This factsheet is for women who are taking hormonal contraceptives, or who would like information about them.

Hormonal contraception is the most effective method of controlling fertility and preventing pregnancy. The effects of hormonal contraceptives are fully reversible once treatment is stopped. The most popular hormonal contraception is commonly known as the pill. Other methods include patches, injections, implants, intra-uterine system (IUS) and the progestogen-only pill (also known as the mini-pill).

 Why would I take hormonal contraception?
What are the main types of hormonal contraception?
How does hormonal contraception work?
How to take hormonal contraception
Side-effects of hormonal contraception
Interaction of hormonal contraception with other medicines
Names of common hormonal contraception

Why would I take hormonal contraception?

Nearly four million women in the UK use hormonal contraception as a convenient and effective way to control fertility and prevent pregnancy.

Hormonal contraception is also sometimes used to treat heavy periods and endometriosis and to relieve severe premenstrual symptoms.

Hormonal contraception doesn't protect against sexually transmitted diseases.

What are the main types of hormonal contraception?

There are a number of different types of hormonal contraception.

  • Combined oral contraceptive (COC) pill. This is often just called the pill and contains two hormones – a progestogen and oestrogen. These are similar to the hormones that you produce in your ovaries.
  • Progestogen-only pill (POP). This is sometimes called the mini-pill and can be taken by women who can't take the COC pill.
  • Contraceptive patch and ring. Oestrogen and a progestogen can also be taken via an adhesive skin patch and as a vaginal ring.
  • Long-acting injections. There are two main hormone injections that can provide long-lasting contraception for eight or 12 weeks. Both injections contain a progestogen.
  • Implant. This is inserted under your skin. It releases a constant amount of a progestogen, giving contraception for up to three years.
  • Intra-uterine system (IUS). This is a plastic T-shaped device that is placed in your womb (uterus). It releases progesterone and works for up to five years.

Emergency hormonal contraception

If you think your contraception may have failed, you can get emergency hormonal contraception (EHC) from your doctor, pharmacy, sexual health clinic or NHS walk-in centre. EHC is a tablet containing levonorgestrel, a type of progestogen.

Although often called the morning-after pill, it works for up to 72 hours after unprotected sex. But it's important to take it as early as possible for maximum effectiveness. EHC can prevent or delay an egg from being released or it can prevent fertilised eggs from implanting into the wall of the womb (uterus). This should stop you from getting pregnant. As an alternative to EHC, you can have an IUD fitted by your GP up to five days after unprotected sex. This also prevents and egg from fertilising or implanting in your womb.

How does hormonal contraception work?

Your monthly cycle is controlled by two main hormones, oestrogen and progesterone. Oestrogen levels rise after your period, causing an egg to develop and be released from your ovaries (ovulation). The lining of your womb thickens in preparation for a fertilised egg. After you have ovulated, progesterone helps the womb lining grow even thicker.

The egg travels down your fallopian tubes and, if you don’t become pregnant, your body naturally absorbs the egg. The levels of oestrogen and progesterone in your body fall, and the womb lining comes away leaving your body as a menstrual period.

Hormonal contraceptives contain artificial (synthetic) versions of hormones. They mimic the action of oestrogen and progesterone on your body. When taken correctly, they interfere with your normal monthly cycle to prevent pregnancy.

Hormonal contraception works in three ways by:

  • preventing your ovaries from releasing an egg
  • thickening the mucus from your cervix (the neck of the womb) which makes it more difficult for sperm to enter your womb and fertilise the egg
  • making the lining of your womb too thin for a fertilised egg to implant into

How to take hormonal contraception

Combined oral contraceptive (COC) pill

Most COCs are taken for 21 days. This is then followed by a break of seven days before the next course of 21 days. You will have a bleed when you stop taking tablets. This is called a withdrawal bleed.

Some brands, known as every day (ED) types, have 28 pills in the packet. They include seven inactive dummy pills, removing the need for a seven-day break. You just go from one packet to the next.

The COC pill is designed to be taken every day. If you miss taking a tablet, it can mean that you’re at risk of becoming pregnant. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Progestogen-only pill (POP)

POPs are taken every day with no break. If you’re taking the progestogen-only pill, the contraceptive effect may be lost only a few hours after a missed pill (or 12 hours for Cerazette). This means it’s important to take your pill at the same time every day.

If you miss a pill and realise more than three hours later (or 12 hours later for Cerazette), you will need to use extra contraception, such as a condom, for the next two days to prevent pregnancy. Ask your doctor or nurse for advice.

