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Choosing the best contraceptive pill for you

Maddie Braidwood - The Lowdown

by Maddie Braidwood · Oct 27, 2020

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Reviewed by Dr Becky Mawson on Oct 18, 2021

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A step by step guide to finding the contraceptive pill that could best work for you. Get the lowdown on symptoms and side effects including mood, skin, sex drive and headaches.

Whether you are a first-time contraception user, feeling fed up with spotty skin, or you just don’t want the cramps every month – it’s always good to have an idea of what contraception may work best for you. Some hormonal contraception options will help these symptoms, but in some cases they may be related to side effects such as mood swings, acne and weight gain.

If you want to weigh up your options and find the best one for you, then look no further. We have written a guide which compares different benefits and side effects of the two types of contraceptive pills, the combined pill and the progestogen-only pill (aka mini-pill):

The main difference between the two are that the combined pill contains two hormones, oestrogen and progestogen, whereas the progestogen-only pill just contains progestogen.

What is the best contraceptive pill for preventing pregnancy?

When we look at how effective a contraceptive pill is we look at typical and perfect use. At the Lowdown, we have come up with an easy guide about different contraceptives to help you to find the most effective option. The effectiveness of both types of contraceptive pills is similar. If we look at 100 sexually active women taking the pill for a year, with perfect use less than 1 will get pregnant but if we look at typical use 7 women will get pregnant during that year. 

It is important to think about how good you will be at remembering to take a pill every day when you are choosing which contraceptive method is best for you. There are now apps available to help you remember to take your pill. We recommend taking your pill when you do something routinely every day like brushing your teeth to help build the habit.

Best contraceptive pill for acne?

Acne is a common problem in many teenagers. During puberty changes in your hormones can result in oily skin and acne. However, acne doesn’t just occur during puberty and can be common in your 20s and 30s. The Lowdown has put together a detailed guide about acne and contraception.

The combined contraceptive pill can improve acne for many women as it helps control some of the hormonal changes which can lead to an increased grease production in the skin. The best combined pills for acne are ones that help reduce androgen hormones, these include a progestogen called drospirenone which can be found in Yasmin, Lucette and Eloine.

One of the side effects of the progestogen-only pill is that it can cause or worsen acne but not all women will notice a change in their skin with this method.

Running low on pills?

Best contraceptive for mood swings?

At the Lowdown, we have put together a useful guide about how contraception can affect mood. For some women, their natural hormone cycle causes mood swings and can have an impact on their quality of life. For other women, they feel the hormones in contraceptives can lead to changes in their mood and mental wellbeing.

Some women suffer from mood swings and emotional changes linked to the menstrual cycle, sometimes known as premenstrual syndrome. In extreme cases, women may suffer from a condition called premenstrual dysphoric disorder (PMDD) where they have symptoms of mood swings, depression, anxiety and anger outbursts.  In both these situations, the combined pill can help reduce the symptoms especially when used continuously so women do not have as many hormonal fluctuations. We’ve also written a guide to PMS and PMDD for you!

What pill is best if I am overweight?

Being overweight does not necessarily mean you are not healthy. Unfortunately, in the world of contraception there are strict guidelines about using certain pills when you have a BMI over a certain level. For those women with a BMI 35 and over, it is advised that progestogen-only pills are safer for you to use than combined pills.

If you are overweight then using the combined contraceptive pill can cause an increased risk of strokes, blood clots and heart attacks and therefore other progestogen only or non-hormonal contraceptive options will be considered safer for you. 

The progestogen-only pill options are: Aizea, Cerazette, Cerelle, Desogestrel, Desomono, Desorex, Micronor, Nacrez, Norgeston, Noriday and Zeelleta.

What pill is best for heavy periods?

Both the progestogen-only pill and combined pill can help with heavy periods. The progestogen-only pill can take up to three months to have benefit and may cause irregular bleeding or spotting during this time.  

At the time of writing, 47% of Lowdown users said the progestogen-only pill stopped their periods and 49% of combined pill users found it made them lighter. So dependent on whether you want your periods to stop altogether or just be made lighter you can choose which suits you best. Remember that you can use the combined pill continuously which means periods will also be stopped.

What pill is the best for period pain?

Period pains can have a significant effect on a woman’s life and lead her to miss work or school. In some cases there might be reasons for the period related pain like endometriosis or adenomyosis. The combined pill can help to reduce pain associated with periods especially when it is used continuously or with less breaks for bleeding. 

Which contraceptive pill is best for migraines?

If you suffer from migraines with aura, you should avoid the combined pill. Instead, it would be best to consider a progestogen only or non-hormonal contraceptive method. Aura is a term used to describe any sort of neurological disturbance, which can appear before the headache or other symptoms of a migraine. A visual aura is a visual change like flashing lights or blurring of vision which happens with or before the migraine. Taking the combined pill increases your risk of having a stroke if you suffer from migraines with aura. Women who have migraines but no aura can still use the combined pill with caution if other options are not appropriate. For more information The Lowdown team have put together a guide about headaches, migraines and contraception.

