TOPIC

When to seek a medical review of your pill or patch

by Dr Melanie Davis-Hall · Dec 9, 2021

Reviewed Icon

Reviewed by Dr Becky Mawson on Dec 13, 2021

Stethoscope
The Lowdown now offers a choice of 3 months, 6 months, or 12 months supply of the pill, which you can choose depending on your circumstances… whether you’re trying out a new method or brand for the first time or have been best friends with microgynon for years

TLDR… what’s the lowdown?

  • Prescriptions for the combined pill, patch or ring can be given for up to 12 months as a time
  • At The Lowdown you can order a supply of up to 3 months, 6 months or 12 months depending on your circumstances 
  • You should have at least an annual review of your combined pill, patch or progestogen-only pill with your contraception provider
  • There are a number of reasons why you should seek out a medical review before then to check your chosen method remains a safe and suitable option for you

 

We at The Lowdown are delighted to be able to offer online ordering for your combined pill, patch or progestogen only pill. We’ve been listening to your feedback and have worked with our pharmacy to extend the length of your pill prescriptions so you never have to run out again! 

We now offer a choice of 3 months, 6 months, or 12 months supply which you can choose depending on your circumstances… whether you’re trying out a new method or brand for the first time or have been best friends with microgynon for years. Studies have shown provision of more pills packs was associated with fewer pregnancy tests, fewer pregnancies, and lower costs for users – no surprises there!

So now renewing your contraception is so much easier – no doctor’s visits or nurse appointments, and potentially may only be needed once a year – when should you seek out a medical review to check your contraception is still safe and suitable for you to use?

Combined pill and patch

The combined pill is a very commonly used method of contraception and the most frequently reviewed method at The Lowdown. It contains two hormones – oestrogen and progestogen, and can help with acne and heavy or painful periods. The patch contains the same hormones but is a thin beige plastic plaster, which is stuck to the skin and changed weekly. It’s a great option if you want the benefits of the combined pill, but don’t want to take a pill every day.

Guidance in the UK tells us for these methods you should have a medical review at least once a year. If ordering your pill or patch through The Lowdown you’ll be asked to complete a form containing a series of questions, including about your blood pressure, height and weight, and medical and family history when you first order. When you reorder you will be asked to confirm these answers or tell us whether something has changed. 

However there are some circumstances where you should seek a medical review before then, including the following… 

If you develop:
  • Calf pain, swelling or redness
  • Chest pain, breathlessness or coughing up blood
  • Weakness or loss of sensation in the arms, legs or face, or changes to speech 

These could be symptoms of a blood clot in the legs or the lungs, also known as a deep vein thrombosis (DVT) or pulmonary embolism (PE), or a stroke. These are small but recognised risks of combined contraception and require urgent medical attention. 

If you develop:
  • A breast lump, breast skin changes, nipple discharge or new nipple inversion
  • New migraine
  • New symptoms in the hour before a migraine starts which may be a sign of a migraine aura 
  • Persistent unscheduled vaginal bleeding

These symptoms should prompt you to speak to your doctor. Your doctor will review and potentially investigate these symptoms depending on the situation. It may be that some of these symptoms mean you should stop or switch your contraception. 

If you develop any of the conditions listed below you should seek advice from your doctor or contraception provider. In most cases having one of these conditions will mean it is not safe for you to start or continue on combined contraception.
  • High blood pressure
  • High body mass index (>35 kg/m2)
  • Migraine or migraine with aura
  • Deep vein thrombosis or pulmonary embolism
  • Blood clotting abnormality
  • Antiphospholipid antibodies
  • Angina, heart attack, stroke or peripheral vascular disease
  • Atrial fibrillation
  • Cardiomyopathy
  • Breast cancer or breast cancer gene mutation
  • Liver tumour
  • Symptomatic gallstones
  • Current smoker (any number of cigarettes) or quit within the last year AND you are over the age of 35
Checking if any medications or medicines can affect your contraception
  • When you are prescribed a new medication or buy over the counter medicines, you should check whether the medicine could affect your contraception and its effectiveness. Check this with the prescriber of any new medication, with your contraceptive provider or your pharmacist. Read our blog about antibiotics and how some may interact with your contraception.
Other important things to make sure you have covered when reviewing your contraception:

 

A note about the patch…

If you are using the combined patch it is important to be aware that the patch may be less effective at protecting you against pregnancy if you weigh more than 90kg. This is regardless of your height or BMI. This does not mean you cannot use it, for example if it helps with heavy or painful periods, but extra precautions such as condoms or switching to an alternative is recommended to protect against pregnancy.