Contraceptive patches

Contraceptive patches are worn every week for three weeks and then you have a week without wearing a patch. They are very sticky and should stay on even when you’re showering, swimming or exercising. However, if the patch does come off, you will be protected against pregnancy if you replace it within 48 hours. If your patch has been off for longer than this, you will need to use another method of contraception for the next seven days. Ask your doctor or nurse for advice.

Contraceptive ring

Your doctor or nurse will show you how to insert a contraceptive ring into your vagina. With clean hands, you can insert and remove the ring with your fingers. You should keep the ring in your vagina for three weeks and then remove it. You will then have one week without the ring, before you insert another new one.

Long-acting injections

Long-acting hormonal contraception injections are given by your doctor or nurse. They are injected into one of your large muscles, such as your buttocks or upper arm. You will need to have the injection every eight or 12 weeks.

Implant

Progestogen implants are narrow flexible rods, about the size of a match stick. The rod is inserted under the skin of your upper arm using a local anaesthetic, so you won’t feel any pain. Your nurse or doctor will put the implant in and will also remove it when it needs to come out. The implant can stay in for up to three years.

Intra-uterine system (IUS)

An IUS is a plastic frame that is placed in your womb (uterus) to prevent your eggs from reaching the sperm and being fertilised. Your doctor or nurse will put it in. This can be uncomfortable and sometime painful. It is often used for women who have had children. Speak to your doctor or nurse if you would like painkillers or local anaesthetic.

Side-effects of hormonal contraception

All hormonal contraceptives can have some side-effects, but these aren’t common. For most women, the benefits of hormonal contraception outweigh the risks. Some of the main side-effects of hormonal contraception are listed below.

  • The COC pill, patches and ring can increase your risk of developing blood clots in your veins (deep vein thrombosis or DVT). This risk is very small – lower than the risk of DVT that is naturally associated with being pregnant.
  • The COC pill, patches and ring are also linked to a small increased risk of developing breast or cervical cancer. However, this is thought to return to normal within 10 years of stopping contraception. These contraceptives are thought to provide protection again ovarian cancer.
  • POPs can cause headaches, mood swings and breast tenderness. They can also make you feel sick and cause your abdomen (tummy) to become bloated. These side-effects usually reduce after a few months.
  • Depo-Provera, which is a progestogen-only contraceptive injection, can cause a temporary thinning of your bones. It can also cause weight gain. Women taking Depo-Provera may also find that it takes between six and 12 months for periods to return to normal or to conceive after stopping the injections.
  • An intra-uterine system can sometimes cause an infection in the first 20 days after it is inserted. There is also a small possibility that the IUS can be pushed out of the uterus at the time of insertion.
  • Many forms of hormonal contraception will cause changes in your menstrual pattern. You may have irregular or no bleeding, or bleeding on and off throughout the time when you’re taking contraception.

 

Interaction of hormonal contraception with other medicines

Talk to your GP or pharmacist before you take any other medicines or herbal remedies at the same time as hormonal contraceptives.

Combined and progestogen-only oral contraceptives can become less effective if you’re taking certain other medicines. These include medicines used to treat epilepsy, such as carbamazepine and phenytoin, and some medicines used to treat bacterial infections, particularly rifabutin and rifampicin.

St John’s wort can also cause combined oral contraceptives to become less effective.

Some antibiotics, such as ampicillin and doxycycline, may reduce the effectiveness of combined oral contraceptives. You should use other forms of contraception, for example a condom, while you’re taking a course of antibiotics and for seven days after stopping.

Names of common hormonal contraception

Examples of the main types of hormonal contraception are shown in the table.

You may have noticed that your medicine has two or more names. All medicines have a generic name, which is its official medical name. Many medicines also have at least one brand name, which is the trade name. Generic names are written in lower case and brand names start with a capital letter.

