Patient guide to the combined pill

About the combined pill

The combined pill is a form of contraception containing the female sex hormones oestrogen and progestogen.

The combined pill mainly works by preventing ovulation. This means that an egg is not normally released from the ovary. It also thickens the mucus in the cervix, making it harder for sperm to enter the womb. At the same time, the lining of the womb is affected so that an egg cannot attach to it.

When taken correctly, the combined pill protects very effectively against pregnancy. It does not protect against sexually transmitted infections. Use a condom if there is a risk of sexually transmitted infections, for example with a new partner.

The combined pill is a hormonal form of contraception taken daily to protect against pregnancy.

How to take the combined pill

Take the first combined pill on the first day of your period. It is important to be certain that you are not pregnant when you start the combined pill. You must therefore use another form of contraception, for example a condom, until you can take the first pill.

Take one combined pill every day, preferably at roughly the same time. It can help to link taking the pill to a regular routine, such as brushing your teeth or going to bed.

There are different types of pack. With one type, you take pills for 21 days and then have a 7-day break, during which you will normally have a bleed. Other packs have 28 pills, with the last 7 containing no hormones. Read the patient information leaflet for your particular pill.

It is possible to take the combined pill without breaks or with fewer breaks, meaning that you skip one or more breaks and delay bleeding. This may be useful, for example, if you have a lot of period pain or want to avoid bleeding during a holiday. The disadvantage may be spotting or sudden, unexpected bleeding.

If you miss a pill by more than 12 hours, so that more than 36 hours have passed since your last pill, vomit shortly after taking the pill or have severe diarrhoea, protection against pregnancy may be reduced. Read the patient information leaflet to find out what to do, or contact the clinic for advice about your situation. You may need to use condoms for a time.

If you need to remain completely immobile for a long time, for example because of major surgery, you must stop taking the combined pill and use a non-hormonal contraceptive method for at least 4 weeks beforehand and until 2 weeks after you are mobile again.

Side effects

Mild side effects are common at first. Most become less troublesome or disappear completely after the first 2-3 months.

Common side effects include:

• Spotting or irregular bleeding
• Breast tenderness
• Nausea
• Headache
• Mood swings, in rare cases depression
• Changes in sex drive
• Stomach discomfort
• Worsening of spots, although many people notice an improvement

Serious side effects are very rare, but the combined pill can increase the risk of blood clots. Contact a doctor urgently if you develop sudden pain or swelling in a leg, sudden shortness of breath, chest pain, coughing up blood, a sudden severe headache, visual disturbances, paralysis, changes in sensation or difficulty speaking.

Checks at the clinic

After starting the combined pill, you must come for a check at the clinic after 3 months and then once a year. Your blood pressure is measured, among other checks. If everything is fine, your prescription for the combined pill is renewed for one year at a time.

Also contact the clinic if side effects are very troublesome, if you are unsure how to take the pills, or if you want to change your form of contraception and do not feel this can wait until your next check.

Clinically updated 24 June 2026