It is important that you also have an annual face to face Pill check with your own GP to ensure that your current Pill continues to be the best form of contraception for you.

The combined pill may sometimes cause a rise in blood pressure. This is why you should have your blood pressure checked every six months. If your blood pressure becomes too high, the pill may need to be stopped for your safety.

The Combined Contraceptive Pill is not suitable for you if you:

• are pregnant
• over the age of 35 and you smoke
• over the age of 35 and you stopped smoking less than one year ago
• are very overweight (BMI>35)
• take certain medicines (see interactions of the pill with other medicines)
• have had a thrombosis (a blood clot in your leg or lungs)
• have anyone in your close family having a blood clot under the age of 45
• have had a stroke or suffer from a disease that narrows your arteries
• have high blood pressure
• have heart disease
• if you have an irregular heartbeat
• if you suffer from severe migraines
• have diabetes with complications or diabetes for over 20 years
• have breast cancer
• have gall bladder or liver disease
• if you are known to have mutations that make your blood more likely to clot, such as factor V Leiden deficiency
• if you have systemic lupus erythematosus with positive antiphospholipid antibodies

If you have or develop any of the above conditions, then you should stop the pill and tell your doctor straight away.

You should tell your doctor if you are taking the pill and you need to go into hospital for an operation, or you have an accident which affects the movement of your legs. You may need to stop taking the pill for a period of time to reduce your risk of blood clots until you make a full recovery.

There are risks from taking the combined pill. For most women, however, the risks are small. The oestrogen in the pill can cause your blood to clot more readily. This is why people with a higher risk of blood clots cannot take the pill. Taking the pill can increase your risk of developing the following conditions:

• Deep Venous Thrombosis (blood clots in the legs)
• Pulmonary Embolus (blood clots in the lungs)
• Stroke
• Heart Attack
• Breast Cancer
• Liver Cancer
• Cervical Cancer

However, the pill does offer some protection against developing endometrial cancer, ovarian cancer, and colon cancer. 

The risk of a blood clot (thromboembolism) is higher:

• during the first year of use
• when re-starting use after a break of 4 or more weeks

Take one pill around the same time every day for 21 days, and then no pills are taken for the next seven days. During these seven days, you will usually have a period like bleed, although it may happen later. Start your next packet of pills on the eighth day, regardless of whether you are still bleeding or not. You will be protected from pregnancy during the seven-day break, as long as you have taken your pills correctly and you start the next pack on time.

You should take the pill around the same time each day. If you do not do this, or if you miss a pill then you could become pregnant. 

If you forget to take your Combined pill, then read the leaflet that comes with your brand of pill for advice on what to do. A missed pill means that you are 24 or more hours late in taking your pill. There is a chance of your ovaries producing an egg and you becoming pregnant if you miss pills. You are particularly at risk if the missed pills are at the end or beginning of the packet.

The advice on what to do depends on how many pills you have missed, and when in the cycle they were missed. 

More detailed advice can be found on the NHS Choices website for missed combined contraceptive pills. 

Most women taking the combined pill do not suffer from side effects. If they do, then the most common side-effects include:

• headaches
• nausea
• breast tenderness

Less common side effects include:

• tiredness
• reduced sex drive (libido)
• mood changes
• skin changes

The side effects will often improve as the body gets used to the medication. If any of them become bothersome, then speak to your doctor or nurse about changing your pill to a different one. 

The POP is not suitable for you if you:

• are pregnant
• have unexplained bleeding in between periods or after sex
• have had a stroke
• have heart disease or arterial disease
• have had breast cancer
• have severe liver disease
• have a liver tumour
• take other medicines that may affect the pill
• do not want your periods to change

If you have or develop any of the above conditions, then you should stop the pill and tell your doctor straight away.

There are risks from taking the POP. Taking the pill may slightly increase your risk of developing the following conditions:

• Breast Cancer. It may give you a very small increased risk of developing breast cancer like the combined pill. 
• Ovarian Cysts. These are usually small and do not require any treatment.
• Ectopic pregnancy. If you do become pregnant while on the POP, there is a small risk of it being an ectopic pregnancy. However, an ectopic pregnancy is still far less likely when taking the POP than when not using any form of contraception. 

There are 28 pills in a pack. You need to take one pill every day within 12 hours of the same time each day. There is no break between packs of pills; you start the next pack the next day when you finish a pack.

