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The Contraceptive Pill

The Contraceptive Pill

There are many types of contraception (birth control). The Contraceptive Guide on this page can help you find out more about these different options.

The COCP
The Mini Pill
Contraception Guide

Welcome to Qoctor’s online doctor service which provides assessment for contraception. First, you’ll need to answer some simple health questions and have a chat with a doctor. The consultation fee is $24.99.

If treatment is appropriate, you can have your prescription sent as an eScript to your phone OR electronically to your local pharmacy. Alternatively you can have medication delivered by an Australian partner pharmacy- in this case, the cost of medication is added at the checkout. All treatment and advice is issued subject to your doctor’s assessment.

Unsure which option is best for you? Consult with one of our practitioners via our general GP appointments HERE

The COCP (“the pill”)

  • The combined oral contraceptive pill prevents pregnancy by stopping ovulation.
  • It is taken daily for 21 days in a row, then 7 inactive or “sugar pills” are taken, during which a woman will have a withdrawal bleed like a period.
  • Some women may skip the sugar pills and take the active pills back-to-back for several months at a time to avoid having periods.
REQUEST THE COCP (“the pill”)

The Mini Pill

  • The progesterone only pill, sometimes called the “mini pill”, works by thickening the mucus in the cervix, preventing sperm from getting through to fertilise the egg.  In some women, it prevents ovulation.
  • It must be taken every day during the same 3 hour timeframe.
  • There are no inactive or sugar pills, so unlike the combined oral contraceptive pill, there are no breaks.
  • It may be a suitable option in women for whom the combined pill is contraindicated.
REQUEST THE MINI PILL
REQUEST THE COCP
REQUEST THE MINI PILL

Just like when you see a doctor in clinic, request which of these pills you usually take, or wish to commence. Then the doctor will assess whether it’s suitable and safe for you.

SELECT THE COCP

PROCEED

SELECT THE MINI PILL

PROCEED

Qoctor Contraception Guide – what are the different types of contraception?

Combined Oral Contraceptive Pill

( COCP or “the pill”)

91% effective

The combined oral contraceptive pill prevents pregnancy by stopping ovulation. It is taken daily for 21 days in a row, then 7 inactive or “sugar pills” are taken, during which a woman will have a withdrawal bleed like a period.  Some women may skip the sugar pills and take the active pills back-to-back for several months at a time to avoid having periods.

Pros

  • It’s cheap and generally very safe
  • If taken correctly it’s very effective
  • Most women get no side effects
  • Can be started and stopped as desired, no need for removal of implants or devices
  • May help regulate periods, and allow women to plan around their periods
  • Packs can be taken back-to-back without sugar pills, to skip a period
  • It may help premenstrual tension
  • It may improve acne
  • It may help symptoms of PCOS
  • It may reduce period pain and help women who have endometriosis
    It may reduce the risk of ovarian cancer and uterine cancer
  • If you decide you wish to become pregnant, there is little or no delay to return to fertility when you stop taking the pill

Cons

  • It involves remembering to take a pill every day
  • It does not protect against sexually transmitted infections
  • Some women get side effects (see detailed information leaflet below)
    If you smoke and are over 35, if you have migraine with aura, or any contraindications to the combined oral contraceptive pill, it may not be suitable for you (see detailed information leaflet below).
  • It requires a new prescription every 6-12 months and an annual blood pressure check
  • It cannot be used if breastfeeding as it can cause reduced milk supply
  • Vomiting, diarrhoea and certain medications can reduce the effectiveness of the pill, and other precautions will be needed to avoid pregnancy
  • It slightly increases the risk of a blood clot in the leg or lung, which can be serious or life-threatening

Progesterone Only Pill

(the POP or “mini pill”)

91% effective

The progesterone online pill must be taken every day during the same 3 hour period. There are no inactive or sugar pills. It works by thickening the mucus in the cervix, preventing sperm from getting through to fertilise the egg. In some women, it prevents ovulation.

