To understand how hormonal contraception works, let’s first look at your normal menstrual cycle. The levels of a hormone called oestrogen usually rise after your period. This causes your ovary to release an egg (ovulation) about two weeks after the first day of your period. Your womb lining also changes, making it ready to receive the egg if it’s fertilised. If the egg isn’t fertilised, the levels of two hormones called progesterone and oestrogen fall, triggering a period. Overall, this process normally takes just under a month, although this can differ between women.
Contraceptives such as the combined contraceptive pill affect the levels of oestrogen and progestogen (a man-made type of progesterone) in your body. This interferes with your own natural menstrual cycle and prevents your ovaries from releasing eggs. Other types of hormonal contraceptives such as those containing progesterone may also prevent your ovaries from releasing eggs. These types of contraceptives may make the mucus in your cervix (the entrance of your womb) thicker. This means sperm are less able to enter. They may also prevent the lining of your womb from becoming ready to receive an egg.
Oral contraceptives come as a tablet that you swallow. There are two main types of oral contraceptives available, which are listed below. For any hormonal contraception to work, you need to follow the instructions in the patient information leaflet that comes with your medicine. Speak to your pharmacist or GP if you have any questions.
Combined oral contraceptive pillThe combined contraceptive pill contains two hormones – progestogen and oestrogen. Most pills (eg Cilest) are taken every day for 21 days. This is followed by a seven day break before starting again. You’ll have your period (called a withdrawal bleed) when you stop taking the tablets. Some brands (eg Femodene ED) have 28 pills in the packet. They include seven dummy pills, so you don’t have to rely on memory to count your seven-day break. Some combined pills contain the same amount of hormones throughout the 21 days, while others contain different amounts in them, which change throughout the month.
Always take your pill each day as recommended. Read the patient information that comes with your medicine, as this will tell you how to take your tablets correctly. If you forget to take two or more pills in a row, you’ll need to use another type of contraception for seven days. For example, you could use condoms during this time.
If you've already had sex before you realise you missed your pill, you may need emergency contraception, depending on where you are in the pack. See our section on emergency contraception for more details. If you’re unsure what to do, check the leaflet that came with your pill or talk to your pharmacist or GP for advice.An advantage of the combined pill is that your periods may become more regular, lighter and less painful. The combined pill may also reduce your risk of ovarian and endometrial (womb) cancer, colon cancer and pelvic inflammatory disease.
Some disadvantages of the combined pill include the following.
- There’s a chance you might get side-effects (unwanted effects of taking a medicine) such as headaches, nausea, breast tenderness and changes in mood.
- If you have severe diarrhoea or vomiting, the pill may not work properly.
- You can’t use it while breastfeeding a baby under six months old.
- It doesn't protect you against sexually transmitted infections (STIs).
Taking the oral contraceptive pill can increase your risk of breast cancer, cervical cancer and blood clots. These risks are small. The combined oral contraceptive pill isn't suitable for everyone. For example, you’ll be advised to use a different type of contraception if you:
- get migraine with aura
- have liver or heart disease
- are over 35 and smoke
- are at risk of getting cardiovascular disease (heart disease)
- are overweight
- have high blood pressure
The progestogen-only pill or ‘the mini-pill’ (eg Cerazette or Norgeston) is taken every day with no break. It's important to take your pill at the same time every day. If you miss a pill or take it too late, you’ll need to use extra contraception (eg a condom) for two days. Follow the advice on the leaflet that comes with your pill or ask your pharmacist or GP for advice. Advantages of the progestogen-only pill include the following.
- It might be suitable for you if can’t take the combined oral contraceptive.
- It’s safe to use if you’re breastfeeding.
Some disadvantages of the progestogen-only pill are listed below.
- Your periods may change. They may become irregular, light or stop altogether.
- You might get side-effects, which include headaches or changes in your hair or skin.
- If you have diarrhoea or vomiting, the pill might not work properly.
The contraceptive patch (eg Evra) is worn on your skin. It releases oestrogen and progestogen. You’ll wear a new patch every week for three weeks and then have a week without a patch.
