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Hormonal contraception

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

Hormonal contraception is the most effective method of controlling fertility and preventing pregnancy. Hormonal contraceptives that are available for women include the combined oral contraceptive pill (commonly known as ‘the pill’), the progestogen-only pill (also known as the ‘mini-pill’), contraceptive patches, injections, implants, vaginal contraceptive ring and the intrauterine system (IUS).

If you’re a woman of childbearing age, almost any time you have sex without using contraception there is a chance you might get pregnant.

Hormonal contraceptives, when taken correctly, interfere with your normal monthly cycle to prevent pregnancy. Hormonal contraceptives work by:

  • preventing your ovaries from releasing an egg
  • thickening the mucus in your cervix (the neck of the womb) so it’s difficult for sperm to enter your womb (uterus)
  • preventing the lining of your womb from growing so a fertilised egg can’t implant

Hormonal contraceptives are sometimes used to manage heavy periods (menorrhagia), endometriosis and premenstrual syndrome (PMS). Hormonal contraceptives are also sometimes used to treat polycystic ovary syndrome (PCOS) and acne in women. Hormonal contraceptives don’t protect against sexually transmitted infections (STIs).

There are several types of hormonal contraceptives available: oral contraceptives, patches, injections, implants, intrauterine system (IUS) and the vaginal contraceptive ring. It’s important that you find the type that best fits your individual needs.

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  • Oral contraceptives Oral contraceptives

    Oral contraceptives come as a tablet that you swallow. There are two types of oral contraceptives available.

    Combined oral contraceptive pill

    The combined oral contraceptive (or ‘the pill’) contains two hormones – progestogen and oestrogen. The pill needs to be taken every day for 21 days (eg Cilest). This is followed by a break of seven days before starting the next course. You will have your period when you stop taking the tablets. This is called a withdrawal bleed.

    Some brands known as EveryDay pills (eg Femodene ED) have 28 pills in the packet. They include seven dummy pills, removing the need for a seven-day break. The contraceptive goes on working during the seven day break.

    You must take the pill every day as recommended. If you miss a dose, it can mean that you’re at risk of becoming pregnant. If you miss taking a pill, or pills, your chances of becoming pregnant depend on where in the month you missed taking the pill and how many you have missed.

    If you miss taking one pill at the start of a pack, or start your pack a day late, then take the last pill you missed and carry on taking the rest of the pack as usual.

    If you miss two or more pills, start the pack more than two days late, or if you have missed earlier pills in the pack, take the last pill you missed and carry on taking the rest of the pack as usual. However, you should also use another form of contraception, such as a condom, for the next seven days.

    If you’re unsure about what to do, talk to your nurse or GP for advice. If you have had unprotected sex in the previous seven days, you may need emergency contraception.

    Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    The combined oral contraceptive can help manage PMS, heavy and painful periods, and reduce your risk of non-cancerous breast disease, pelvic inflammatory disease, and ovarian and endometrial cancer. Some forms of the pill can also help to ease the symptoms of polycystic ovary syndrome.

    The combined oral contraceptive isn’t suitable for everyone. For example, your doctor will recommend alternative contraceptive methods if you’re over 35, smoke, are very overweight or take certain medicines. If you have diabetes or high blood pressure, or if you get migraine with aura, your doctor may also suggest other forms of contraception.

    Progestogen-only pill

    Progestogen-only pill or ‘the mini-pill’ (eg Cerazette or Norgeston) is taken every day with no break. If you miss a pill or don’t take it within three hours (12 hours for Cerazette) of the usual time, the contraceptive effect may be lost. This means it's important to take your pill at the same time every day.

    If you miss a pill or take it too late, you will need to use extra contraception, such as a condom, for the next two days.

    Progestogen-only pill is suitable for women who can’t take the combined oral contraceptive and is safe to use if you’re breastfeeding. Unlike the combined oral contraceptive pill, there is no seven day break so your periods may change. They can become irregular, more frequent or stop altogether. This isn’t harmful, but you may find it inconvenient. If this happens, ask your GP or nurse if you can try a different progestogen-only pill.

