Combined oral contraceptive pill

Commonly known as 'the 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.

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

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

What is the 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 periods lighter.
  • There are a variety of brands and strengths of the pill available in New Zealand, which contain a different combination of oestrogen and progestogen.
  • Your doctor will assess 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.  

What are the pros and cons of the pill?

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. 

How well does the pill work?

  • The pill is one of the more reliable forms of contraception.
  • If used perfectly (taken 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. 

How to take the pill

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: 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: 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: 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.    

What should I do if I miss my doses?

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.

What if I have diarrhoea (runny poo) and vomiting (being sick)?

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 taking.  

Who cannot take the pill?

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.

Side effects

Like all medicines, the pill can cause side effects although not everyone gets them. 

Side effects What should I do?
  • Breast tenderness
  • Headaches
  • Mood changes
  • Skin changes
  • These may go away with time. If 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.
  • Signs of blood clots such as swelling, pain or change in colour in one or both legs, chest pain, difficulty breathing or shortness of breath. Read more about hormonal contraceptives and blood clots.
  •  Tell your doctor immediately or phone Healthline 0800 611 116.

Interactions

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.

Learn more

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

Reference

  1. Oral contraceptives NZ Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland and Dr Alice Miller, FRNZCGP, Wellington Last reviewed: 23 Mar 2021