What You Need To Know About The Pill
When it comes to the pill, what are your options?
“There are two types of contraceptive pill: the combined pill, which contains oestrogen and progesterone and prevents the release of an egg (aka ovulation), and the progesterone-only pill, which thickens the mucus in the neck of the womb, making it harder for the sperm to reach the egg. The progesterone-only pill is also known as the mini-pill, and it’s worth knowing that this needs to be taken at the same time every day to be effective, plus or minus three hours. You should consider the mini pill if you smoke, are 35 or older or have a BMI of over 30. The pill may also not be right for you at all if you have, or have had, blood clots, a stroke, high blood pressure, severe migraines, breast cancer or a family history of blood clots under the age of 45. You should discuss all of this with your GP, who will then recommend a pill to you.” – Dr Zahra Ameen, consultant gynaecologist and obstetrician at the Cadogan Clinic
How effective is the pill compared to other forms of contraception?
“When taken correctly, the pill is over 99% effective. This means that less than one in 100 women will fall pregnant over one year of pill use. However, there are several factors that influence its efficiency. Forgetting to take the pill can obviously increase your risk, while taking certain antibiotics can also interfere with its effectiveness. Moreover, if you are sick within two hours of taking the pill, you should take it again, and if you have diarrhoea, consider taking additional precautions.” – Mr Narendra Pisal, consultant gynaecologist at London Gynaecology
What is your GP likely to give you as standard?
“Chances are you will be offered Microgynon 30. This is because it is an old-fashioned, tried-and-tested pill, and lots is known about it. It contains oestrogen as well as a type of progesterone called levonorgestrel. There are many different pill brands, all with slightly different combinations and doses of hormones. Research suggests levonorgestrel-containing pills may have the lowest risk of blood clots. If you are offered Ovranette, Levest, and Rigevidon as an alternative to Microgynon, be aware that these all contain the same hormonal make-up.” – Dr Deborah Lee, GP at Dr Fox Online Pharmacy
How should you start taking the pill?
“Taking your first pill on the first day of your period will ensure you are starting it when you aren’t pregnant and will also mean the pill is effective immediately. In fact, as long as you start your pill at any time on days one to five of your cycle (day one is the first day of bleeding), you can assume the pill will work immediately. If you start on day six or beyond, the pill will take seven days to be effective, so you will need to abstain from sex or use a condom until you have taken seven pills correctly and these seven days have passed.” – Deborah
Are some pills better than others when it comes to side effects?
“The more modern, third-generation pills such as Marvelon and Femodene tend to have less in the way of progestogenic side effects, such as mood swings, acne, bloating and breast tenderness. Yasmin has also been found to be highly beneficial for women with acne – it is generally a preferable choice to Dianette, which is not actually a licensed contraceptive pill, although it works like one, it has a much higher thrombosis risk than Yasmin. Oestrogen tends to improve acne, so if you struggle with breakouts, you will probably do better on a 30mcg rather than a low dose 20mcg pill. If you have previously struggled with nausea, headaches and breast tenderness when taking the pill, try a pill with a lower dose of oestrogen, such as a 20mcg pill. Meanwhile, if breakthrough bleeding is an issue, try changing to a pill with a different progesterone content, or increasing the dose of oestrogen, such as Norimin.” – Deborah
“There are also pills available that have a four-day break, such as Zoely, and a two-day break, such as Qlaira. These pills are associated with lighter and less painful periods. In fact, Qlaira is also licensed as a treatment for heavy menstrual bleeding.” – Mr Narendra
Is it true you can take your pill back-to-back without a seven-day break?
“Yes, this is true. When the pill was first invented in 1962, it was packaged as three weeks of pills followed by a seven-day break to give a monthly withdrawal bleed because women tend to like to see a bleed every month which reassures them they aren’t pregnant. However, you only bleed on the pill because certain hormones have been withdrawn. Research shows continuous pill taking is safe and effective. You can either run three packs together by missing out the seven-day break, and have four periods a year, or you can take the pill indefinitely, but take a seven-day break when you start to bleed. The seven-day break can also be reduced to five days – it doesn’t have to be seven days – this was initially chosen as it means you stop and start your pills on the same day of the week, which can be less confusing.” – Deborah
“In my clinical practice, I often advise women to take the pill continuously without a break. This not only makes it easier to remember, but by blocking periods completely, it also improves a lot of period-related symptoms such as heavy bleeding, pain and anaemia. Plus, a lot of women forget to restart the pill after their seven-day break. We also know that forgetting to take your pill in the first half of your cycle is more likely to lead to failure of contraception. In theory, it’s a lot easier to take the pill continuously.” – Mr Narendra
If you forget to take a pill, what should you do?
