Combined Oral Contraceptive (COC) Guide
Safe, Evidence-Based Information About Combined Oral Contraceptive Pills From PharmaBee
Combined oral contraceptives (COCs), often referred to as the combined pill, are one of the most widely used forms of reversible contraception in the UK. When prescribed appropriately and taken correctly, they provide highly effective contraception while also offering additional health benefits for some people, such as helping to regulate menstrual cycles, reduce heavy or painful periods and improve acne in some individuals.
Combined pills contain two hormones—an oestrogen and a progestogen—which work together to help prevent pregnancy. Although all combined pills work in similar ways, they are not identical. Different brands contain different types or amounts of hormones, meaning one pill may be more suitable than another depending on your medical history, current health, lifestyle and treatment goals.
At PharmaBee, our online service allows adults aged 18 years and over to request combined oral contraception through a secure online consultation reviewed by a qualified UK independent prescriber. Whether you are starting a combined pill for the first time, continuing your current contraception or considering changing to another combined pill, every consultation is assessed individually.
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What Is A Combined Oral Contraceptive (COC)?
A combined oral contraceptive (COC) is a prescription-only medicine that helps prevent pregnancy using two naturally occurring female hormones in synthetic forms: an oestrogen and a progestogen. These hormones work together to prevent pregnancy in several different ways, making combined pills one of the most effective forms of reversible contraception when taken correctly. Combined pills have been used safely by millions of people worldwide for more than 60 years and remain one of the most commonly prescribed forms of hormonal contraception in the UK.
Combined pills should not be confused with progestogen-only pills (POPs), sometimes known as the “mini pill”. Although both help prevent pregnancy, they contain different hormones and have different benefits, risks and suitability criteria. Because combined pills contain oestrogen, they are not suitable for everyone. Some medical conditions and lifestyle factors increase the risks associated with oestrogen-containing contraception, which is why every patient requesting treatment through PharmaBee completes a detailed clinical assessment before any prescribing decision is made.
How Does A Combined Oral Contraceptive Work?
Preventing Ovulation
The main way a combined pill works is by preventing ovulation. The hormones contained in a combined pill prevent your ovaries from releasing an egg each month. Without an egg to fertilise, pregnancy cannot occur. This is the primary way that combined oral contraceptives help prevent pregnancy.
Thickening Cervical Mucus
Combined pills also make the natural mucus found at the entrance to the womb (the cervix) thicker and stickier. When cervical mucus becomes thicker, it is much more difficult for sperm to pass through, making fertilisation less likely. This provides an additional layer of protection against pregnancy.
Changing The Lining Of The Womb
Combined pills also cause changes to the lining of the womb (the endometrium). These changes make the lining less suitable for implantation should fertilisation occur. Although preventing ovulation is the main way combined pills work, these additional effects contribute to their overall effectiveness.
Combined Oral Contraceptive Pills Available Through PharmaBee
At PharmaBee, our qualified UK independent prescribers currently prescribe the following combined oral contraceptive pills where they are considered safe and appropriate following an individual clinical assessment. Although these medicines all belong to the same family of contraception and work in similar ways, they are not identical.
Microgynon® 30
Contains: Ethinylestradiol 30 micrograms / Levonorgestrel 150 micrograms
Microgynon® 30 is one of the most widely prescribed combined oral contraceptive pills in the UK and has been used safely by millions of people worldwide. It contains a standard dose of oestrogen together with the progestogen levonorgestrel. For many healthy adults, Microgynon® 30 provides reliable contraception when taken correctly and is often well tolerated. Like all combined oral contraceptives, Microgynon® 30 is not suitable for everyone.
Microgynon® 30 ED
Contains: Ethinylestradiol 30 micrograms / Levonorgestrel 150 micrograms
Microgynon® 30 ED contains exactly the same active hormones and provides the same contraceptive protection as Microgynon® 30. The difference is the way the tablets are packaged. Each pack contains 21 active hormone tablets and 7 inactive reminder tablets. The inactive tablets do not contain hormones and do not contribute to the contraceptive effect of the medicine. They are included to help maintain the routine of taking one tablet every day.
Rigevidon®
Contains: Ethinylestradiol 30 micrograms / Levonorgestrel 150 micrograms
Rigevidon® contains the same active ingredients and hormone strengths as Microgynon® 30 and works in exactly the same way to help prevent pregnancy. It is commonly prescribed as an equivalent alternative and is suitable for many people following an individual clinical assessment.
Yasmin®
Contains: Ethinylestradiol 30 micrograms / Drospirenone 3 mg
Yasmin® is a combined oral contraceptive that contains the same amount of oestrogen as Microgynon® 30 but a different type of progestogen called drospirenone. Because the progestogen differs from that found in levonorgestrel-containing pills, some people may find Yasmin® better suits their individual needs. As with all combined oral contraceptives, our prescribers carefully assess your medical history, blood pressure, BMI, medicines and other relevant risk factors before recommending treatment.