Pros

  • It’s cheap and generally very safe
  • If used correctly it is more than 99% effective
  • Most women get no side effects
  • It can be started and stopped as desired, no need for removal of implants or devices
  • It can be used when breastfeeding
  • If you have certain contraindications to the COCP (such as high blood pressure, obesity or migraine with aura) the POP is often still safe to use
  • If you decide you wish to become pregnant, there is little or no delay to return to fertility when you stop taking the progesterone only pill

Cons

  • It must be taken within the same 3 hour period of time each day, or contraceptive cover may be lost
  • It does not necessarily regulate a woman’s periods as well as the COCP
  • It does not protect against sexually transmitted infections
  • Some women get side effects such as irregular bleeding (see detailed patient information leaflet below)
  • It requires a new prescription every 6 to 12 months

Contraceptive vaginal ring

(Nuvaring ®) 

91% effective

This is a small flexible plastic ring which a woman can easily insert into her vagina. It stays in place for 3 weeks, and is removed for one week during which a period will occur. A new ring is inserted after that. It contains the same hormones as the combined oral contraceptive pill, but they are released into the vagina instead of the gut.

Pros

  • It does not interfere with sex
  • Periods may become lighter and less painful
  • It still works if you have vomiting or diarrhoea, whereas the contraceptive pill may not
  • You don’t have to remember a daily dose
  • Normal fertility returns when you stop taking it
  • If you decide you wish to become pregnant, there is little or no delay to return to fertility when you stop using the Nuvaring

Cons

  • If you smoke and are over 35, if you have migraine with aura, or any contraindications to the combined oral contraceptive pill, it may not be suitable for you (see detailed information leaflet below).
  • Some women get side effects (see detailed information leaflet below)
  • It requires a new prescription every 6-12 months and annual blood pressure check
  • It cannot be used if breastfeeding as it can cause reduced milk supply
  • It may occasionally fall out during sex, or while passing a bowel motion
  • It does not prevent sexually transmitted infections

Contraceptive Diaphragm

88% effective

Diaphragms are soft flexible domes made of silicone or latex, which act as a barrier, preventing the sperm getting to the egg. They are fitted inside the vagina and cover the cervix.

Pros

  • You just use it when you have sex, you don’t need to remember a regular dose of medication
  • There are no significant side effects or health risks involved
  • If you decide you wish to become pregnant, there is no delay to return to fertilit

Cons

  • To be effective, it needs to be used with “spermicide” – this is a gel or foam that kills sperm. Some people may find this a bit messy and inconvenient.
  • A diaphragm needs to be fitted by a nurse or doctor, who will advise correct use and placement.
  • It does not prevent sexually transmitted infections

Condoms

82% effective

Popular and widely available, condoms act as a barrier to sperm entering the vagina.

Pros

  • They protect against sexually transmitted diseases, not just pregnancy.
  • They are non-hormonal and do not cause side effects (though some people may be sensitive to them)
  • They are cheap and readily available
  • If you decide you wish to become pregnant, there is no delay to return to fertility

Cons

  • Sex must be interrupted to put on a condom
  • They can break, split or be damaged by cosmetics or oil-based products- so any lubricants used should be water based
  • They don’t allow for “planning ahead” to the same degree as a pill or longer acting contraceptive option

Mirena® Coil (IUS)

99.8% effective

The Mirena Coil or Intra-uterine System (IUS) is a small T-shaped plastic device that is fitted inside the uterus and slowly releases a progesterone hormone. It causes thickening of the mucus in the cervix, so sperm cannot get through. It also prevents a pregnancy attaching to the wall of the uterus. A doctor or nurse must fit it, in a procedure similar to having a pap smear.

