Combined Oral Contraceptive Pill – Patient Information Leaflet
Key points every woman who takes the pill should know:
- No contraceptive option is 100% effective, though taken correctly the combined oral contraceptive pill is extremely reliable.
- Different pill brands have different pack designs-it’s important that you understand how your particular pill should be taken- carefully read the instructions contained in the pack or talk to your pharmacist if you’re not sure.
- If a woman is older than 35 and is still smoking or has smoked regularly within the past year, the pill should not be prescribed.
- Vomiting or diarrhoea when taking the pill, or a missed pill, can lead to pregnancy.
- The pill does NOT protect against sexually transmitted infections.
- The pill slightly increases a woman’s risk of getting a blood clot– this is a rare but serious side effect- so it’s important to know the risk factors and symptoms (see below)
- Smoking whilst on the pill further increases clotting risk.
- <Migraine WITH aura> (even once in your life) means you should never take the pill as there is a risk of stroke.
- You need a blood pressure check at least once a year when taking the pill
- All sexually active women are advised to have regular pap smears
How effective is the pill?
- Around 0.3% of women who use the pill perfectly will become pregnant each year
- Around 9% of women will become pregnant if they take the pill correctly most of the time
- More than 80% of sexually active women will become pregnant within a year if they use no contraception
Who shouldn’t take the pill?
The pill should not be taken if any of the following apply to you:
- Increased risk of clotting:
- obesity with body mass index (BMI) more than 35
- if your parent, brother, sister or child had a blood clot before the age of 45
- any history of blood clots in your legs (also known as DVT/deep vein thrombosis), in your lungs (pulmonary embolism) or in your eyes
- significantly reduced mobility for any reason such as wheelchair use, illness, or recent major surgery
- any condition (or a family history of any condition), which may put you at an increased risk of blood clots , e.g antiphospholipid syndrome, factor V Leiden, prothrombin mutation, protein S, protein C and antithrombin
deficiencies.
- Increased risk of heart disease or stroke:
- a history of <migraine with aura>, even if only one previous episode
- if you have a parent, brother, sister or child who has had a stroke, heart attack or arterial disease before the age of 45
- if you have more than one risk factor for heart disease (such as smoking, being overweight, diabetes, high blood pressure or a family history of heart disease)
- high blood pressure (hypertension)
- if you have ever had a heart attack, heart disease, stroke, mini-stroke/TIA, atrial fibrillation (A.F) disease of the heart valves or blood vessels
- diabetes which has affected your blood vessels, kidneys, eyes or nerves
- undiagnosed headaches or new onset of migraine since starting the pill
- Increased risk of breast cancer:
- breast cancer- now OR in the past
- an undiagnosed breast lump
- a strong family history of breast cancer
- if you are a carrier of a breast cancer gene such as the BRCA1 or BRCA2 mutations
- Other:
- allergy to any of the ingredients contained in the pill (check the leaflet in your pack)
- history of weight loss (bariatric) surgery
- unexplained/irregular vaginal bleeding
- breast-feeding, pregnancy, or if you suspect you may be pregnant
- cancer of the uterus (womb), cervix or vagina
- liver disease, e.g. cirrhosis, hepatitis, jaundice, liver tumours
- current gallbladder disease
- organ transplant complicated by rejection
- inflammation of the pancreas (pancreatitis)
Some other conditions MAY mean the pill is not suitable for you-if you have any of the following, you should consult a doctor prior to taking the pill:
- diabetes
- high cholesterol or triglycerides
- obesity with BMI between 30 and 35
- history of organ transplant NOT complicated by rejection
- history of high blood pressure in a previous pregnancy
- if you have a parent, brother, sister or child who had a blood clot after the age of 45
- migraine
- epilepsy
- rheumatic disease such as rheumatoid arthritis or lupus (SLE)
- kidney disease
- sickle cell disease
- history of organ transplant (not complicated by rejection)
- conditions causing malabsorption (i.e. the gut does not absorb food & medicines properly), such as coeliac disease or ulcerative colitis
Clotting risk and the pill
- Women who take the pill have a higher risk of developing a blood clot
- Smokers’ risk of clots is elevated still further
- In the rare event of a clot, a blood vessel can be blocked, leading to stroke, heart attack , DVT or pulmonary embolism. These conditions may be fatal
- The risk of developing a blood clot when taking the pill is still lower than the risk of developing a clot when pregnant
- Pills containing the following ingredients have a higher clotting risk : desogestrel, drosperinone, gestodene, and norgestimate. If possible, it is safer to take a pill containing lower risk ingredients such as levonorgestrel, norgestrel or norethisterone
- Long haul flights also increase the risk of clotting and women who take the pill should watch for symptoms of a clot in the days and weeks after a flight
- Symptoms of a clot include the following:
- A painful/swollen leg
- Chest pains worse on taking a deep breath, unexplained shortness of breath, coughing up blood
- Numbness or weakness of an arm or leg, or sudden problems with speech or eyesight
The Pill and Cancer
- Taking the pill increases the risk of some types of cancer but may protect against others
- The overall risk of cancer is lower if you take the pill
- Breast cancer occurs more often in women who take the pill. All women are advised to check their breasts regularly, and consult a doctor if they notice changes
- There may be a link between the pill and a slightly increased risk of certain cancers including cervical. It is therefore important to have regular pap smears
- The pill may reduce risk of cancer of the ovary, uterus and bowel
What are the possible risks and side effects of taking the pill?
- The pill can cause side-effects, but serious side effects are very uncommon
- For most women the benefits of taking the pill outweigh the risks
- It may cause a rise in blood pressure. You should have your blood pressure checked at least annually
- Weight-gain is not a proven side-effect of the pill
- There is no convincing evidence that the pill causes mood changes
- Common temporary side effects include breast tenderness, nausea, acne, skin pigmentation changes and headaches
- If side-effects don’t settle within 2 to 3 months you should consider trying an alternative contraceptive
Changes in bleeding pattern while taking the pill
- If I don’t have a period as expected what should I do?
- If you do not bleed as expected while you are taking your sugar pills, but have been taking your pill correctly, it is unlikely that you are pregnant- it is quite common for there to be no bleeding between pill packs. However, if in any doubt, you should do a pregnancy test.
- What does it mean if I have unexpected bleeding while taking the active pills?
- In the first few months after starting the pill, you may experience some vaginal bleeding whilst taking the active pills- this may vary from spotting to a light flow. Do not stop taking your pill. Whilst this usually settles after 2 or 3 months, we advise you to consult a doctor if it occurs, because it may be a sign of pregnancy, infection or other gynaecological problems
- If you feel unwell or if you have abdominal or pelvic pain, you should see a doctor immediately.
Breastfeeding and the pill
- If you are breast-feeding, the pill is not recommended because it can reduce the flow of milk.
- There are other more suitable contraceptive options available on our website such as the <progesterone only pill / POP/ mini pill>
Can other medications affect my pill?
- If you take any other medication you need to be certain that it doesn’t interact with the pill. If you are in any doubt you should speak to a pharmacist
- There are a number of medications that interact with the pill. You can find a more complete list in the Consumer Medicines Information Leaflet. Below is a list of the most common ones:
- Epilepsy medications
- HIV medications
- St John’s Wort