The patch is sticky and should stay on even when you're showering or exercising. If the patch comes off, you’ll be protected against pregnancy if you replace it within 24 hours. If your patch is off for longer than this, you’ll need to use another method of contraception for the next seven days. Check the leaflet that comes with your patches or ask your pharmacist or GP for advice.
Some advantages of the patch include the following.
- Your periods may become light and less painful.
- You only need to remember to put your patch on once a week.
- It will still work if you vomit or have diarrhoea.
Some disadvantages of the patch are listed below.
- Like the combined pill, patches will not be suitable for you if you smoke and are over 35, or if you’re overweight.
- Your periods may change – they may become more painful.
- You might get side-effects (unwanted effects of taking a medicine) such as breast tenderness, nausea (feeling sick) and changes in mood.
- It might irritate your skin.
You should change the position of each new patch to reduce the chance of it irritating your skin. Don’t wear the patch on broken skin or on your breasts.
The contraceptive ring (NuvaRing) releases oestrogen and progestogen into your vagina. Your GP or nurse will show you how to insert the ring into your vagina. You should keep the ring in your vagina for three weeks and then remove it. You’ll then have one week without the ring, before you have a new one.
Advantages of the vaginal ring include the following.
- Your periods may become lighter.
- It will still work if you have vomiting or diarrhoea.
Disadvantages of the vaginal ring are listed below.
- You might get side-effects (unwanted effects of taking a medicine), which include vaginal discharge and feeling sick (nausea).
- Like the combined pill, the vaginal ring isn’t suitable for you if you smoke and are over 35 or if you’re overweight.
If you find sex uncomfortable while using the ring, you can remove it for up to three hours. If you leave the ring out for longer by accident, you may need to use extra contraception (eg condoms) for seven days. Check the instructions provided with the ring, or ask your pharmacist or GP if you’re unsure.
Contraceptive injections contain the hormone progestogen. They provide contraception for eight or 12 weeks. There are three different brands of injection. Depo-Provera and Sayana Press protect you from pregnancy for 12 weeks, and Noristerat protects you for eight weeks.
The injection is given into a muscle, such as your buttock, upper arm or thigh, by your GP or nurse.
The advantages of the contraceptive injection are listed below.
- Your periods may become lighter.
- It isn’t affected by other medicines, such as antibiotics.
- It's safe to use if you’re breastfeeding.
- You don’t need to remember to take a daily pill.
The disadvantages of the contraceptive injection include the following.
- Your periods may become irregular or stop altogether.
- Once you have had the injection, it isn’t reversible. So, any side-effects (unwanted effects of taking a medicine) might not improve until you were due for your next injection.
- It will take some time for your fertility to return to normal after the injection wears off.
- The injections may make you more likely to gain weight.
- Your GP may not advise this type of contraception if you’re at risk of getting osteoporosis.
The contraceptive implant (eg Nexplanon) is a narrow flexible rod about the size of a matchstick. Your GP or nurse will insert the implant under your skin in your upper arm. It releases progestogen, protecting you from pregnancy for three years.
Advantages of having an implant are listed below.
- You don’t need to remember to take daily pills.
- It isn't affected if you vomit or have diarrhoea.
Disadvantages of having an implant are the same as using the other types of contraception that contain progestogen, (such as injections or the pill). These include the following.
- Your periods may stop or become irregular.
- You may have side-effects (unwanted effects of taking a medicine) such as acne, breast tenderness and changes in mood.
An IUS (eg Mirena) is a plastic T-shaped device that is placed in your uterus (womb). An IUS releases the hormone progestogen and protects you from pregnancy for up to five years. You can have it removed at any time if you’d like to become pregnant though.
It can also help manage heavy periods. The IUS is fitted by a GP or nurse. It has two soft threads that hang through the cervix into the top of your vagina. Your GP or nurse will explain how to feel for these threads once a month to make sure the IUS is still in place.
Advantages of the IUS are listed below.
- It can make your periods lighter, shorter and less painful.
- You don’t need to remember to take daily pills.
- It isn't affected by other medicines.
- It’s safe to use if you’re breastfeeding.
Disadvantages of the IUS include the following.
- You may find it uncomfortable to have an IUS fitted or removed.
- Your periods may take a few months to settle after having an IUS fitted.
- An IUS can also cause small fluid-filled cysts on your ovaries to develop. These can cause pain but don’t usually need to be treated.