Pros

  • Once it’s inserted, there is no need to remember to take any doses of contraceptives- it’s taken care of
  • For many women, it makes periods very light or stop altogether
  • It lasts for 5 years, though you can have it removed sooner if you need to
  • If you decide you wish to become pregnant, there is little or no delay to return to fertility when you have the Mirena coil removed
  • It does not interfere with sex
  • It is not affected by any other medications

Cons

  • There can be irregular vaginal bleeding in the first few months after getting it inserted
  • The risk of pregnancy is very low indeed (in fact it’s one of the most effective methods of contraception), but in the rare case that pregnancy does occur, it more likely it will be an ectopic pregnancy, i.e outside the uterus- which can be a serious condition.
  • It does not prevent sexually transmitted infections
Click here if you need a referral to a gynaecologist to discuss having a Mirena Coil inserted

The Copper Coil or IUD

99.2% effective

This is a small T-shaped coil made of plastic and copper. A doctor or nurse must fit it, in a procedure similar to a pap smear. The copper kills sperm.

Pros

  • Once it’s inserted, there is no need to remember to take any doses of contraceptives- it’s taken care of
  • It does not interfere with sex
  • It is not affected by any other medications
  • It contains no hormones so side effects are minimal, and there are few contraindications
  • It can be left in for up to 10 years, though you can have it removed sooner if you need to, and normal fertility should return quickly if you decide you wish to become pregnant.

Cons

  • Unfortunately, unlike the Mirena/IUS, the copper coil may lead to heavier or more painful periods, though this often settles over time
  • The risk of pregnancy is very low indeed (in fact it’s one of the most effective methods of contraception), but in the rare case that pregnancy does occur, it more likely it will be an ectopic pregnancy, i.e outside the uterus- which can be a serious condition.
  • It does not prevent sexually transmitted infections

Long-acting contraceptive injection / depo injection

94% effective

This is an injectable progesterone hormone which lasts for 12 weeks.

Pros

  • Once it’s injected, there is no need to remember to take any doses of contraceptives- it’s taken care of until your next dose is due
  • It does not interfere with sex
  • It is not affected by any other medications
  • It may make periods lighter or stop altogether
  • It may reduce premenstrual tension

Cons

  • Some women get unpredictable vaginal bleeding
  • Return to fertility after stopping it can be slow- up to a year in some women- so it’s not a great option if you are planning a pregnancy in the near future.
  • Some women report weight gain
  • It does not prevent sexually transmitted infections

Qoctor does not offer prescriptions for the long-acting contraceptive injection- if you’d like to discuss this option, we suggest you speak to your GP or family planning clinic

Implanon ® (subdermal implant/rod/bar)

99.95% effective

The implant is about the size and shape of a matchstick. It is inserted under the skin of the upper arm. The doctor will give local anaesthetic injection to numb the area first. It contains the hormone progestogen, which stops the ovary from releasing an egg and thickens the cervical mucus so sperm cannot get through.

Pros

  • Once it’s inserted, there is no need to remember to take any doses of contraceptives- it’s taken care of
  • It does not interfere with sex
  • It may make periods lighter or stop altogether
  • It may reduce premenstrual tension
  • It lasts for 3 years, though you can have it removed sooner if you need to, and normal fertility quickly comes back
  • It is highly effective at preventing pregnancy
  • If you decide you wish to become pregnant, there is little or no delay to return to fertility when you have the Implanon removed

Cons

  • Insertion can be a bit painful, and there will be a small scar, and removal will also involve a minor procedure.
  • Periods may be irregular, heavier, lighter or prolonged- though often this settles with time. Some women may end up with no periods.
  • It does not prevent sexually transmitted infections

Qoctor does not offer prescriptions for the subdermal contraceptive implant/ Implanon- if you’d like to discuss this option, we suggest you speak to your GP or family planning clinic

Tubal Ligation

Tubal occlusion by metal microinsert is 99.8% effective

Tubal ligation is 99.5% effective

This is an operation performed via keyhole surgery by a gynaecologist. The fallopian tubes are clipped or blocked, to prevent the egg getting into the uterus. It is very effective. It involves an operation under a general anaesthetic. It should be viewed as a permanent and irreversible loss of fertility, so you need to be sure you don’t want any more children.

