Combined pills: who they suit and who they do not

The combined pill has been used by hundreds of millions of people and is one of the best understood medicines there is. For the right person it is reliable, reversible, and brings benefits well beyond contraception.

For a smaller group it is not the safe choice, and knowing which group you are in is the whole point of the safety screen. This article covers both.

How it works

The combined pill contains an oestrogen and a progestogen. Together they mainly stop your ovaries releasing an egg, and they also thicken cervical mucus and thin the lining of the womb. Taken correctly it is more than 99 percent effective. With typical real-world use, where pills are sometimes missed, effectiveness is around 91 percent, which is why a steady routine matters.

It is fully reversible. When you stop, your own cycle and fertility return, usually within a few weeks to a couple of months, so it does not affect your ability to conceive later on.

The benefits beyond contraception

Lighter, more predictable periods: the combined pill often reduces heavy menstrual bleeding and makes cycles regular. You can also run packets together to have fewer or no bleeds.

Less period pain: many people find cramps improve.

Premenstrual symptoms: some formulations help with the mood and physical symptoms before a period.

Skin: certain combined pills improve acne.

Long-term: combined pill use is linked with a reduced lifetime risk of ovarian and womb cancer.

Who the combined pill suits

If you are generally healthy, do not smoke or are under 35, have normal blood pressure, no history of blood clots or migraine with aura, and you would like a regular bleed or one of the benefits above, the combined pill is very likely a good fit.

Who should choose differently

The combined pill is not suitable for everyone, and the reasons come down to oestrogen and the risk of blood clots and stroke. It is avoided if you get migraine with aura at any age, if you are 35 or older and smoke, if you have had a DVT or pulmonary embolism, if you have an inherited clotting condition, if you have uncontrolled high blood pressure, if you have had certain heart conditions or a stroke, or in the first weeks after childbirth.

Some other things, such as a higher body mass index, well-controlled high blood pressure, or a family history of clots, do not rule it out but do shift the balance, and are weighed up individually rather than treated as a flat yes or no.

Does it affect future fertility?

The combined pill does not reduce your long-term fertility. When you stop, ovulation and your natural cycle return, usually within weeks, and for most people there is no lasting effect on the ability to conceive. If your periods were irregular before you started the pill, they may be irregular again afterwards, because the pill was masking rather than fixing the underlying pattern. That is useful to know, but it is not a reason to avoid the pill.

What the assessment checks

Before prescribing a combined pill we check your blood pressure, which is not optional and is the single most important measurement, along with your smoking status, your migraine history in detail, your weight, and your personal and family history of clots. New combined pill users are usually reviewed at three months, mainly to recheck blood pressure and see how you are getting on.

Side effects and what is normal

In the first three months, breakthrough bleeding, breast tenderness, nausea, or mood changes are common and usually settle. If they do not, switching to a different combined pill, or to a progestogen-only pill, often resolves it. Any new severe headache, leg swelling or pain, chest pain, or breathlessness should be acted on straight away, because these can be signs of a clot.

Not the right pill for you if...

If any of the oestrogen-related cautions apply to you, the progestogen-only pill is usually the safer route and works just as well at preventing pregnancy. If you would rather not think about a daily pill at all, a long-acting method, fitted free on the NHS and at most GP surgeries, may suit you better.

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Begin your assessment at this link. Online or in person at Westfield London.