You should take the pill around the same time each day. If you do not do this, or if you miss a pill then you could become pregnant. 

If you forget to take your Progestogen-only pill, then read the leaflet that comes with your brand of pill for advice on what to do. Take it as soon as you remember. This may mean that you take two pills in one day (do not take more than one missed pill). If you are more than 12 hours late in taking it (more than 36 hours since your last pill), then you are not protected from pregnancy.

After missing a pill, continue taking your pill each day, but avoid sex or use extra contraception (such as condoms) for 48 hours until the pill becomes effective again. This is The Faculty of Sexual Health and Reproductive Healthcare's recommendation which may differ from the manufacturer's advice. It takes two days for the POP to thicken cervical mucus so sperm can't get through or survive.

If after the missed pill or in the 48 hours that followed it, you have had unprotected sex without a condom then you will need to use Emergency Contraception.

More detailed advice can be found on the NHS Choices website for missed POP.

Most women taking the progestogen-only pill do not suffer from side effects. If they do, then the most common side-effects include:

• headaches
• nausea and vomiting
• breast tenderness

Less common side effects include:

• reduced sex drive (libido)
• mood changes
• acne
• ovarian cysts

The side effects will often improve as the body gets used to the medication. If any of them become bothersome, then speak to your doctor or nurse about changing your pill to a different one. 

If you are prescribed any of the following medications, then it is important to speak to your GP or nurse about alternative or additional forms of contraception. This is because these medications may make both the combined and the progestogen-only pill less effective.

• St John's wort (a herbal remedy for depression and anxiety)
• The antibiotics rifampicin and rifabutin (used to treat TB and meningitis). Other antibiotics do not reduce the effectiveness of the pill.
• Epilepsy drugs: carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone, and topiramate.
• Anti-retroviral medicines used to treat HIV.

You can also obtain the contraceptive pill free through the NHS. This could be through:

• your GP surgery
• contraception clinics
• sexual health clinics

Use the NHS service finder here.

Long-acting reversible contraceptives (LARC) are also very effective. They allow you to avoid having to remember to take your contraceptive pill every day. There are four types of LARC available. These include:

• Contraceptive Implant
• Contraceptive Injection
• IUCD (Intrauterine contraceptive device) also known as the 'coil.'
• IUS (Intrauterine contraceptive system)

Implant

A small rod-shaped implant is inserted under the skin of the upper arm and releases the hormone progesterone. This provides contraception for 3 years.

Injection

An injection of the progesterone hormone is given into the muscle. This lasts between two to three months depending on the brand.

IUCD

This small device is inserted into the uterus. It lasts up to 10 years.

IUS

This is a type of IUCD which contains the hormone progesterone. This can last up to five years.

Please click on the links above for further information about each type of LARC.

Certain things may make the combined and the progestogen only pill less effective, and this increases your chances of becoming pregnant. 

• Missing the pill
• Vomiting or severe diarrhoea
• Certain medicines (please refer to the section above on interactions between the pill and other medicines)

Vomiting

If you are taking the Combined Pill:

• If you vomit within 2 hours of taking the pill then you need to take another pill straight away. This is because the pill may not be fully absorbed into your bloodstream. Therefore it will not be effective. You would take your next pill at your usual time. 
• If you continue to vomit, then you would need to use additional contraception such as condoms until you have taken the pill for seven days without vomiting. 

If you are taking the POP (progestogen-only pill):

• If you vomit within 2 hours of taking the pill, then you need to take another pill straight away. This is because the pill may not be fully absorbed into your bloodstream. Therefore it will not be effective. You would take your next pill at your usual time. 
• If you don't take another pill within 12 hours of your normal time, use additional contraception, such as condoms, for 48 hours.
• If you continue to vomit, then you would need to use additional contraception such as condoms until you have taken the pill for two days without vomiting. 

Diarrhoea

If you are taking the Combined Pill:

• If you develop severe diarrhoea (6 to 8 stools within 24 hours), then you will need to use additional contraception such as condoms while you have the diarrhoea, and for two days after the diarrhoea stops. 

If you are taking the POP (progestogen-only pill):

• If you develop severe diarrhoea (6 to 8 stools within 24 hours), then you will need to use additional contraception such as condoms while you have the diarrhoea, and for 48 hours after the diarrhoea stops. 

If you have any queries about this or if your sickness or diarrhoea continues, then speak to your GP, contraception nurse, pharmacist or call NHS 111 for more information.