Click here if you need a referral to a gynaecologist to discuss a tubal ligation

Vasectomy- this option is for the male partner

This is a minor operation carried out under local anaesthetic which involves cutting the tubes that transfer sperm to the penis. It is very effective and should be viewed as a permanent and irreversible loss of fertility. So, a man needs to be absolutely sure he does not want any more children.

Qoctor offers referrals for men to have a vasectomy- find out more
REQUEST THE COCP
REQUEST THE MINI PILL

FAQs About the COCP

How reliable is the pill as a form of birth control?

The contraceptive pill is a reliable form of birth control if it’s used correctly. However, with typical use, women tend to miss pills from time to time, which reduces the overall reliability.

  • 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 do not use the contraceptive pill or any other method of birth control.
Who shouldn’t choose the pill as their form of birth control?

The pill should not be taken in the following circumstances ( there’s quite a lot of information here, but it’s important!)

Increased clotting risk:

  • obesity with body mass index (BMI) more than 35
  • a history of blood clots in your legs (also known as DVT/deep vein thrombosis), in your lungs (pulmonary embolism) or in your eyes.
  • if a first degree relative (parent, brother or sister) had a blood clot before the age of 45.
  • any condition (or a family history of any condition), which may put you at an increased risk of blood clots, for example Factor V Leiden.
  • A significant reduction in your mobility for any reason, for example illness, or recent major surgery wheelchair use.

Increased risk of heart disease or stroke:

  • if you have a first degree relative (parent, brother or sister) 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)
  • a history of migraine with aura, even if only one previous episode
  • 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
  • unexplained headaches or new onset of migraine since starting the pill

    Increased risk of breast cancer:

  • breast cancer- now OR in the past
  • a breast lump that has not yet been assessed by a doctor
  • a strong family history of breast cancer
  • if you are a carrier of a breast cancer gene such as BRCA1 or BRCA2.

  Other reasons to avoid the pill:

  • 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 a suitable form of birth control 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.

If you take the contraceptive pill and any of the issues above concern you, it’s advisable to speak to your doctor.

Does the pill cause blood clots?

The contraceptive pill increases your risk of getting a blood clot, as compared to a woman who is not on the pill.

  • We know that women who use the pill for birth control have a higher risk of developing blood clots
  • Some forms of the contraceptive pill cause a higher risk of clots than others-depending on the type of progesterone.
  • If your contraceptive pill contains the following types of progesterone, there is a higher clotting risk : desogestrel, drosperinone, gestodene, & norgestimate.
  • Therefore, if possible, it is safer to take a pill containing a lower risk progesterone: levonorgestrel, norgestrel or norethisterone.
  • If you smoke whilst taking the pill, your risk of a clot is elevated 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.
  • However, it’s important to remember that your risk of developing a blood clot when taking the pill is still lower than the risk of developing a clot when pregnant.
  • Long haul flights can also increase the risk of clotting- 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:
    • Pain or swelling in the leg
    • Sharp chest pain worse on taking a deep breath, unexplained shortness of breath, and/or coughing up blood
    • Numbness or weakness of an arm or leg, or sudden problems with speech or eyesight

If you use the contraceptive pill for birth control and are concerned about the risk of a blood clot, we advise that you speak to your doctor

Does the pill cause cancer?

  • Taking the pill increases the risk of some types of cancer but may protect against others
  • Your 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 see a doctor if they notice changes
  • Women who use the pill for birth control may also have a small increase in risk for cervical cancer. It is therefore important to have regular pap smears.
  • However, the pill may reduce your risk of cancer of the uterus, ovary, and bowel
What are some common side effects of taking the pill?

