Combined oral contraceptive pill

Commonly known as ‘the pill’

Key points about combined oral contraceptive pill

  • The combined oral contraceptive pill (also called 'the pill') is used to prevent pregnancy.
  • Find out how to take it safely and possible side effects.
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There are 2 types of oral contraception available in Aotearoa New Zealand. These are:

  • the combined pill, known as ‘the pill’, which contains the hormones oestrogen and progestogen. This page covers information about the combined pill. 
  • the progestogen-only pill, which contains only progestogen. Read more about the progestogen-only pill.

August 2023: Oralcon 30 ED has replaced the Levlen ED brand of combined oral contraceptive pill

Note that the Oralcon pills are a different colour – the 21 active pills are white and the 7 inactive (‘’sugar”) pills are yellow. This is the opposite of the Levlen ED brand.

 

Front and back of Levlen ED and Oralcon 30 ED blisters

Image credit: Adapted from Levlen brand change to Oralcon, Pharmac

How to change over to Oralcon 30 ED from Levlen ED

  1. When you're on the last blister pack of your Levlen ED, finish all the active (yellow) tablets before starting Oralcon 30 ED.
  2. Start Oralcon 30 ED in the area that's coloured orange on the front of the blister (see image above).
  3. Take your first active tablet from the new pack on the day after taking the last active tablet in your previous pill pack. Start with the day corresponding to the day of the week.

The pills in the orange area on the front of the blister pack are active tablets so you may not bleed until you've finished the first blister pack of Oralcon 30 ED.

Read more about the brand change to Oralcon 30 ED(external link)

As an example (circled in blue on the image below): If your last active (yellow) tablet of Levlen ED is on a Friday, you should start your Oralcon 30 ED on Saturday. Start on the Saturday from the area that's coloured orange on the front of the blister. This is an active (white) tablet of Oralcon 30 ED. Then follow the arrows as usual. 

If you're not sure which are the active/inactive tablets in your oral contraceptive blister, or you have any other questions about the contraceptive pill change, ask your healthcare provider.

Example identifying what day to finish Levlen ED and start on Oralcon 30 ED blisters

Image credit: Adapted from Levlen brand change to Oralcon, Pharmac

 

Examples of the combined pill
  • Brevinor®
  • Brevinor-1®
  • Levlen ED®
  • Loette®
  • Femme-Tab®
  • Mercilon®
  • Microgynon 20®
  • Microgynon 30®
  • Microgynon 50®
  • Monofeme®
  • Norimin®
  • Oralcon 30 ED®
  • Yasmin®
  • Yaz®

The pill is a form of contraception that you take every day to stop getting pregnant. The pill contains a combination of 2 hormones – oestrogen and progestogen.

  • The pill works by stopping ovulation (eggs being produced and released from your ovary).
  • It is also used to treat heavy menstrual (period) bleeding (also called menorrhagia). It makes the lining of your uterus thinner which makes your periods lighter.
  • There are a variety of brands and strengths of the pill available in Aotearoa New Zealand, which contain a different combination of oestrogen and progestogen.
  • Your doctor will decide on the best combination for you.
  • If you experience side effects, you may need to try a few different types before you find one that suits you.  

Pros Cons

✔ You can choose to have a period each month or not.

✔ Doesn’t interfere with having sex.

✔ Periods are likely to be regular, shorter, lighter and less painful.

✔ Can be taken up to menopause in a healthy non-smoker.

✔ May help with premenstrual syndrome symptoms, improve acne and reduce symptoms of endometriosis. 

✔ May reduce risk of endometrial cancer, ovarian cancer and colorectal cancer. 

✔ May help with symptoms of polycystic ovary syndrome such as acne, excessive hair growth and irregular periods. 

✘ Needs to be taken each day at the same time of the day, whether you have sex on that day or not.

✘ Does not protect against sexually transmitted infections (STIs), so it’s important to use condoms.

✘ May cause irregular bleeding for a few months after starting. As long as you have not missed any pills, it will still be working. If the bleeding continues, talk with your nurse or doctor. 

  • The pill is one of the more reliable forms of contraception.
  • If used correctly, the pill is 99% effective in preventing pregnancy.
  • However most of us are not perfect, so in real life it is usually only 92% effective. This means that about 8 out of 100 people who use the pill each year will get pregnant. 

To make sure the pill works best, you need to take it every day, whether you have sex on that day or not. It is also important to know that if you are sick (vomiting) soon after taking your pill, then it may not be absorbed and may not work. 

When taking the pill, you don't need to have a period every month. The following 3 options allow you flexibility and choice. With every option you  need to take one pill each day, at roughly the same time. A standard pill packet contains 21 ‘active’ hormone pills and 7 non-hormone pills. The most effective option is if you take the hormone pills continuously (the ‘not have a period’ option).

