How to choose the right contraceptive pill for you

There are two types of contraceptive pills: the combined pill and the mini pill. Both types of pills contain man made hormones that are similar to the ones your body makes. The combined pill contains both oestrogen and progestogen, and the mini pill contains only progestogen.

Both the combined pill and mini pill can prevent pregnancy by:

• increasing the amount of mucus at the cervix (a narrow opening that connects your vagina and womb) to stop sperm getting into your womb
• changing the lining of your womb to stop a fertilised egg from attaching
• preventing ovulation (when your ovaries release an egg) — note, not all mini pills can do this

However, not every pill will be suitable for you.

The combined pill might not be right for you, if you:

• are 35 years old or older and are overweight or smoke
• are very overweight
• cannot take the hormone oestrogen

If any of the above apply to you, you may be able to take the mini pill instead.

If you’ve ever had breast cancer, heart disease, or a stroke in the past, then you may not be able to use either the combined pill or the mini pill. You should speak to a doctor if you still want to consider hormonal contraception in this case.

Combined pill

Combined pills contain an oestrogen called ethinylestradiol, and a progestogen such as levonorgestrel or desogestrel.

You can take most combined pills once a day for 21 days with a 7 day pill free break, such as Microgynon 30 or Levest.

Some combined pills are called ‘everyday pills’ or ED pills, like Microgynon 30 ED. You should take ED pills every day with no break. ED pills contain 21 pills with active hormones and 7 pills without any hormones. ED pills are useful if you prefer to take a pill every day without any break.

A combined pill can either have:

• the same amount of hormones in each pill, like Rigevidon
• different amounts of hormones across 21 pills (also known as phasic pills), as found in Qlaira or TriRegol

Phasic pills copy the natural hormonal changes in your menstrual cycle., and you need to take them in a precise order to effectively prevent pregnancy.

Note, if a patient wants to take the combined pill for the first time, we would not recommend a pill that contains either drospirenone (such as Yasmin or Lucette), desogestrel (such as Marvelon or Gedarel) or gestodene (like millinette). These pills have a slightly higher risk of blood clots. Instead, we would recommend an alternative pill with a lower risk.

Mini pill

The mini pill contains a progestogen type hormone, like norethisterone or desogestrel. You should not take a pill free break when taking the mini pill. You start the next blister strip of pills straight after you have finished the previous strip.

You should take the mini pill at exactly the same time each day.

You may not have complete contraceptive protection if you are late to take your mini pill by:

• 3 or more hours when taking mini pills such as Noriday or Norgeston
• 12 or more hours when taking pills such as Cerazette or Cerelle

You can read the patient information leaflet found inside the mini pill packet, or ask your pharmacist for more information.

Remember, no contraceptive pill will protect you against STIs (sexually transmitted infections), so use a condom to practise safe sex.

The best contraceptive pill for you will depend on a range of factors, such as:

• if you can tolerate taking oestrogen or progestogen
• your age
• your weight
• if you smoke
• if you have other health conditions, such as heart problems or liver disease
• if you or anyone in your immediate family have ever had a blood clot

Your doctor can also help you decide which contraceptive pill is the right one for you.

Most side effects

There is no particular contraceptive pill that has the most side effects, as you will not know how a pill works with your body until you take it for a while.

Generally, most contraceptive pills have similar side effects. You should give your body 2 or 3 months to adjust to taking a pill, before you judge it by its side effects.

Choosing a low oestrogen pill may help with some side effects if you are sensitive to that hormone. For example, you may start to take Levest which contains 30 micrograms of ethinylestradiol (a type of oestrogen). If you experience side effects with Levest, you may consider switching to Gedarel as it contains a lower amount of 20 micrograms of ethinylestradiol.

Other alternatives to try are a phasic pill, or an oestrogen free (progestogen only) pill.

Best for acne

Combined contraceptive pills will work best to treat your acne. Progesterone in a contraceptive pill on its own does not help acne, which is why you’ll need to use a combined pill rather than a mini pill.

