Oral Contraception
There are many methods of contraception these days, but the oral contraceptive pill - sometimes just referred to as 'the pill' - remains one of the most popular. This because it's very effective, convenient, and in the UK it's free on an NHS prescription. Oral contraceptive pills are only available with a prescription from your doctor, with the recent exception of the emergency contraceptive pill ("morning after pill") Levonelle, which is now available to purchase from most UK pharmacies after a consultation with the pharmacist to check they're suitable for you - there's more about Levonelle at the bottom of the page.
How do they work?
Oral contraceptive pills contain hormones that make the mucus in the cervix thicker, preventing sperm from entering the womb; and also make the lining of the womb thinner making it less likely that a fertilised egg would be able to attach. Pills containing an oestrogen and a progestogen ("combined oral contraceptives") also prevent you from ovulating (releasing an egg from an ovary).
Although progestogen-only contraceptives have a slightly higher rate of contraceptive failure, all types of oral contraceptive pill can still be up to 99% effective at preventing pregnancy when they are taken correctly - but the risk of pregnancy increases if they are not taken as they should be, or if pills are missed or taken late and additional contraceptive precautions are not used.
Types of oral contraceptive pill
There are several different types of oral contraceptive pill available. The choice of which type is right for you will depend on a number of factors, including your age and medical history and any other medicines you might be taking, the risk of side effects compared to the benefits of convenience, and of course your personal choice. Some are taken daily for 3 weeks, with a 1 week break; others contain "dummy pills" for the 1 week break, so you can just carry on taking one pill from the pack every day and don't need to break your routine.
Oral contraceptive pills can be classed as Combined Oral Contraceptives, or Progestogen-Only Contraceptives.
Combined Oral Contraceptives
Combined Oral Contraceptives are considered to be the most effective type for general use. They contain two hormones in each pill: an oestrogen, and a progestogen. They can be further categorised into low-strength or medium-strength pills; and monophasic, biphasic, or triphasic, depending on whether the pills contain varying amounts of the hormones over the course of each cycle, or if every pill in the pack is the same.
Different combined oral contraceptives contain different types of oestrogen and progestogen, and there are advantages and disadvantages between them - for example, some may have a lower incidence of side effects, but may have a slightly higher risk of causing blood clots. In general, when you start taking a pill for the first time, your doctor will check your medical history and will advise on the best type of pill for you.
Examples of combined oral contraceptives include Cilest Tablets, Microgynon-30 Tablets, Yasmin Tablets, and Qlaira Tablets.
Cilest Tablets and Microgynon-30 Tablets are classed as monophasic, standard strength oral contraceptive pills.
Yasmin Tablets contain an oestrogen alongside a newer progestogen which may reduce the chance of any bloating or water retention, if those symptoms become a problem with other oral contraceptive pills; however they can also cause the body to retain potassium, which makes them unsuitable for some women.
Qlaira Tablets are a newer brand of oral contraceptive pill and have a "multi-phasic" approach ? one tablet is taken every day for all 28 days of the cycle, without a 7-day break. In each monthly Qlaira pack, there are 6 different types of tablet, 5 of which contain different strengths of oestrogen and progestogen as the month progresses, and the final 2 tablets contain no active ingredients. (You don't need to worry too much about taking the right strength of tablet on the right day ? there are stickers included for you to easily mark each Qlaira blister pack with the correct days of the week, so you just need to take the next tablet along on the right day until each pack is finished.) Qlaira is different in that the oestrogen component is the same as the oestrogen that occurs naturally in the body, and it has been associated with shorter and lighter monthly bleeds than other combined oral contraceptives.
There is another pill called Dianette Tablets, which contains an oestrogen in a strength that makes it an effective oral contraceptive pill, but it also contains an anti-androgen called "cyproterone acetate" which is used to treat women who suffer from conditions where androgen (male) hormones need to be opposed; it is prescribed for women who either have persistent acne that has not responded to antibiotic treatment, or "hirsutism", a female condition where hair grows excessively on the face and body. Although Dianette also provides contraceptive protection to women being treated for these conditions, it is not prescribed primarily as an oral contraceptive to other women.
Progestogen-Only Contraceptives
Progestogen-Only Contraceptives (also known as "mini pills"), as the name suggests, only contain a progestogen and do not contain an oestrogen. There are certain advantages to progestogen-only contraceptives, for example they can be taken by breastfeeding women, as they do not interfere with milk production; and they are often prescribed if you have had a reaction to the oestrogen component of a combined oral contraceptive, or if a combined pill is not suitable because of your age or medical history.
However, there are potential disadvantages too: there is a higher failure rate with this type of oral contraceptive, and for maximum effectiveness each day's pill needs to be taken at precisely the same time of day. In fact, if you are late in taking a day's pill by 3 hours or more, it's classed as a "missed pill". There is one progestogen-only contraceptive called Cerazette which improves this margin of error from 3 hours to 12 hours, but it is much more expensive to the NHS and carries an increased risk of blood clots.
