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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).

About hormonal contraception

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.

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

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

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.

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

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)

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

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 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.

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.

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

 

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

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources .


  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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