- There’s a chance the IUS might not stay in place. If you can’t feel the threads of your IUS, contact your GP.
- An IUS doesn't protect you against sexually transmitted infections (STIs).
If you think your contraception may not have worked properly – don’t panic. You can get emergency contraception from your pharmacy, sexual health clinic or your GP. There are three methods of emergency contraception: two types of pill and an intrauterine device (IUD). An IUD is different from an IUS. See our non hormonal contraception topic for more information about having an IUD.
The two types of pill are called ellaOne and Levonelle; they are sometimes called the ‘morning after pill’. Levonelle can be taken up to three days after unprotected sex, but works better when taken sooner. ellaOne can be taken up to five days after unprotected sex. Their side-effects (unwanted effects of taking a medicine) include feeling or being sick, feeling tired or dizzy, and pain in your abdomen (tummy) or back.
Alternatively, you can have an IUD fitted by your family planning clinic or GP. This will work up to five days after unprotected sex. Sometimes, it will work with a longer delay too, depending on where you are in your menstrual cycle.
Side-effects are the unwanted effects of taking a medicine. As with all medicines, there are some side-effects linked with hormonal contraceptives. Ask your GP, nurse or pharmacist to explain how these risks apply to you. The side-effects differ slightly between the types of contraception, so we’ve explained these in the sections above.
For most women, the benefits of hormonal contraception outweigh the risks. Hormonal contraceptives prevent unwanted pregnancy, may relieve painful periods (dysmenorrhoea) and may reduce your risk of ovarian, endometrial (womb) cancer and pelvic inflammatory disease. Hormonal contraceptives can also be used to manage heavy periods (menorrhagia), endometriosis, premenstrual syndrome (PMS) and acne. Your GP will help you to understand the benefits and risks of using hormonal contraception, and suggest the best types for you.
Medicines used to treat epilepsy or some viruses, and certain antibiotics can stop oral contraceptives, contraceptive patches, implants and vaginal rings working properly. The herbal remedy St John's wort can also reduce how well they work.
Check with your GP or pharmacist before you take any medicines or herbal remedies.
Examples of the main types of hormonal contraception are shown in the table.
You may have noticed that your medicine has two names. All medicines have a generic (biological) name. Many medicines also have a brand name, although the key ingredients are the same. Generic names are in lower case, whereas 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, Ovysmen, Norinyl-1
ethinylestradiol with norgestimate
ethinylestradiol with desogestrel
Marvelon, Mercilon, Gedarel
ethinylestradiol with drospirenone
Yasmin ethinylestradiol with gestodene
Femodene, Femodene ED, Katya 30/75, Triadene, Femodette, Sunya 20/75, Millinette 20/75, Millenette 30/75
ethinylestradiol with levonorgestrel
Levest, Microgynon, Microgynon 30 ED, Ovranette, Rigevidon, Logynon, TriRegol, Logynon ED
mestranol with norethisterone
ethinylestradiol with cyproterone acetate
estradiol with dienogest
Contraceptive patches ethinylestradiol with norelgestromin
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, Sayana Press
norethisterone enantate Noristerat Progestogen-only implant etonogestrel Implanon IUS Intra-uterine progestogen-only device
At what age should I stop taking hormonal contraceptives?
Unless there’s a reason it’s not suitable for you, you can use hormonal contraceptives like the pill until you’re 50. If you have any questions about the type of contraception you’re using, speak to your GP. They will discuss your options with you to help you make a decision that’s right for you.
The age you're advised to stop taking hormonal contraceptives (or swap type) depends on the type of contraception you're using, your medical history and other factors. If you're using combined contraception (tablets, patch or ring), you may be advised to stop at 35 if you smoke or stopped smoking recently.
There are also other reasons that you may need to stop taking the combined pill. For example, if you have migraine with aura, high blood pressure, are overweight, or are at risk of cardiovascular disease (heart disease). You may be able to switch to another type of hormonal contraception instead.
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 discuss possible alternatives with you. These may include options including intra-uterine devices (IUD or IUS) or barrier methods, such as condoms.
Can I take the pill so I don't have a period while I'm on holiday?
