenderness, headaches, mood changes, or changes in bleeding.

These effects often improve with time. If they continue or become troublesome, talk to your doctor. A different pill or another contraceptive method may work better for you.

Dosage and Administration

Standard Dosage

Most combined oral contraceptive pills are taken once a day, preferably at around the same time every day.

Some packs contain 21 active pills followed by a 7-day hormone-free interval. Others contain 28 pills, including active pills and inactive or reminder pills.

Not all combined pills follow the same schedule, so always follow the instructions that come with your particular pill.

If you miss a pill, what you should do depends on how many pills you missed and where you are in the pack. Check the instructions for your specific pill or speak with a healthcare professional if you are unsure.

Extended-Cycle Dosage

With an extended-cycle regimen, active pills are taken for a longer period before a hormone-free interval. This can reduce how often you have withdrawal bleeding.

The schedule varies depending on the product, so follow the instructions provided by your doctor or with the medicine.

Contraindications of Combined Oral Contraceptive Pills

Although the combined pill is safe for many women, it may not be suitable if you have certain medical conditions.

Side Effects of Combined Oral Contraceptive Pills

Most women tolerate the combined pill well, but side effects can occur, particularly during the first few months.

Common Side Effects

Possible side effects include:

Some women report weight gain after starting the pill, but research does not show that combined oral contraceptive pills consistently cause significant weight gain in most users.

Serious Side Effects

Serious complications are uncommon, but the combined pill can slightly increase the risk of blood clots. In rare cases, blood clots can lead to serious problems such as stroke or heart attack.

The risk is higher in some women, including those who smoke, have certain medical conditions, or have other risk factors for blood clots.

Get urgent medical help if you develop sudden chest pain, difficulty breathing, coughing up blood, sudden severe headache, sudden changes in vision, or painful swelling in one leg.

Benefits Beyond Contraception

The combined pill can offer several benefits in addition to preventing pregnancy.

How to Start and Stop the Pill

Starting the Pill

The combined pill can usually be started at different points in the menstrual cycle if pregnancy has been reasonably ruled out.

If you start the pill within the first 5 days of your period, you are generally protected from pregnancy straight away. If you start later in the cycle, you may need to use condoms or another backup method for the first 7 days.

The exact instructions can vary between products, so check the information provided with your pill or ask your doctor.

Stopping the Pill

You can stop taking the combined pill when you decide that you no longer want to use it. You do not usually need to finish the pack first, although stopping partway through a pack may cause irregular bleeding.

Fertility generally returns quickly after stopping the pill. If you do not want to become pregnant, start another reliable contraceptive method when you stop taking it.

Conclusion

The combined oral contraceptive pill is an effective way to prevent pregnancy and can also help with some period-related problems and acne. Since it is not suitable for everyone, talk to your healthcare provider before starting it.