Acne is caused by changing hormone levels that lead to inflammation on your skin. Testosterone (an androgen) is a hormone that is involved in the development of acne spots, blackheads and whiteheads. So you should try to use a combined pill that has ‘anti androgenic activity’. Birth control pills that have anti androgenic activity will help to counteract the effects of testosterone on your skin, so your acne will get better and is less likely to come up in future.

Progestogens, such as drospirenone or dienogest, are anti androgenic. These hormones can block testosterone from making too much oil on your skin and are found in combined pills like Lucette or Qlaira.

Certain progestogens, such as levonorgestrel and desogestrel, have low androgenic activity. These hormones are found in Levest and Mercilon.

You’ll have to take a contraceptive pill for a few months before you see an improvement in your acne. You can always switch to a different contraceptive pill if your acne is not getting better.

Best for weight loss

It’s difficult to pinpoint which contraceptive pill is best for weight loss as there’s not enough scientific evidence to show that contraceptive pills directly cause weight gain or weight loss.

Depending on how your body weight has changed over the years, you might know whether you tend to put on weight through water retention rather than fat gain. In this case, combined pills that contain drospirenone may help you lose that extra water and make it feel like weight loss.

Drospirenone is a type of mild diuretic, which means it can help you get rid of water. Both Yasmin and Lucette contain drospirenone. It may feel like you are losing weight, but it’s likely that this weight loss is temporary.

The best and safest way to lose weight is to make a plan with a healthcare professional, as part of the process involves looking at what you eat and how much exercise you do.

Best for heavy periods

The combined pill is the best contraceptive pill to treat heavy periods.

After you take the pill daily for 21 days, you’ll usually need to have a 7 day pill free break. During this 7 day break, you’ll have some withdrawal bleeding (like a mini period). This bleeding should be much lighter and less painful than your normal period. If the bleeding is still heavy, your doctor can switch you to another pill to try.

There are other ways you can take your combined pill, which may be more convenient and pose no extra risk. Speak to your doctor about this.

Best for endometriosis

Both the combined pill and mini pill can be used to help symptoms of endometriosis.

If you have endometriosis, you may experience more symptoms, such as pain, either during ovulation or when you get your period. The natural changes of your hormones can make these symptoms feel worse.

Both the combined pill and mini pill give your body a steady dose of the same amount of hormones. Stopping the changing levels of hormones can help reduce flare ups of endometriosis.

To help with endometriosis, you can take the combined pill continuously, which means you do not need to have a 7 day pill free break.

You may have to try a few different types of contraceptive pills before you find the one that works best for you. Your doctor will be able to guide you every step of the way.

Stops your period

You can take either the combined pill or the mini pill to stop your period. If you only want to delay your period as a one off, like for a holiday, you can get period delay tablets.

Combined pill

It’s completely safe to take the combined pill continuously, without having a 7 day pill free break at the end of a 21 day blister strip.

If you do this, you may still have some bleeding or spotting. If this occurs for more than 3 to 4 days, you can take a 4 day break, as long as you have used at least 21 pills in a row before this.

You might choose to have a 7 day pill free interval if you want to:

• regulate irregular periods
• predict when you will bleed

If you do not want to have a 7 day pill free break after every combined pill blister strip, you have another option. You can take 3 blister strips back to back (63 pills in total), and then take a 4 or 7 day pill free break (this is known as ‘tricycling’).

You’ll have fewer periods in a year, so you can plan your activities around this. For example, if you know you have a party to go to or an important event planned, you can take your pill free break later.

Mini pill

You have to take the mini pill every day at the same time. Your period may stop or you will have a ‘breakthrough bleed’ for a few days, but these are usually unpredictable.

Best for over 35s

If you’re over 35, the mini pill is the best contraceptive pill for you to use if you smoke. If you do not smoke and are over 35, you can still use the combined pill.

As you get older, you’ll have an increased risk of getting:

• heart disease
• breast cancer
• endometrial cancer
• obesity

Oestrogen can contribute to this natural risk that occurs as you get older. As the mini pill does not contain oestrogen, it’s much safer to take if you’re over 35 years old.