Contraception Treatment

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Contraception

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We may be able to prescribe you a repeat private prescription of your pill after you complete an assessment to check it's suitability. If you have not been prescribed the pill by your doctor or nurse before then this service is not appropriate for you, please contact your GP or local contraceptive clinic instead. Please ensure you read all the information below before you start an assessment.

The Combined Contraceptive Pill

The combined contraceptive pill contains artificial forms of oestrogen and progestogen. Each brand of the pill will provide different types of the two hormones and at different strengths. 

If used correctly then the pill is a very effective (over 99%) form of contraception. This equates to about 3 women in 1,000 using the pill correctly will become pregnant each year. It is less effective when not taken correctly. Correct use means not missing the pill, restarting the pill on time and using additional contraception where necessary. 

How it works:

1. It stops the ovary from releasing an egg each month.

2. It thins the endometrial lining, reducing the chances of a fertilised egg implanting in the uterus (womb) and growing.

3. It thickens the mucus in the cervix reducing the chances of sperm travelling to the womb and fertilising an egg.

You should have your blood pressure checked every six months, as this pill can cause it to rise. If your blood pressure becomes too high, then you will need to look at alternative contraceptive options with your doctor or nurse.

There are uncommon but serious risks from taking the pill. The risks include blood clots which can lead to a DVT (deep vein thrombosis), a PE (pulmonary embolus), a stroke or a heart attack. Other risks include a slightly higher chance of breast cancer, cervical cancer and a rare form of liver cancer. 


The Progestogen Only Pill (POP)

This pill is commonly used when the combined pill is not suitable. It can also be used while breastfeeding. 

It works by thickening the cervical mucus making it difficult for the sperm to enter the uterus. Some types of this pill including Cerazette also stop ovulation.

This pill is 99% effective if used correctly. This type of pill should be taken every day without a break. It should be taken at the same time each day. It is important to read the information leaflet contained with the medication carefully. This pill does not increase your chances of blood clots. 

The POP can cause periods to change. They may stop, become more or less frequent, or become lighter. The side effects are usually mild and can include irregular periods, mood changes, nausea, headaches, skin changes such as acne and breast tenderness. The risks from this pill are very small and include breast cancer and ovarian cysts.

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Common Symptoms

The Combined Pill

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 Progestogen-only pill (POP)

Most women taking the POP 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. 

Common Treatments

Possible treatments we prescribe if clinically appropriate:

It is vital that you read the Patient Information Leaflet for important information about your pill before you request a repeat prescription. Please click on the link below for the particular pill you are requesting.

 

Combined Oral Contraceptive 21-day pills:

Microgynon® 30 (63 tablets £2.82*)

(Ethinylestradiol 30 mcg and Levonorgestrel 150mcg)

Ovranette® (63 tablets £2.20*)

(Ethinylestradiol 30 mcg and Levonorgestrel 150mcg)

Rigevidon® (63 tablets £1.89*)

(Ethinylestradiol 30 mcg and Levonorgestrel 150mcg)

Marvelon® (63 tablets £7.10*)

(Ethinylestradiol 30 mcg and Desogestrel 150 mcg)

Yasmin® (63 tablets £14.70*) 

(Ethinylestradiol 30 mcg and Drospirenone 3 mg)

Lucette® (63 tablets £9.35*) 

(Ethinylestradiol 30mcg and Drospirenone 3 mg)

Cilest® (63 tablets £7.16*)  

(Ethinylestradiol 35 mcg and Norgestimate 250 mcg)

Mercilon® (63 tablets £8.44*)  

(Ethinylestradiol 20 mcg and Desogestrel 150mcg)


12-hour Progestogen Only Pills:

Cerazette® (84 tablets £9.55*)

(Desogestrel 75mcg)

Cerelle® (84 tablets £3.50*)

(Desogestrel 75mcg)


*Prices shown are cost price of the medication, taken from the British National Formulary 2018, and are given as a guideline. Pharmacies will add a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices. The medication is paid for at your chosen pharmacy. 

 

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Having a Contraceptive Pill Check

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.

Who the Combined Pill may not be suitable for

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.

Risks from taking the Combined Pill

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 blood clots with the Combined Pill

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

Combined pills that contain ethinylestradiol in combination with levonorgestrel, norgestimate or norethisterone are considered to have the lowest risk of thromboembolism (blood clots).

The risk of a blood clot is increased if you:

  • Travel for extended periods (e.g. during long-haul flights)
  • If you have a major operation
  • Have a period of prolonged immobility because of injury or illness
  • If you develop one or more of the risk factors for blood clots 
  • Have given birth within the last few weeks

If any of the above apply to you it is important to watch out for symptoms of a blood clot.


Risk Factors for blood clots

The following can increase a person's risk of developing blood clots:

  • being overweight: Having a BMI of over 30
  • being over the age of 35 and a smoker
  • having a raised blood pressure: >140/90mmHg
  • having a close relative who has had a blood clot at a young age <50
  • suffer from migraines particularly with an aura
  • having a cardiovascular condition such as atrial fibrillation, arrhythmia, coronary heart disease or cardiac valve disease
  • having diabetes with complications
  • having a medical condition that may increase the risk of thrombosis (eg. cancer, systemic lupus erythematosus, sickle cell disease, Crohn’s disease, ulcerative colitis, haemolytic-uraemic syndrome
  • taking any other medicines that can increase the risk of thrombosis (e.g. corticosteroids, neuroleptics, antipsychotics, antidepressants, chemotherapy)

The risk for blood clots depends upon the type of progesterone contained in the combined pill with oestrogen. Pills containing Drospirenone, Gestodene and Desogestrel, such as Marvelon, Yasmin and Lucette have the highest risk. See the table below for the relative risk for different CHC (combined hormonal contraceptive pills).

The table is from the European Medicines Agency: Benefits of combined hormonal contraceptives (CHCs) continue to outweigh risks – CHMP endorses PRAC recommendation.

How to take the 21-day Combined Pill

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 miss a Combined Pill

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

Possible side effects from the combined pill

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. 

Who the Progestogen-only Pill may not be suitable for

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.

Risks from taking the Progestogen-only Pill

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. 
How to take the 12-hour Progestogen-only Pill

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 miss a Progestogen-only pill

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.

Possible side effects to the Progestogen-only Pill

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. 

Interactions of the contraceptive pill with other medicines

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.
Where else the pill is available from

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

  • your GP surgery
  • contraception clinics
  • sexual health clinics
Alternative forms of contraception

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.

What may make the pill less effective

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.

When to seek urgent medical advice

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.

Safe Sex

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.

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

Start a Contraception Assessment


Do you require a repeat prescription for your contraceptive pill? 


We could send you a treatment plan with a prescription, if appropriate, within an hour and you can collect your medication from your local pharmacy.