Online consultations
If you are too busy to go to your Doctor, why not Click here to visit Pharmacy2U's recommended provider of online consultations for the contraceptive pill. All prescriptions issued here will be dispensed at Pharmacy2U.
Risks and benefits of oral contraceptive pills
There are some risks and benefits that apply to oral contraceptive pills in general, and which will be discussed with your doctor when you are first prescribed a pill. In terms of benefits, your periods may be lighter and shorter; any symptoms of pre-menstrual tension may be lessened; they have been shown to reduce the incidence of some breast diseases and ovarian cysts; and taking an oral contraceptive pill has been shown to reduce the risk of developing some forms of cancer.
There are risks too, but most are uncommon. There is a small increased risk of having a blood clot in a vein, however this risk is much smaller than during pregnancy, and the risk seems to reduce after you have taken the pill for a year. If you are already at a higher risk of a blood clot, for example if you smoke or are obese, the doctor will take this into account when prescribing a pill. If you have existing heart disease or several risk factors for heart disease, which would include diabetes, high blood pressure, or a close family history of circulation problems, the doctor may recommend that you do not take an oral contraceptive pill at all and will discuss alternative contraceptive methods with you.
Taking an oral contraceptive pill can increase your blood pressure, so most doctors will ask you to have a blood pressure check around once every 6 months.
Some medicines, not all of them prescription-only, can stop the contraceptive pill from being effective, so if you start taking any new medicines ? prescribed or otherwise ? it's important to check with your doctor or pharmacist that they will not affect your pill. Common examples of medicines that can make the pill less effective include some antibiotics, the herbal supplement St John?s Wort, and some medicines for epilepsy.
Some women who take the pill experience other side effects, such as headaches, stomach upsets, breast soreness, or mood changes. These are relatively uncommon and should get better quickly; if they persist, the doctor may wish to change the type of pill you are taking.
There are some side effects, mainly associated with combined oral contraceptives rather than progestogen-only contraceptives, which are more serious and mean you should stop taking the pill and see your doctor straight away. These include chest pains, breathlessness, an unexplained swelling or pain in the calf of one leg, severe stomach pains or headaches, fainting or collapse, problems with speech, vision or hearing, numbness in any part of the body, or any other unusual symptoms. The leaflet inside each pack gives more details of these.
Missing a pill
If you forget to take a pill, the guidance about what to do next can vary from one type of pill to another. It's important to carefully check the instructions in the leaflet that came with your contraceptive pills for the most specific advice. If you can't find it quickly, or need to discuss the advice on the leaflet, talk to a pharmacist or your doctor.
The main point to remember is that missing a pill ? or taking a pill more than 3 hours late, in the case of progestogen-only pills ? is likely to mean that you will have lost your contraceptive protection and must take additional precautions for a while. Taking two tablets the next day does not work and is likely to do more harm than good ? read the leaflet carefully and/or talk to a pharmacist or doctor.
Emergency Hormonal Contraception - The "Morning After Pill"
As well as Combined Oral Contraceptives and Progestogen Only Contraceptives, there is another category of oral contraceptive pills used in a regime called "emergency hormonal contraception". These pills are sometimes referred to as the "morning after pill", as the regime is given after unprotected intercourse, or where another contraceptive has failed - for example if a condom has split, or oral contraceptive tablets have been missed.
It is available as a single pill called "Levonelle", and can be prescribed by a doctor for free on the NHS, or purchased from most pharmacies. Levonelle contains a progestogen called levonorgestrel, which works by preventing the release of an egg from an ovary, preventing sperm and egg meeting, or by preventing an egg from implanting in the womb, depending on the time it is taken.
Levonelle must be taken as soon as possible after unprotected intercourse - ideally within 12 hours, but no later than 72 hours. The earlier it is taken, the more likely it will be effective. It is 95 per cent effective if taken within 24 hours, 85 per cent if used within 24 to 48 hours, and 58 per cent effective if used within 48 to 72 hours. After 72 hours, you should see your doctor, as another method of emergency contraception ? an intra-uterine device - can be effective up to 5 days after intercourse.
The most common side effect with Levonelle is nausea, which in some cases may lead to vomiting. If vomiting occurs within 3 hours of taking the dose of Levonelle, the tablet may not have been fully absorbed by the body, and another dose should be taken, as long as the time since unprotected intercourse is still within 72 hours as above.
Levonelle can affect, and be affected by, some medicines prescribed by your doctor or taken without prescription. Your pharmacist or doctor will ask you about any other medicines you are taking and will advise accordingly.
While it is possible to purchase or be prescribed Levonelle tablets in advance of you needing them, so that you can take a dose as soon as possible after unprotected intercourse should the need arise, it is important to understand that Levonelle is not a substitute for an effective regular method of contraception. Talk to your pharmacist or doctor if you need more advice about effective regular methods of contraception.
Links to other websites
Family Planning Association
http://www.fpa.org.uk/
Brook Advisory Centres
http://www.brook.org.uk/