Ways to take the pill

Option 1: To have a period each month

Take the hormone pills for 21 days, THEN take the non-hormone pills for 7 days. Repeat this every month. Your period will start while you are taking the non-hormone pills.

Option 2: To have a period every few months

Take the hormone pills for 21 days, then go straight on to taking the hormone pills from a new packet, missing the 7 non-hormone pills. When you want to have a period, take the non-hormone pills for 7 days, then start the hormone pills again from a new packet.

Option 3: To not have a period (also called continuous regimen)

Take the hormone pills for 21 days and then go straight on to taking the hormone pills from a new packet. Do not take the 7 non-hormone pills. Repeat this every month. This means you won’t get your period. This way of taking the pill is the best way to protect you from pregnancy.    

Some packs of the combined pill have 21 active pills and 7 non-active sugar pills. The non-active sugar pills are also called non-hormonal placebo or reminder pills. These pills are meant to help you remember to take your pill every day and start your next pack on time.

Taking the non-active sugar pills will trigger withdrawal bleeding, which is similar to a period. You are still protected from pregnancy during this time. The hormone-free days must not be longer than 7 days. At the end of the hormone-free days, start a new pack.

Always start your new pack of pills on time, even if your period hasn’t ended. Your period should stop in a few days. If you don’t have a period, start your new pill pack and see your healthcare provider.

Note: There are different ways to take the non-active sugar pills, depending on whether you want to have a period every month, every few months or not have a period. See how to take the pill above.

If you miss 1 pill

If you forget to take a pill, take it as soon as you remember, and take the next one at the normal time (even if this means taking 2 pills together). If you miss 1 pill, you are still protected from pregnancy.

If you miss 2 or more pills

Take a pill as soon as you remember and the next one at the normal time (even if this means taking 2 pills together). Depending on how you are taking the pill, you might need to take other steps to protect yourself from pregnancy. Check out the information below for your pill-taking options. 

It can be complicated working out what to do if you have missed some pills, so if you are not sure what to do ask your doctor, nurse or pharmacist as soon as you can. The following is some guidance.

Options 1 or 2: Traditional or other tailored (not continuous) regimens

During week 1 (ie, after starting the pill for the first time or in the week after the non-hormone pills)

If 2 or more active hormone pills are missed, you need to go back to taking hormone pills daily AND use condoms or avoid having sex for the next 7 days. If you have had unprotected sex in the week before or during this first week, contact your doctor, nurse, pharmacist or Healthline 0800 611 116 for advice. You may need to use emergency contraception.

During week 2 or any weeks of a tailored regimen that are not within the first or last weeks of active hormone pill taking

If 8 or more hormone pills are missed, you need to go back to taking hormone pills daily AND use condoms or avoid having sex for the next 7 days.

During week 3 or in the week prior to a scheduled break from hormone pills

If 2 or more of the last 7 hormone pills are missed, you should skip the non-hormone pills and go straight on to taking the hormone pills from the next packet. If you decide to continue with the non-hormone pills, you will need to use condoms or avoid having sex until you have taken 7 hormone pills in a row.

Option 3: Continuous regimen

If you have been taking the hormone pills correctly for at least 7 days in a row before the missed pills, up to 8 pills can be missed and you are still protected from pregnancy.

If you have missed more than 8 pills in a row, OR have not been taking the hormone pills for at least 7 days in a row before the missed pills, then your pill will not be working. You need to start taking hormone pills AND use condoms or avoid having sex for the next 7 days. If you have had unprotected sex during or after missing more than 8 pills in a row, contact your doctor, nurse, pharmacist or Healthline 0800 611 116 for advice. You may need to use emergency contraception.

Vomiting and ongoing diarrhoea can stop your body absorbing your pill, which may stop it from working.

  • If you vomit within 2 hours of taking a pill, take another pill as soon as possible.
  • If you have ongoing vomiting or bad diarrhoea lasting 24 hours or more, you should act as if your pill is not working on those days and follow the missed pill advice above for the regimen you are using.  

Most people who want to can take the pill, but the pill is not suitable for everyone. 

You should NOT use the pill if you:
  • are over 35 and smoke
  • are overweight (BMI > 35)
  • have gallstones
  • have breast cancer or have had breast cancer in the past 
  • have diabetes with complications
  • have high blood pressure
  • are about to have major surgery
  • have had a heart attack, stroke or blood clot in legs or lungs
  • have parents, brothers or sisters who have had a blood clot in their legs or lungs
  • are pregnant, have had a baby within the last 3 weeks or started breastfeeding within the last 6 weeks
  • are taking certain medicines such as lamotrigine, over-the-counter preparations or herbal remedies.

Your doctor or nurse will be able to work out whether the pill is safe for you.