How long can you use the pill or patch for?

Lots of us have heard the myths like you can’t use the pill for longer than 10 years or you should have a break every few years. The Lowdown? You may use the combined pill or the patch for contraception until the age of 50 provided there are no contraindications. After age 50, the risks of use generally outweigh the contraceptive benefits and you should be advised to switch to an alternative method.

For those who can safely use combined contraception there is no arbitrary maximum length of time for which the pill or patch can be used. In fact, repeated starting and stopping is discouraged because the risk of a blood clot in the legs or lungs is highest in the months after you start, or when restarting after a break of more than a month. 

Advice on travel, high altitude and having surgery….

Due to the small increased risk of blood clots in the legs or lungs whilst using combined contraception you should look out for and reduce other risk factors for blood clots such as periods of immobility. You should reduce periods of time where you have reduced mobility such as on long haul flights by regularly moving around. 

If you are considering trekking to high altitudes (above 4500 m or 14500 feet) for longer than one week consider switching to an alternative contraceptive method. This is because the risk of blood clots may be higher at altitude.

Those who are immobile or have restricted mobility for an extended period of time (due to surgery or other reasons) are at increased risk for blood clots which may be further increased by use of combined contraception. You should therefore be advised to stop and switch to an alternative method of contraception at least 4 weeks prior to planned major surgery or a period of expected immobility. Talk to your doctor or surgeon if you are unsure. 

Progestogen-only pill

Guidance around review of the progestogen-only pill (POP) is less strict due to fewer health risks associated with progestogen-only contraception and prescriptions can be issued for up to 12 months at a time. 

If ordering your POP through The Lowdown you’ll be asked to complete a form containing a series of questions, including about your medical history when you first order. When you reorder you will be asked to confirm these answers or tell us whether something has changed. 

In general reviews and follow-up should be tailored to the individual and you should be able to seek advice from your doctor, nurse or contraceptive provider at any time if problems arise, including if you are experiencing unwanted side effects.

Key reasons to seek a medical review of your contraception include the following diagnoses:  

  • Angina or heart attack
  • Stroke
  • Breast cancer
  • Liver cirrhosis
  • Liver tumour

 

Bleeding on the POP

Bleeding patterns are very unpredictable in the first 3 months of progestogen-only pill use and breakthrough bleeding is common. Some lucky women may have no periods or infrequent periods, whereas others may bleed more frequently or have prolonged bleeding. This can settle the longer you use the mini pill. Although these symptoms may be annoying, they can be normal. If your bleeding pattern suddenly changes, or you get bleeding associated with other symptoms, consider doing a pregnancy test and STI test. If irregular bleeding continues or is problematic speak to your GP.

Some other points to make sure you’ve covered when reviewing your contraception are included in this handy checklist. If you don’t know – click on the links!

As always, if you are unhappy with your method of contraception or think you are experiencing unwanted side effects you can seek advice at any time from your contraception provider, doctor or nurse or from our medical team here at The Lowdown. This is also the case if you have any questions about your contraception. 

Tags
  1. Faculty of Sexual and Reproductive Health. Combined hormonal contraception. FSRH Guideline. January 2019. Amended November 2020
  2. Faculty of Sexual and Reproductive Health. Combined hormonal contraception. FSRH Guideline. January 2019. Amended November 2020

Dr Melanie Davis-Hall BMBS (Hons) BMedSci (Hons) DSFRH MRCGP is a GP from London experienced in women’s health. Mel qualified as a doctor from Nottingham University in 2014. She worked as a Clinical Fellow in Sexual Health in 2016 during which she achieved the Diploma in Sexual and Reproductive Health. Mel has an interest in medical writing and editing, working as Clinical Director at The Lowdown to review all clinical content.