  • Contraceptive patches Contraceptive patches

    The contraceptive patch (eg Evra) is worn on the skin and releases oestrogen and progestogen into your bloodstream. A new patch is worn every week for three weeks and then you have a week without wearing a patch. The contraceptive goes on working during the seven-day break.

    The patch is very sticky and should stay on even when you're showering, swimming or exercising. If the patch comes off, you will be protected against pregnancy if you replace it within 48 hours. If your patch is off for longer than two days, you will need to use another method of contraception for the next seven days. Ask your doctor, nurse or pharmacist for advice.

    Don’t wear the patch on broken skin or on your breasts. Change the position of each new patch to help reduce the chance of any possible skin irritation.

  • Vaginal contraceptive ring Vaginal contraceptive ring

    The contraceptive ring (eg NuvaRing) releases oestrogen and progestogen directly into your vagina. Your doctor 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 will then have one week without the ring, before you insert a new one.

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  • Long-acting injections Long-acting injections

    Hormone injections contain progestogen and provide long-lasting contraception. There are two brands, Depo-Provera protects you from pregnancy for 12 weeks and Noristerat protects you for eight weeks.

    The injection is given into your buttock or upper arm by your doctor or nurse.

    The benefits of having a contraceptive injection are that their action isn’t affected by other medicines and they are safe to use if you’re breastfeeding.

    Long-acting injections can cause irregular periods and these can carry on for some months after you stop the injections. They can also affect your bones so, if you’re at risk of developing osteoporosis, speak to your GP or nurse. When you stop using long-acting injections, it can take up to a year for your fertility to return to normal. Once you have had an injection, any side-effects you get from it will continue for the time it takes for the injection to wear off.

  • Implant Implant

    The contraceptive implant (eg Nexplanon) is made up of narrow flexible rods, about the size of a match stick. The implant is inserted under your skin in your upper arm. It releases a constant amount of progestogen, protecting you from pregnancy for up to three years.

    The implant is fitted and removed, usually using local anaesthesia, by a doctor or nurse. This completely blocks pain from the area and you will stay awake during the procedure.

    Implants can affect your periods. They can become irregular, more frequent or stop altogether. When the implant is first put in you may have some side-effects. These include breast tenderness, mood changes and headaches. Implants can cause acne, or if you already have acne you may find that it gets worse. An implant can sometimes cause skin irritation or an infection in your arm where it’s been inserted.

  • Intrauterine system (IUS) Intrauterine system (IUS)

    An IUS (eg Mirena) is a plastic T-shaped device that is placed in your womb. It releases progesterone and protects you from pregnancy for up to five years. It can also help manage heavy periods. The IUS is fitted by a doctor or nurse. The IUS has two soft threads which hang through the cervix into the top of your vagina. Your doctor or nurse will show you how to feel these threads once a month to make sure the IUS is in place and hasn’t moved.

    The IUS isn’t affected by other medicines and is safe to use if you’re breastfeeding.

    An IUS can affect your periods. They can become irregular, more frequent or stop altogether. When the IUS is put in you may have some side-effects. These can include breast tenderness, acne and headaches. 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.

    An IUS can sometimes cause a womb infection in the first 20 days after it’s inserted. There is also a small risk that the IUS may go through the wall of your womb when it’s put in, or of it being pushed out of the womb.

  • Emergency hormonal contraception Emergency hormonal contraception

    If you think your contraception may have failed, you can get emergency hormonal contraception (from your doctor, pharmacy, sexual health clinic or NHS walk-in centre). There are three methods of emergency contraception; two types of pill and an intrauterine device (IUD).

    The two types of pill are called ellaOne and Levonelle, which are sometimes called the ‘morning after pill’. Levonelle can be taken up to 72 hours (three days) after unprotected sex and ellaOne can be taken up to five days after. However, it's important that you take it as early as possible for it to be most effective.

    Alternatively, you can have an emergency IUD fitted by your GP or family planning clinic up to five days after unprotected sex or within five days of the earliest time you could have released an egg.