It's usually fine to run three packets of combined contraceptive pills back-to-back without having a seven-day break. This will usually stop you having a period.
If you take a contraceptive pill that contains a different amount of hormones throughout the month, see your GP. They’ll be able to give you advice if you’d like to delay your period.
If you take three packets of your contraceptive pill without a break in between, it’s likely to delay your period. If you have a 28-day packet (once a day, every day), the last seven pills are dummies (inactive pills). So if you want to avoid your period, skip these seven pills and move straight to the next packet.
In some contraceptive pills, the dose of hormones is different for different weeks of the cycle. If you’re taking this type of pill and would like to delay your period, speak to your pharmacist, GP or nurse for advice.
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. This means it’s more likely that your contraception won't work.
The combined pill partly works by stopping your ovaries from producing eggs. In your pill-free week, your natural balance of hormones starts to return and your ovaries get ready to produce an egg. Once you start the new packet of pills, your ovaries shut down again to prevent you from releasing an egg.
If you miss a pill at the beginning or end of your cycle your contraception might not work properly. This is because there’s a chance your ovaries may start working again and release an egg.
Always check the leaflet that comes with your pill for advice on what to do if you are late taking a pill or miss one altogether. You may wish to use emergency hormonal contraception if you have missed pills. You can get this from a pharmacy or family planning clinic, or your GP can write you a prescription.
What's the risk of getting deep vein thrombosis (DVT) from the combined oral contraceptive pill?
The combined oral contraceptive pill can slightly increase your risk of having a blood clot. There’s a small amount of proof that suggests you’re most at risk of having a blood clot in the first three months of starting them.
Taking a combined hormonal contraceptive slightly increases your risk of having a blood clot (such as deep vein thrombosis, or DVT). This risk is very small. It’s smaller than the risk of getting a blood clot from pregnancy.
The risk of having a blood clot varies depending on the type of pill you take − the risk is higher with pills that contain more oestrogen. New combined pills that contain hormones such as desogestrel, gestodene or drospirenone may also have a slightly higher risk.
Your risk of having a blood clot in a vein is higher if you use the combined pill and you:
- have a family history of blood clots
- smoke and are over 35
- are overweight
If you have migraine with aura, your risk of stroke might be increased if you take the combined pill. If you have any of these risk factors, let the person treating you know. They will recommend different types of contraception.
The risk of having a blood clot is higher when you are not moving for long periods of time. If you have planned surgery coming up, you may be advised to stop taking the combined pill a few weeks beforehand.
For information on how to reduce the risk of DVT while travelling, see our information on DVT.
- Overview of contraception. The Merck Manuals. www.merckmanuals.com/professional, published August 2013
- Map of Medicine. Contraception. International View. London: Map of Medicine; 2014 (Issue 3)
- Gynaecology. Sexual health and contraception. Oxford handbook of general practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published date March 2014
- Contraception – natural family planning. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2012
- Menorrhagia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2012
- Endometriosis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published May 2014
- Premenstrual Syndrome. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2014
- Oral contraceptives. The Merck Manuals. www.merckmanuals.com/professional, published August 2013
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed January 2015 (online version)
- Your guide to contraception. Family Planning Association. www.fpa.org.uk, published January 2014
- Evra patient information leaflet. EMC. www.medicines.org.uk, published January 2014
- Contraceptive injections. Family Planning Association. www.fpa.org.uk, published July 2014
- Progesterone-only contraceptives: progestogen implant. BMJ Best Practice. www.bestpractice.bmj.com, published 22 July 2014
- Mirena patient information leaflet. EMC. www.medicines.org.uk, published August 2013
- Combined pill: your guide. Family Planning Association. www.fpa.org.uk, updated January 2014
- Brynhildsen J. Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks. Ther Adv Drug Saf 2014; 5(5):201–13. doi 10.1177/2042098614548857
- Infertility. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2013
- Contraception. BMJ Best Practice. www.bestpractice.bmj.com, published 22 July 2014
- Contraception – general overview. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 5 November 2012
- Combined oral contraceptive pill (first prescription). PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 24 November 2014
- Contraception – combined hormonal methods. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2014
- Contraception – progesterone only methods. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2012
- Contraception – IUS/IUD. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2012
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