What pill can I take at my age?

If you’re under 50, do not have any health conditions, and do not have other risk factors such as smoking, diabetes or being overweight, you can safely take both contraceptive pills. However, if you are over 50 the risks associated with the combined pill tend to outweigh the benefits and you will be advised to switch to an alternative like the progestogen-only pill. 

What pill can I take if I’ve just given birth?

You can get pregnant as early as 3 weeks after the birth of your baby, even if you are breastfeeding and have not restarted your periods. Experts recommend a 12 month gap between having a baby and conceiving again, this helps reduce complications such as future premature delivery or low birth weight.

Women can safely use the progestogen-only pill straight away after delivery and should ideally be started less than 3 weeks after birth before you can become pregnant again. If the combined pill is your contraception of choice then it can safely be started from 6 weeks after delivery. 

What pill can I take if I’m breastfeeding?

If you’re breastfeeding, you can take the progestogen-only pill straight away and can use the combined pill from when your baby is 6 weeks old. 

What contraceptive pills will affect my sex drive?

Sex drive is a difficult thing to measure and therefore some of our advice is trial and error to find the right contraceptive for you. Some pills might lower your sex drive while others can improve it, this can vary from person to person and does not depend on the pill. Progestogen only methods seem to have more impact on sex drive but it is an area which needs better understanding. 

At the time of writing, the reduction in sex drive seems to be highest among users of progestogen-only hormonal contraception – with 50% of progestogen pill users, 48% of implant and 47% of injection reviewers reporting a loss of sex drive.

Contraceptive pill risks and side effects

Every contraceptive pill may have side effects that will vary from person to person. Some side-effects take a couple of weeks to subside, and most resolve by 3 months as your body adapts to the pill. 

If you are a first-time pill user, the best combined pill options are Microgynon, Rigevidon, Ovranette and Levest as they have a lower risk of blood clots, and are usually what the doctor will prescribe first time.

Side effects from the combined pill reported by our users include:

  • Tender breasts (50.51%)
  • Vaginal discharge (44.2%)
  • Enlarged breasts (43.6%)
  • Period like cramping (37.83%)
  • Vaginal dryness (36.03%)
  • Back pain (29.97%)
  • Increased sweating (26.66%)
  • Nausea or vomiting (25.54%)
  • Thrush (18.49%)
  • Cystitis (12.74%)
  • High blood pressure (12.11%)
  • Increased body hair (11.77%)
  • Darker body hair (6.54%)
  • Headaches (6.34%)
  • Issues wearing contact lenses (5.4%)
  • Pelvic infection (5.37%)
  • Latex allergy (3.66%)
  • Migraines (3.54%)
  • Dizziness (2.14%)
  • Migraines with aura symptoms (0.77%)
  • Hair loss (0.37%)

Side effects from the progestogen-only pill reported by our users include:

  • Period like cramping (35.58%)
  • Tender breasts (33.75%)
  • Vaginal discharge (32%)
  • Increased sweating (29.17%)
  • Back pain (24.75%)
  • Enlarged breasts (24.42%)
  • Increased body hair (22.17%)
  • Vaginal dryness (21.33%)
  • Thrush (17.5%)
  • Darker body hair (17.25%)
  • Nausea or vomiting (16.08%)
  • Migraines (9.58%)
  • Cystitis (9.25%)
  • Hair loss (8.33%)
  • High blood pressure (7.17%)
  • Issues wearing contact lenses (5.08%)
  • Pelvic infection (4.75%)
  • Latex allergy (4.42%)
  • Headaches (3%)
  • Dizziness (1.33%)
  • Migraines with aura symptoms (0.58%)

It is clear that there is no perfect pill and it very much differs from person to person. If you have decided on a pill, check out our contraception pages. It may also be worth checking out our contraception recommender to see what method might suit you the best!

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Tags
  1. FSRH Clinical Guideline: Combined Hormonal Contraception (January 2019, Amended November 2020)

  2. FSRH Clinical Guideline: Progestogen-only Pills (March 2015, Amended April 2019)

  3. FSRH Clinical Guideline: Contraception After Pregnancy (January 2017, amended October 2020)

  4. FSRH Clinical Guideline: Contraception for Women Aged over 40 Years (August 2017, amended September 2019)

  5. Macgregor EA. Migraine and use of combined hormonal contraceptives: a clinical review. 2007

  6. NHS UK, Endometriosis

  7. NHS UK. PMS and PMDD

  8. Primary Care Dermatology Society. Acne. accessed October 2021.

Maddie is an English Language and Linguistics graduate who is passionate about writing. She writes fun and informative content on the weird and wonderful sides of contraception!