  • Side-effects Side-effects of hormonal contraception

    Side-effects are the unwanted effects of taking a medicine. As with all medicines, there are some side-effects associated with hormonal contraceptives. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor or nurse to explain how these risks apply to you. The most common side-effects of hormonal contraception are listed below.

    • Hormonal contraceptives containing oestrogen can increase your risk of breast cancer, cervical cancer and deep vein thrombosis (DVT).
    • The combined oral contraceptive pill can increase your risk of a heart attack or stroke  although this risk is small.
    • Hormonal contraceptives containing progestogen can cause headache, mood swings and breast tenderness. They can also make you feel sick.
    • Hormonal contraceptives will affect your periods. You may have irregular bleeding, no bleeding, or spotting while you’re using contraceptives. You may find this improves your periods, or it may make them more inconvenient.

    For most women, the benefits of hormonal contraception outweigh the risks. Hormonal contraceptives prevent unwanted pregnancy, reduce the amount of blood lost during periods, relieve painful periods and may reduce your risk of ovarian and endometrial cancer.

  • Interactions Interaction of hormonal contraception with other medicines

    Medicines used to treat epilepsy, tuberculosis (TB) and HIV, and certain antibiotics can cause oral contraceptives, contraceptives patches and vaginal contraceptive rings to become less effective. Certain herbal remedies, such as St John's wort, can also make them less effective.

    Different types of hormonal contraception can affect different medicines in different ways. So, if you’re using any type of hormonal contraceptive, it’s important to check with your doctor or pharmacist before you take any medicines or herbal remedies. Your doctor will usually suggest using an additional contraception, such as a condom, during your course of treatment and for some time after stopping treatment.

  • Common names 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. Many medicines also have one or more brand name. 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
    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 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
    norethisterone enantate Noristerat
    Progestogen-only implant  
    etonogestrel Implanon
    IUS  
    Intra-uterine progestogen-only device

    Mirena

  • FAQs FAQs

    At what age should I stop taking hormonal contraceptives?

    Answer

    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, medical history, general health and lifestyle. 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 at 35 if you're a smoker or have stopped smoking only in the previous year. Although taking a combined oral contraceptive doesn’t itself cause you to put on weight, if you do put on a lot of weight you may be advised to stop taking it. You may also be advised to stop taking the pill if you develop other risk factors for heart disease, such as high blood pressure.

    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.

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

    Answer

    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 is 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 packet. 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.

    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?

    Answer

    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 start 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, and it may be too late to stop 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.

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

    Answer

    The combined oral contraceptive pill can increase your risk of having a blood clot, particularly in the first year. The risk is very low – lower than the risk of blood clots naturally associated with pregnancy.

    Explanation

    Taking a combined hormonal contraceptive slightly increases your risk of having a blood clot in one of the deep veins, usually in the leg. The risk of DVT varies depending on the dose of oestrogen and type of progestogens in the pill. For example, combined contraceptives that contain desogestrel, gestodene or drospirenone are more likely to cause DVT than levonorgestrel.

    If you’re taking oral contraceptives, or using the patch or vaginal contraceptive ring you’re at increased risk of developing DVT on a journey of over five hours. It’s important that you take steps to reduce your chances of developing a blood clot. You can do this by wearing compression stockings and exercising the muscles in your lower legs.

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

    Answer

    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.

  • Resources Resources

    Further information

    Sources

    • Hormonal contraceptives. Medicines and Healthcare products Regulatory Agency (MHRA). www.mhra.gov.uk, published 7 March 2012
    • Joint Formulary Committee. British National Formulary. 63rd ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012
    • Contraception. FPA. www.fpa.org.uk, accessed 14 March 2012
    • Polycystic Ovary Syndrome. Prodigy. www.prodigy.clarity.co.uk, published October 2009
    • Acne vulgaris. Prodigy. www.prodigy.clarity.co.uk, published June 2009
  • Related information Related information

  • Author information Author information

    Produced by Stephanie Hughes, Bupa Health Information Team, July 2012.

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