Most women who use the contraceptive pill for birth control do not get any side effects. Serious side effects from the contraceptive pill are very uncommon. However, from time to time, side effects can arise.

  • The contraceptive pill may cause high blood pressure. You should have your blood pressure checked at least once a year if you take the pill.
  • 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 a different form of birth control.

Weight-gain is not a proven side-effect of the contraceptive pill, and there is no convincing evidence that the pill causes mood changes.

Can I use the pill for birth control if I am breastfeeding?

 

  • If you are breastfeeding, the pill is not recommended as birth control because theoretically it might reduce the flow of milk.
  • There are other more suitable types of birth control available such as the mini pill.
Do antibiotics affect the contraceptive pill?

It used to be advised that antibiotics reduce the reliability of the contraceptive pill,in terms of birth control. However, we now know that most antibiotics have no effect on the pill- the exceptions are some uncommonly used antibiotics such as Rifampicin and Rifabutin. For most commonly used antibiotics, there is no impact on birth control, and added precautions are not needed.

Can I use the morning after pill if I’m also taking the contraceptive pill for birth control?

Yes. If you miss a pill and are worried your birth control has been interrupted, it’s possible to take the morning after pill. Speak to your pharmacist or doctor, and follow the instructions carefully.

There are two types of emergency contraceptive pill in Australia

  • Levonorgestrel (brands include Levonelle, Postinor, Postella, Postrelle and Norlevo ) is taken as a single dose within 72 hours of sex, and is available from a pharmacy without a prescription.
  • A newer option is Ulipristal Acetate (the brand name is EllaOne) can be used up to 5 days after sex, but requires a prescription from a doctor and is usually a little more expensive.

FAQs About the Mini Pill (POP)

What is the Mini Pill (POP) and how does it work?

  • The mini pill (progesterone only pill) works by thickening the mucus in the cervix, preventing sperm from getting through to fertilise the egg. In some women, it also prevents ovulation.
  • It must be taken every day during the same 3 hour period, otherwise pregnancy may occur.. There are no inactive or sugar pills, so unlike the combined oral contraceptive pill, there are no breaks- you  take a pill every day.
What are the potential side effects of the Mini Pill (POP)?

  • Most women get no side effects
  • Some women get side effects such as irregular bleeding, headaches, acne, breast tenderness or changes in mood.
How effective is the Mini Pill (POP)?

If used perfectly it is more than 99% effective, though with typical or “normal” use, it is about 91% effective

Can you take the POP when you’re breastfeeding?

Yes, it can be used when breastfeeding, as it does not affect the flow of milk (whereas the combined oral contraceptive pill may reduce breast milk supply)

Is the Mini Pill (POP) used to regulate the menstrual cycle?

The POP is not usually the first choice if a woman wants to regulate her menstrual cycle. This is because the POP has different effects in different women- some may get irregular bleeding, others may get no period at all. So, whilst it may work out well for some users, it is not predictable (unlike the combined oral contraceptive pill or COCP, which tends to give a regular bleeding pattern).

Does the Mini Pill (POP) increase cancer risk?

Whilst there is evidence that the combined oral contraceptive pill (COCP) appears to cause a slight increase in breast cancer during use and for 5-10 years after stopping, the POP has not been connected to any increase in breast cancer.

Does the Mini Pill (POP) cause increased risk of blood clots?

Whilst the combined oral contraceptive pill (COCP) is known to increase a woman’s risk of developing a clot, the risk of having a clot when using the POP is much lower. 

Is there a delay returning to fertility when you stop taking the Mini Pill (POP)?

No, if you wish to become pregnant, there is little or no delay to return to fertility when you stop taking the progesterone only pill.

If you’d like to find out more about the contraceptive pill and other types of birth control, there is further reliable information at Family Planning Victoria , Family Planning New South Wales and Better Health Channel.

REQUEST THE COCP
REQUEST THE MINI PILL

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