Generic name Common brand name(s)
Combined oral contraceptive pill
ethinylestradiol with norethisterone BiNovum, Brevinor, Loestrin 30, Norimin, Ovysmen, Synphase, TriNovum, Loestrin 20
ethinylestradiol with norgestimate Cilest
ethinylestradiol with desogestrel Marvelon, Mercilon
ethinylestradiol with drospirenone Yasmin
ethinylestradiol with gestodene Femodene, Femodene ED, Katya 30/75, Triadene, Femodette, Sunya 20/75
mestranol with norethisterone Norinyl-1
ethinylestradiol with cyproterone acetate Dianette
estradiol with dienogest Qlaira
Contraceptive patches
ethinylestradiol with norelgestromin (patch) Evra
Contraceptive ring  
ethinylestradiol with etonogestrel NuvaRing
Progestogen-only pill
desogestrel Cerazette
etynodiol diacetate Femulen
norethisterone Micronor
levonorgestrel Norgeston
norethisterone Noriday
Progestogen-only injection
Medroxyprogesterone acetate Depo-Provera
norethiserone enantate Noristerat
Progestogen-only implant  
etonogesterl Implanon
IUS  
Intra-uterine progestogen-only device Mirena

What is the risk of getting deep vein thrombosis (DVT) from the combined oral contraceptive pill?
At what age should I stop taking hormonal contraceptives?
What should I do if I'm sick after taking my pill?
Can I take the pill so I don't have a period while I'm on holiday?
Is it true that missing a combined pill at the start or end of the packet is more risky than missing one in the middle?
 

What is the risk of getting deep vein thrombosis (DVT) from the combined oral contraceptive pill?

The combined oral contraceptive pill does increase the risk of having a blood clot (deep vein thrombosis, DVT). However, in most women this is still a very low risk – lower than the risk of blood clots naturally associated with pregnancy.

Explanation

Taking a combined hormonal contraceptive slightly increases your risk of developing DVT – a blood clot in one of the deep veins, usually in the leg.

It's thought that about five women out of every 100,000 who aren't taking the pill get blood clots in a year. This is a low risk.

Some contraceptive pills contain newer types of progestogen called second generation progestogens (eg levonorgestrel), and others contain third generation progestogens (eg gestodene, desogestrel) which were developed even later. The risk of DVT varies depending on what type of progestogens the pill contains. For example, combined contraceptives that contain desogestrel,gestodene, or drospirenone are more likely to cause DVT than levonorgestrel. 

Your risk of developing DVT goes down the longer you have been taking a combined hormonal contraceptive The chances of developing DVT are still very low even when you’re taking a combined hormonal contraceptive. If you take a long flight, over five hours, while taking a combined hormonal contraceptive, this may increase your risk of developing DVT. Speak to your GP or nurse for more advice.

Further information

Sources

  • Collins S, Arulkumaran S, Hayes K, et al. Oxford handbook of obstetrics and gynaecology. 2nd ed. Oxford: Oxford University Press, 2009:597
  • Lidegaard O, Løkkegaard E, Svendsen A, et al. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ 2009; 339:b2890
  • Contraceptives. Joint Formulary Committee, British National Formulary. 58th ed. www.bnf.org, accessed 1 January 2010

 

At what age should I stop taking hormonal contraceptives?

Not everyone can use hormonal contraception and some options may be better for you than others. What you can take will depend on your age, general health and lifestyle and medical history. Your doctor or nurse will discuss your options with you

Explanation

The age at which you’re advised to stop taking hormonal contraceptives will depend on the type of hormonal contraception you’re taking and other lifestyle factors. If you’re using combined hormonal contraception (tablets, patch or ring) then your doctor may ask you to stop when you reach the age of 35 if you’re a smoker or have stopped smoking only in the previous year. He or she may also ask you to stop taking combined contraception if you’re overweight.
You can take the progestogen-only pill until you reach the menopause or until the age of 55, as long as you’re healthy and have no medical conditions that might prevent you from taking it.  

Your GP or family planning nurse can give you information about the benefits and risks of hormonal contraception as you get older. He or she can also discuss possible alternatives with you, an intra-uterine device (IUD or coil) or barrier methods of contraception such as condoms.

Further information

Source

  • Contraception: Your guide to the combined pill. FPA. www.fpa.org.uk, accessed 1 January 2010

 

What should I do if I'm sick after taking my pill?

The effect of the hormonal contraceptive pill may be lost if you’re sick or have diarrhoea. You may need to use extra contraception, such as a condom, while you’re ill and during your recovery.

Explanation

If you’re sick within two hours of taking your pill, take another one as soon as possible. If you’re taking a combined oral contraceptive pill and you’re being sick or have diarrhoea for more than 24 hours, you should use additional contraceptive precautions (such as condoms) for seven days If these seven days go into what would usually be your pill-free/inactive pill period, start the next packet straight away. If you’re unsure, speak to your GP or nurse.