Choosing The Right Combined Oral Contraceptive
There is no single combined oral contraceptive (COC) that is considered the best choice for everyone. The most appropriate option depends on your individual health, medical history, lifestyle and personal preferences. Our prescribers consider a range of factors before recommending a combined oral contraceptive, including your medical history, blood pressure, height and weight, smoking and vaping, current medicines, and previous experience with contraception.
Some medical conditions increase the risks associated with oestrogen-containing contraception, while others may influence which combined pill is most appropriate. Conditions considered include high blood pressure, migraine (particularly migraine with aura), previous blood clots, heart or circulation problems, liver disease, certain cancers, and diabetes and any related complications.
Benefits Of Combined Oral Contraceptives
Highly Effective Contraception
When taken correctly, combined oral contraceptives are one of the most effective reversible methods of contraception available.
Reversible And Flexible
One of the advantages of a combined pill is that it can usually be started or stopped without requiring a medical procedure. For most people, fertility returns relatively quickly after stopping.
May Help Regulate Menstrual Cycles
Many people find that combined pills make their menstrual bleeding more predictable.
May Reduce Heavy Or Painful Periods
Some people notice that their periods become lighter or less painful while taking a combined pill.
May Improve Acne In Some People
Some combined oral contraceptives may improve acne in some people by reducing the effects of hormones that stimulate oil production within the skin.
Fits Easily Into Many People’s Daily Routine
Many people find that taking one tablet each day quickly becomes part of their normal routine.
Risks And Possible Side Effects Of Combined Oral Contraceptives
Like all prescription medicines, combined oral contraceptives have both potential benefits and potential risks. For many healthy adults, they provide safe and effective contraception for many years. However, no medicine is completely free from the possibility of side effects, and combined pills are not suitable for everyone.
Common Side Effects
Many people experience no troublesome side effects. Possible side effects may include headaches, feeling sick (nausea), breast tenderness, mood changes, bloating, breakthrough bleeding or spotting, changes to your withdrawal bleed, and changes in sexual desire.
Changes To Your Bleeding Pattern
Changes to bleeding are one of the most common reasons people have questions after starting a combined pill. During the first few months of treatment, your body is adapting to the hormones contained within the pill. Some people notice lighter withdrawal bleeds, shorter withdrawal bleeds, less painful periods, or occasional spotting between bleeds.
Blood Clots And Cardiovascular Health
One of the most widely discussed risks associated with combined oral contraceptives is the possibility of developing a blood clot. Although the overall risk remains low for most healthy people, it is slightly higher than in people who are not taking a combined pill. Your individual level of risk depends on several factors, including your age, blood pressure, smoking status, BMI, medical history and family history.
Starting A Combined Oral Contraceptive
Starting On Day One Of Your Period
If you start your pill on the first day of your period, contraceptive protection is effective immediately and you do not usually need additional contraception.
Starting At Another Time In Your Cycle
You do not always have to wait until your next period to start a combined pill. If you start your pill after the first day of your period, you may need to use additional contraception, such as condoms, for a short period while the pill becomes fully effective.
Changing from one combined pill to another is often straightforward, but the most appropriate way to do this depends on your individual circumstances and the type of contraception you are currently using.
Missed Pills
Missing pills can reduce the effectiveness of your contraception and, depending on your individual circumstances, may increase the chance of pregnancy. The advice is not always the same for every situation. It depends on which combined pill you are taking, how many pills have been missed, when they were missed within the packet, whether you have taken your previous pills correctly, whether you have had unprotected sex, and whether you have been sick or had severe diarrhoea.
Every combined oral contraceptive supplied by PharmaBee includes the manufacturer’s Patient Information Leaflet. This leaflet contains detailed instructions specific to your medicine, including what to do if you miss one tablet, miss more than one tablet, start your next packet late, are sick after taking your pill, or have severe diarrhoea.
Medicines That May Affect Your Combined Pill
Some medicines can affect how well a combined oral contraceptive works or increase the likelihood of side effects. This is why we ask you to tell us about everything you take during your consultation, including prescription medicines, medicines purchased without a prescription, herbal remedies and food supplements.
Frequently Asked Questions
Alcohol does not affect how well your combined pill works. However, drinking enough alcohol to cause vomiting may reduce the absorption of your pill and could affect its effectiveness.
For most people, fertility returns relatively quickly after stopping a combined oral contraceptive.
Some combined pills can be taken using different regimens, including taking packs back-to-back without a break in certain circumstances. If you are considering changing the way you take your pill, speak with your prescriber first.
Important Information
This guide is intended to provide general information about combined oral contraceptives and should not replace personalised medical advice from a qualified healthcare professional. Every request for treatment submitted through PharmaBee is reviewed individually by a qualified UK independent prescriber. If you experience suspected side effects, these can be reported by patients or healthcare professionals through the MHRA Yellow Card Scheme.
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