If you develop any of the following symptoms listed below, then the pill should be stopped, and you must seek urgent medical advice (from your GP, Out of Hours Service, Urgent care centre, NHS 111). Call an ambulance or go to A&E if the symptoms are severe.

• Pain or tightness in your chest.
• Calf pain or swelling (signs of a blood clot).
• Weakness or numbness of an arm or leg.
• Difficulty breathing.
• Coughing up blood.
• Sudden vision or hearing disturbances.
• Any unusually severe headaches.
• Severe pain in your tummy (abdomen).
• Jaundice (yellowing of your skin or the whites of your eyes).
• A significant increase in blood pressure.
• A faint or collapse.

Please note that i-GP does not treat medical emergencies.

The pill does not protect you against sexually transmitted infections. If you are worried that you may have an STI, go for a check-up at a sexual health clinic as soon as you can. Help protect yourself from catching or passing on an STI  by always using condoms. 

Please use the following links to find your nearest Sexual Health/ GUM clinic.

• England
• Wales
• Scotland
• Northern Ireland

You can call the national sexual health helpline free on 0300 123 7123 for further advice if you are worried.

SH:24 is a free online sexual health service, delivered in partnership with the NHS. They provide free test kits, information and advice - 24 hours a day.

What is abuse?

Abuse is anything another person does that's meant to cause harm. But it's not always easy to know what's abuse or what to do about it.

There are many types of abuse from physical, emotional, sexual, neglect or domestic. Abuse is always wrong and must be stopped. It is important to take the first step and seek help. If you are in immediate danger call 999.

You can find out more about the types of abuse and where you can access help on the YoungMinds Website.

Domestic violence and abuse

If you are experiencing domestic violence or know of someone that may be experiencing abuse that may need help or support then you can contact the following 

• National Domestic Violence Helpline Free 24-hours a day on 0808 2000 247 Run in partnership between Women's Aid and Refuge.
• Men's Advice Line: confidential helpline for men experiencing domestic violence from a partner or ex-partner (or from other family members). Call freephone 0808 801 0327 Monday-Friday 9am-5pm

Help after rape or sexual assault

Please see the NHS website for further information.

• In an emergency call 999
• You can contact the non-emergency police number 101
• Or call NHS 111 for further advice

For specialist medical attention and sexual violence support, you would need to be seen at a sexual assault referral centre (SARC). You can find your nearest one here.

Childline

Childline is there to help anyone under 19 in the UK with any issue they’re going through. Whether it’s something big or small, or are worried that you may be going through abuse, their trained counsellors are there to support you.

Childline is free, confidential and available any time, day or night. You can talk to them:

• by calling 0800 1111
• by email
• through a 121 Webchat
  

If you are worried about a child, don't wait until you are certain. If you have any concerns or suspicions, contact the NSPCC free helpline service to speak to an NSPCC counsellor 24/7 or report your concern online here.

If you think a child is in immediate danger don't delay – call the police on 999.

Modern Slavery Helpline

If you think you are a victim of modern slavery/human trafficking contact the modern slavery helpline. They can help you to understand what is available including information, advice and, ways to access government-funded support. The Modern Slavery Helpline is confidential, but, if you don't want to give your name, that is fine. Find out more here.

Call free 24/7 on 08000 121 700 to get help, report a suspicion or seek advice.

Female genital mutilation (FGM)

FGM is abuse and illegal under the UK law. All girls and women have the right to a life free from pain, period problems and difficulties with childbirth that are caused by female genital mutilation.

Female genital mutilation, female circumcision or ‘cutting’ may cause serious health and emotional consequences that last a lifetime. You can stop it. For advice, support or to report it, call the free 24-hour anonymous FGM helpline on 0800 028 3550. Find out more about it here.

Protecting young people from sexual

exploitation

It is important that young people are kept safe from sexual exploitation. Child sexual exploitation doesn't always involve physical contact and can happen online. It can be stopped and it is everyone's responsibility to report any concerns.

Child sexual exploitation is a hidden crime and can be difficult to identify. Young people often trust their abuser and don't understand that they're being abused. They may depend on their abuser or be too scared to tell anyone what's happening. You can find out more about here.

If you are worried about a child then contact the NSPCC trained helpline counsellors for 24/7 help, advice and support on 0808 800 5000 or email help@nspcc.org.uk

Watch the NSPCC video sharing the story of a young person who has been groomed and sexually exploited.