If you’re taking a progestogen-only pill and you can’t take a replacement pill within three hours of your normal time for taking it (or 12 hours for cerazette), you should use extra contraception, such as a condom, while you’re ill and for two days after you recover.

Further information

 

Source

  • Contraceptives. Joint Formulary Committee, British National Formulary. 58th ed. www.bnf.org, accessed 1 January 2010

 

Can I take the pill so I don't have a period while I'm on holiday?

It's usually fine to run two packets of most contraceptive pills back-to-back without the usual seven-day break. This will stop you having a bleed. However if you take a contraceptive pill where the dose if different for different weeks of your cycle you should see your doctor or nurse for advice.

Explanation

If you take two packets of your contraceptive pill without a break in between, you’re likely to have a period-free holiday. If you’re taking a combined contraceptive pill that comes in a 21-pill packet, it's fine to start taking the second packet straight after the first, without the usual seven day break.
If you have a 28-day packet (once a day, every day), the last seven pills are dummies (inactive pills) to remind you when to start the next pack. You need to know which ones are the dummies. Don’t take these if you’re taking two packets back-to-back.
In some contraceptive pills, the dose of hormones is different for different weeks of the cycle It can be unreliable to take packets of these contraceptive pills back-to-back. Ask your GP or nurse for advice.

Further information

Source

  • Contraception: Your guide to the combined pill. FPA. www.fpa.org.uk, accessed 1 January 2010

 

Is it true that missing a combined pill at the start or end of the packet is more risky than missing one in the middle?

Yes, missing a combined contraceptive pill at the start or end of the packet increases the length of time that you're not protected and makes it more likely that your contraception won't work.

Explanation

The combined pill partly works by stopping your ovaries from producing eggs. In the pill-free period between packets, the usual balance of hormones starts to return and your ovaries begin to prepare to produce an egg. However, once you start the new packet of pills, your ovaries shut down again and ovulation is prevented.

If you miss a pill at the beginning or end of your cycle, your pill-free period is longer. The hormones in your contraceptive pill that usually tell your ovaries not to produce will have worn off. Your ovaries will be working and it may be too late to prevent ovulation.

If you forget to take your pill, you should take it as soon as you remember, and take the next pill at your usual time, even if that means taking two pills together. If you miss only one pill, you don’t need to use extra contraceptives.

If you have missed two or more contraceptive pills from the first seven in the packet, you may not be protected from pregnancy. You should take your pill as soon as you remember and then either abstain from sex or use extra contraception, such as a condom, for the next seven days. You may wish to use emergency hormonal contraception (the morning-after pill) if you have had sex since finishing the previous packet of pills. You can get this from a pharmacy or family planning clinic, or your GP can write you a prescription. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Further information

Source

  • Contraceptives. Joint Formulary Committee, British National Formulary. 58th ed. www.bnf.org, accessed 1 January 2010

Related topics

Related topics

  • Non-hormonal contraception

Further information

FPA
0845 122 8690
www.fpa.org.uk

Sources

  • Contraceptives. Joint Formulary Committee, British National Formulary. 58th ed. www.bnf.org, accessed 31 December 2009
  • Contraception: patterns of use. FPA. www.fpa.org.uk, published November 2007
  • Progestogens. Joint Formulary Committee, British National Formulary. 58th ed. www.bnf.org, accessed 31 December 2009
  • Collins S, Arulkumaran S, Hayes K, et al. Oxford handbook of obstetrics and gynaecology. 2nd ed. Oxford: Oxford University Press, 2009:596
  • Contraception: Your guide to contraceptive injections. FPA. www.fpa.org.uk, accessed 31 December 2009
  • Contraception: Your guide to the contraceptive implant. FPA. www.fpa.org.uk, accessed 31 December 2009
  • Contraception: Your guide to the IUS. FPA. www.fpa.org.uk, accessed 31 December 2009
  • Contraception: Your guide to the combined pill. FPA  www.fpa.org.uk, accessed 31 December 2009
  • Contraception: Your guide to the contraceptive patch. FPA. www.fpa.org.uk, accessed 31 December 2009 
  • Contraception: Your guide to the contraceptive vaginal ring. FPA. www.fpa.org.uk, accessed 1 January 2009
  • Beral V, Doll R, Hermon C, et al. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23257 women with ovarian cancer and 87303 controls. Lancet 2008; 371:303–14
  • Hormonal contraceptives. Medicines and Healthcare products Regulatory Agency (MHRA). www.mhra.gov.uk, accessed 1 January 2010

 

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