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.
There are 2 types of oral contraception available in 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.
On this page you will find information about:
- Examples of the combined pill
- What is the pill?
- What are the pros and cons of the pill?
- How well does the pill work?
- How to take the pill
- What are sugar pills?
- What should I do if I miss my doses?
- What if I have diarrhoea (runny poo) and vomiting (being sick)?
- Who cannot take the pill?
- What are the side effects of the combined oral contraceptive pill?
|Examples of the combined pill|
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.
✔ You can choose to have a period each month or not.
✘ Needs to be taken each day at the same time of the day, whether you have sex on that day or not.
- 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:|
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?|
|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|
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.
The following further reading gives you more information about the pill.
Learn more about the pill:
Combined oral contraceptive pill Family Planning, NZ
Taking your pill continuously Family Planning, NZ
Combined oral contraceptive pill Ministry of Health, NZ
Learn more about the risks of the pill:
Hormonal contraceptives and blood clots Medsafe, NZ
Oral contraceptives and blood clots Ministry of Health, NZ
|Medsafe datasheets on specific brands of the pill|
- Oral contraceptives NZ Formulary
- Reminder: Counsel patients about symptoms and signs of venous thromboembolism when prescribing combined oral contraceptives Medsafe, 2022
Additional resources for healthcare professionals
Combined oral contraceptives and VTE - putting the risk into perspective Medsafe, NZ, 2011
Using New Zealand data to review the risk of venous thromboembolism with combined oral contraceptives Medsafe, NZ, 2018
Oral contraceptives – selecting a pill BPAC, NZ, 2019
Reminder – most broad-spectrum antibiotics do not interact with combined oral contraceptives BPAC, NZ, 2014
Contraception in early adolescence BPAC, NZ, 2011
New Zealand Aotearoa’s guidance on contraception Ministry of Health, NZ, 2020