Most people who take the pill do not develop any side-effects. However, a small number of people feel sick, have headaches or find their breasts are sore when they take the pill. These usually go away within days or weeks of starting the pill. If they continue (persist) there are many different brands of pill you can try, which may suit you better.

Increased risk of blood clots

People taking the pill have a small increased risk of developing a blood clot (thrombosis). Blood clots can cause blockages in veins (causing deep vein thrombosis or pulmonary embolism) or in arteries (which can cause heart attacks or strokes).

  • This may occur at any time during use of the pill. However, the risk of blood clots is highest during the first year after starting the pill or when restarting after a break of 4 weeks or more.
  • You are at increased risk if you have, or have had, blood clots (thrombosis) or have inherited or acquired thrombophilia (eg, antiphospholipid syndrome). Other things that increase your risk are major surgery, trauma, prolonged immobility (confined to a bed or wheelchair for long periods), injury, after pregnancy, smoking, obesity, and older age. See above: "Who cannot take the pill".
  • Seek immediate medical attention if you have a hot, swollen or painful leg, and/or if you  experience chest pain, cough or shortness of breath.

Other side effects

Side effects What should I do?
  • Breast tenderness
  • Headaches
  • Mood changes
  • Skin changes
  • These may go away with time. If they are severe and persistent, tell your doctor or nurse.
  • Breakthrough bleeding (bleeding that occurs intermittently) or spotting   
  • This may go away with time. If persistent, tell your doctor or nurse.
  • Severe stomach pain
  • Signs of liver problems such as dark-coloured urine (pee), yellow skin and eyes
  • Severe headache or loss of vision or fainting or numbness
  • Tell your doctor immediately or phone Healthline 0800 611 116.
  •  Tell your doctor immediately or phone Healthline 0800 611 116.
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product(external link)

A few medicines such as some epilepsy medicines, antibiotics and herbal supplements may interact with the pill and lessen its effectiveness, so always check with your doctor or pharmacist before starting any new medicine.

In February 2017 oral contraceptives have been re-classified in New Zealand, which means that some combined oral contraceptives and progesterone only pills can be purchased from your pharmacy without a prescription, under certain circumstances.

When can the pill be purchased without a prescription?

The pill can be purchased without a prescription, under the following circumstances:

  • Customers must be between the ages of 16 and 39 years for the combined oral contraceptive, and between 16 and 52 years for progesterone only pill.
  • Women must have had them prescribed by their doctor within the past 3 years.
  • Only about 10 brands and strengths of combined oral contraceptives and progesterone-only pills can be purchased such as Brevinor​, Norimin​, Noriday​, Ava 30 and Ava 20.
  • Pharmacists will be able to sell up to 6 months supply at a time.
  • Pharmacists must receive approved training.

The purchase is estimated to cost about $45.

Who cannot purchase the pill without a prescription from their pharmacy?

There are some instances in which the pill cannot be purchased without a prescription from your pharmacy such as:

  • Women under the age of 16 years.
  • Women who are using the pill for the first time.
  • Women with risk factors that require medical supervision.

Language resource

Contraceptive pill Family Planning, Victoria, Australia English(external link), Arabic(external link), Chinese(external link), Hindi(external link), Vietnamese(external link)

The following further reading gives you more information about the pill.

Learn more about the pill:
Combined oral contraceptive pil(external link)l Sexual Wellbeing Aotearoa
Taking your pill continuously(external link) Sexual Wellbeing Aotearoa
Combined oral contraceptive pill(external link) Ministry of Health, NZ
 
Learn more about the risks of the pill:
Hormonal contraceptives and blood clots(external link) Medsafe, NZ
Oral contraceptives and blood clots(external link) Ministry of Health, NZ 

Medsafe datasheets on specific brands of the pill

Resources

The Pill - combined oral contraceptive(external link)(external link) Sexual Wellbeing Aotearoa, NZ, 2019
Contraception – your choice chart(external link)(external link) Sexual Wellbeing Aotearoa, NZ, 2021
Progestogen only pill(external link) Sexual Wellbeing Aotearoa
5 questions to ask about your medications(external link) Health Quality and Safety Commission, NZ, 2019 English(external link), te reo Māori(external link)

References

  1. Oral contraceptives(external link) NZ Formulary
  2. Reminder: Counsel patients about symptoms and signs of venous thromboembolism when prescribing combined oral contraceptives(external link) Medsafe, 2022

Brochures

the pill 1

The Pill - combined oral contraceptive(external link)

Sexual Wellbeing Aotearoa, NZ, 2019

contraception your choice chart

Contraception – your choice chart(external link)

Sexual Wellbeing Aotearoa, NZ, 2021

Progestogen only pill(external link)

Sexual Wellbeing Aotearoa, NZ, 2018

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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Alice Miller, FRNZCGP, Wellington; Angela Lambie, Pharmacist

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