Conflicting medical advice, ever-advancing research and the personal experiences of those taking it mean conversations surrounding the contraceptive pill can feel like a minefield of information to sift through. Overwhelming though it may seem, the contraceptive pill (developed in the 1950s, FYI) has changed the lives, freedom and health of women globally, empowering them to make their own decisions about pregnancy and sex, whilst also aiding in other health concerns, be it painful menstrual cycles, acne or heavy monthly bleeding. But how do you know where to start in picking a pill that’s right for you? The truth is, there’s no such thing as the perfect birth-control method, but there are certainly differences between the two types of pill that can make your experience a whole lot easier once you understand. Let’s break it down…
Although we commonly talk about ‘the pill’, it’s important to note that there are two types of contraceptive pill: the combined pill and the progestogen-only pill, and within those there are different active ingredients, strengths and brands available too says Pharmacist and advisor to progestogen-only pill, Hana, Deborah Evans. Both the progestogen-only pill and combined pill must be prescribed by a doctor, however you can now also purchase a desogestrel progestogen-only pill in pharmacies without a prescription, following a consultation with a pharmacist.
The Combined Pill
The combined pill contains synthetic versions of the hormones progesterone and oestrogen (ordinarily produced in the ovaries) and works by preventing ovulation from occuring. It is 99.7 percent effective, if taken correctly (more on this later) making it a great option for those looking to enjoy sex with a minimal risk of pregnancy. This type of pill is generally taken every day for 21 days of your cycle, followed by a 7 day break during which you might experience a withdrawal bleed- spoiler, contrary to popular belief this is not a normal period!
Although having this 7 day break was deemed ‘necessary’ for a long time, in recent years doctors have shared that this is in fact not essential when taking the combined pill, and that should someone wish, they can skip the break altogether!
“The seven day break makes the pill more ‘natural’ and acceptable for some women,” says Consultant Gynaecologist Narendra Pisal. “A lot of women prefer to have a regular monthly period, as they feel reassured by it for various reasons (such as they feel it is more physiological to ‘have the blood come out’ and also a period means there is no pregnancy). Taking a break does not make the adverse effects any worse or more common (such as headaches, sleep issues).”
As it turns out, there are no health benefits from taking the 7 day break once advised by doctors, and patients can take back to back doses without worry. There is no buildup of menstrual blood if you do not take a break, and the withdrawal bleed experienced when someone does follow the 21 days on, 7 days off cycle is not an indication that someone isn’t pregnant.
The pill can become less effective if you take it more than 24 hours apart, vomit within 2 hours of a dose or have severe diarrhoea that lasts for more than 24 hours, which is important to remember!
- Skin conditions such as acne can improve.
- Improvement or absence of PMS (premenstrual syndrome) which can cause uncomfortable symptoms and mood changes in the days before your period starts.
- It’s one of the most non-invasive methods of contraception currently available, and natural fertility is restored once someone discontinues use of the pill, which can be done at any time.
- It can lead to lighter ‘periods’ aka withdrawal bleeds if the 7 day break is taken, which can be more comfortable and convenient.
- Those suffering with migraines are advised to use another method of contraception because of the higher risk of blood clots.
- The combined pill has been linked to changes in libido and sexual desire.
- The combined pill has been linked to increased feelings of depression, however this varies from person-to-person and is something that should be discussed with a doctor should you feel concerned.
- It is not suitable for those over the age of 35 who smoke.
You may also not be protected from pregnancy if you:
- Are taking the pill for the first time and you haven’t yet taken seven hormone pills in a row.
- Are taking another medicine that may affect the pill absorption, e.g. some anti-epilepsy medications.
The Progestogen-Only Pill
Next up: the progestogen-only pill. Also known as the mini-pill or POP, it contains a synthetic version of the hormone progesterone which alters cervical mucus to make it harder for sperm to travel to meet an egg. Some progestogen-only pills also contain desogestrel, which works to prevent ovulation, meaning no egg is released for sperm to fertilise.
Similarly to the combined pill, the mini-pill should be taken at the same time every day and is designed with no break between pills to be its most effective.
