The combined pill contains artificial versions of the hormones oestrogen and progesterone which are both produced naturally in the ovaries. Most combined pills contain a type of oestrogen called ethinylestradiol, and this is combined with one of around a dozen types of progestogen. It's the level of the oestrogen - and how it interacts with the type of progestogen - that can impact the side effects and benefits you experience.
Why am I bleeding on the combined pill?
Spotting, or 'breakthrough bleeding', can occur in the first few months of taking the combined pill. So whilst it can be a pain and ruin a few pairs of pants - there's no need to worry. If you have been taking the combined pill for more than 3 months and your spotting is continuing, or you're experiencing new or irregular bleeding then we'd recommend that you get in contact with your doctor or nurse for advice. They'll likely ask you to do a pregnancy test or STI test and come in for an examination. If you take your pill for 21 days and then have a break of up to 7 days you will likely have a withdrawal bleed, which is similar to a period where the womb lining sheds in response to a drop in hormones. Some people may experience very light bleeding or no bleeding at all during the break. If you take the combined pill back to back (without a break) you won't have a withdrawal bleed but may experience spotting or breakthrough bleeding. Find out more in our guide to continuous pill taking.
What are the different types of combined pill?
The brands of combined oral contraceptive pill are different based on the type and dose of oestrogen and progestogen they contain. Learn more about the different types and groups of pill. Some brands are monophasic, meaning each pill contains the same doses of oestrogen and progestogen. Others are multiphasic, meaning each pill may contain slightly different doses of hormones, often to replicate changes in the menstrual cycle. Pill packs may also contain only 'active' pills containing hormones or 'active' and placebo pills.
What is the difference between combined pill and mini pill?
The combined oral contraceptive pill contains both oestrogen and progestogen whereas the progestogen-only pill, also known as the mini pill, only contains progestogen. The mini pill is also taken everyday whilst users of the combined pill commonly take a 7 day break - although taking the combined pill back to back or continuously is an option - learn more about taking the pill back to back. Find out more about each pill's differences in our guide to the combined pill vs the mini pill.
Can I buy the combined pill online?
Absolutely! You can order over 30 brands of the combined pill online through The Lowdown from £7 per month (including delivery). Head to our Pill Prescriptions service to fill in a short questionnaire about you and your medical history. Your request will then be reviewed by our pharmacy. If it's approved (and 95% of requests are!) we'll post a 3 month supply of your chosen pill directly to your door in discreet packaging.
How the Combined pill works:
The combined pill works in three ways. Firstly by preventing the ovaries from releasing an egg and then by thickening cervical mucus making it harder to sperm to swim towards the uterus. It also prevents the lining of the womb from thickening enough to allow a fertilised egg to implant itself in it.
There are a few things that can stop the combined pill from working properly including vomiting, some antibiotics, or missing a pill. Take a look at our complete guide to the combined pill to find out more. You can also use our Missed pill calculator to help you understand what to do if you miss a pill.
How to use the Combined pill:
You should take the combined pill around the same time every day. We recommend keeping your pill packet somewhere you look at everyday (like your makeup bag) to remind you to take it, or set an alarm on your phone. Most types of combined pill are designed to be taken for 21 days followed by a 7 day break during which you'll experience a withdrawal bleed (like a period). For most brands you can choose to shorten this break or miss it out altogether (check out our blog on taking your pill back to back). Some specific pill brands may have different instructions so always check the packet.
Depending on where you are in your cycle when you start taking the pill, you might not be protected against pregnancy straight away. Find out more about stopping the combined pill.
Coming off the pill is easy - you just stop taking it. When you do this you’re no longer protected from pregnancy. If you want to stop the pill but do not wish to become pregnant then you should complete your current packet before stopping and consider switching to another form of contraception before you stop taking your pill. If you have unprotected sex and stop your pill before the packet is finished you may ovulate (release an egg from the ovary) and could become pregnant. Read our complete guide to coming off the pill.
How safe is the Combined pill:
The combined pill is safe to take. There are however some small risks associated with taking the pill. With any combined type of hormonal contraception that contains oestrogen, there is a slightly increased risk of developing blood clots in your veins and arteries. The combined pill may also increase your blood pressure. Your doctor will check your individual risk before prescribing the pill. Use of the combined pill is also associated with small increased risks of breast cancer and cervical cancer. These reduce with time after stopping. It's also important to remember that the combined pill does not protect you from STIs.