“You can and should take the two missed pills together. The combined pill should be taken once a day and ideally at the same time every day. However, you do have 24 hours to remember to take it. If it is taken more than 24 hours after the last pill was taken, this counts as a missed pill. As soon as you realise your pill is more than 24 hours late, take the most recently missed pill, plus the next pill on time, even if this means taking two together. However, if you’ve missed several pills, don’t take more than two at any one time – this could make you feel very sick. If this happens, you need to take emergency contraception. You must continue to take your pills correctly and abstain or use a condom for seven days. After this, your contraceptive cover will be restored.” – Deborah
What are the signs your pill isn’t agreeing with you?
“Side effects are common when you first start the pill, but these are usually mild and settle within the first three months. The most common are nausea, headaches, breast tenderness and breakthrough bleeding. If your symptoms are still troubling you after three months, you may need to switch to a different brand. Nausea and headaches are often oestrogen-related symptoms, so changing to Mercilon or Femodette could help. If your skin issues have worsened on the pill, you may benefit from a switch to a pill with a more skin-friendly progesterone such as Marvelon, Femodene, or Yasmin. Yasmin contains drospirenone and has specific anti-testosterone effects to help the skin. Other serious adverse effects of the pill include raised blood pressure, and focal migraine also called migraine with aura. Your blood pressure should be regularly measured while you are on the pill. If you ever develop a migraine-type headache on the pill you should see a doctor immediately.” – Deborah
When coming off the pill, how long will it take for your period to get back to normal?
“The pill will be totally out of your system within six weeks and your periods should return quickly. However, many women will have a period long before this. If you think about it, it only takes missing a few pills to get pregnant, which shows just how quickly reversable the pill is, and how fast ovulation can occur. If you have not had a period within three months, do a pregnancy test and see your GP.” – Deborah
Is it true the pill can affect fertility if taken for a long time?
“No, once you come off the pill, your fertility will go back to normal, and you may ovulate within two weeks after stopping. However, it may take longer for ovulation to resume if you are older or if you have been taking the pill for a significant period of time.” – Zahra
“Studies show the pill does not affect your long-term fertility. In fact, fertility rates in the two years after stopping the pill, the IUD and the injection are the same. One recent study, which included data from nearly 15,000 women using a range of different methods of contraception, found 83% were pregnant within 12 months of discontinuing the method, and there was no significant difference between users of different methods.” – Deborah
If you’re thinking about coming off the pill, is there anything you can do to ease the transition?
“It’s worth tracking your cycle to help work out whether or not your body is getting back on track – the Clue App is great. Ideally, you want to get back to normal ovulation as soon as possible, as this means you’ll be getting the benefits of oestradiol and progesterone plus their many benefits on skin, bone health, mood and metabolism. Just remember that a ‘normal’ cycle is anything from 21-35 days so don’t be alarmed if you don’t go straight into the often quoted ‘perfect’ 28-day cycle, if indeed you get there at all. In the meantime, thinking about your diet can give things a helping hand:
Try The Mediterranean Diet: A good, all-round anti-inflammatory diet, such as the Mediterranean diet, is a wise choice when eating for your cycle. Include plenty of fresh, colourful fruit and veg, legumes, healthy fats, wholegrains, spices and herbs with a small amount of animal protein like dairy, eggs and oily fish.
Up Your B Vitamins: B vitamins – especially B2, B6, B9 and B12 – can be depleted by the pill. B vitamins are crucial for energy production, hormone synthesis and our ‘happy’ neurotransmitters serotonin and dopamine. Eat plenty of beans, wholegrains and leafy greens like kale and rocket.
Increase Magnesium: The pill can also deplete levels of magnesium, so eat plenty of dark leafy greens, avocados, almonds and edamame beans. Supplementing with 400mg per day of magnesium glycinate can help, especially if you struggle with sleep, migraines and anxiety.
Don’t Forget About Fat & Protein: You need fat and protein to build hormones. Include a palm-sized portion of protein together with a small amount of healthy fats like avocados, olive oil, nuts and seeds into as many meals as you can.
Don’t Cut Out Carbs: Women on a ketogenic or very low-carb diet (less than 50g per day) may find it impacts their cycle. But not all carbs were created equal – prioritise wholefood sources like oats, brown rice, quinoa, sourdough and sweet potatoes.
Up Your Fibre: Getting your gut health on track can also help. Eat plenty of fibre (aim for eight portions of vegetables and two fruit per day) plus fermented foods like kefir, sauerkraut, miso and kimchi.” – Emma Bardwell, registered nutritional therapist and women’s health specialist
For more information visit EmmaBardwell.com, DoctorFox.co.uk, CadoganClinic.com and London-Gynaecology.com
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