The POP is often a popular choice for people who might find it hard to remember to stop and restart taking medication, says Hussain Abdeh, Clinical Director and Superintendent Pharmacist at Medicine Direct. Similarly if you cannot use contraception containing oestrogen, this is also a useful alternative. The POP is suitable for people of all ages, including if you are over 35 years old and smoke. However, it must be taken at the same time each day; taking it later than 3 hours after your scheduled time may mean it is ineffective. Most people who take the POP find their periods stop altogether which can be a huge advantage to those who experience painful periods or other difficult symptoms when menstruating and simply make things like sexual spontaneity, swimming and wearing whatever you like to feel more attainable.
- The mini pill can be taken whilst breastfeeding.
- It can be taken by those over the age of 35 who smoke.
- You can start taking the mini-pill straight after childbirth, abortion or miscarriage.
- There are less risks of developing blood clots unlike the combined pill which is associated with higher risk.
- If taken correctly, it’s more than 99% effective. This means fewer than 1 in 100 who use the progestogen-only pill as contraception will get pregnant in 1 year. With “typical use” of the progestogen-only pill (the way it’s taken by a lot of women in real life), it’s only about 91% effective.
- Some users develop more frequent or irregular bleeding while taking the mini pill.
- Some users may experience headaches, breast tenderness and acne, but these symptoms generally get better within the first few months of using the pill.
- Women who have had breast cancer, or who currently have it, are also not advised to take the progestogen-only pill. Similarly, if you have arterial disease, heart disease, or have had a stroke, it is not advisable to use the POP.
So, what’s with the different names?
Now we’ve broken down the two types of pill, you might be wondering why you and everyone you know end up taking one with a different name? It can be confusing, but the different names given to contraceptive pills still fall into the categories of combined and POP, but simply have different brand names. Pills under different brand names contain the same hormones and the same dose of hormones, they have simply been produced by a different manufacturer and given a different brand name. Simple!
How to know which pill is right for you:
Landing on an effective method of contraception for you can be something that happens with ease, or for others take time and trial and error to find what works best- be it the pill, the coil, implant, condoms or other forms of contraception. It’s important to remember that whilst contraceptives like the pill work to prevent pregnancy, they do not protect you from the spread of STIs, and so a barrier method such as a condom is always advisable. Safe sex is fun sex!
When deciding between the two types of contraceptive pill, it’s important to discuss with your doctor any ongoing health conditions you are currently experiencing, or any you have experienced in the past, as this will undoubtedly impact which is safe for you to take. Other factors when deciding between the combined pill and POP include: if you’re someone who likes structure and routine and is able to remember to take a pill at the same time every day, if you’re a smoker, if you are somebody who cannot take oestrogen, or if you prefer to experience ‘periods’ (aka withdrawal bleeds). It’s a hugely personal decision but the benefits of the pill being something you ingest daily means you can stop taking it at any time- something that may help you feel more in control of your health and symptoms, in comparison to alternatives like the coil which must be removed by a professional.
How to make taking the pill work for you:
“Forgetting pills, losing the pack, not refilling your prescription on time — these are the main reasons why people might get pregnant when they use the pill” say the team at Planned Parenthood. “It’s good to plan ahead and think about the best way for you to use the pill correctly.” Here are some ways to help you remember to take your pills every day:
- Use the Planned Parenthood birth control reminder app or set an alarm on your phone.
- Keep your pill pack next to something you use every day (like your toothbrush or phone charger).
- Keep your pills in your bag so they’re always with you.
Knowledge is power…
It’s worth knowing that both hormonal pills are linked to a small but significant increased risk of breast and cervical cancer, says Dr Jessica Braid of online health platform, Adio. “The combined oral contraceptive can also affect our gut health and has been shown to negatively affect the gut wall increasing the risk of ‘leaky gut’ and also have an impact on our gut microbiome increasing the risk of inflammation.
As a hospital doctor with a placement working in gynaecology, I saw widespread use of hormonal contraception and little information on non-hormonal options. Since then, I have worked in a natural medicine practice for 15 years, and believe that in 90% of cases it’s about educating patients on body awareness and hormone balance.Dr Jessica Braid
Contraception is an incredibly personal choice, and whilst the pill carries risk, so does that of many other contraceptive alternatives. If you’re concerned about side effects or struggling to make a call about which option is best for you, speak to a GP or healthcare professional, and know that what works for others may not be best for your body. Empowerment = having the power to decide for yourself.