Combined oral contraceptive pill
Also known as: the combined pill, COC, the pill, combined oral contraceptive, Microgynon, Yasmin, Logynon, Marvelon
The combined pill is a hormonal contraceptive that contains two hormones, oestrogen and a progestogen. It mainly works by stopping the ovaries releasing an egg. It carries a very small risk of blood clots; sudden breathlessness or chest pain needs a 999 call or A&E. Pain and swelling in one leg can be a clot, and the NHS advises getting medical help through an urgent GP appointment or NHS 111.
- Generic name
- Combined oral contraceptive pill
- Active ingredient
- Combined oral contraceptive pill (variants: ethinylestradiol, levonorgestrel, norethisterone, desogestrel, gestodene, norgestimate, drospirenone)
- Product type
- Small-molecule medicine
- Drug class
- Combined hormonal contraceptives
- Brand names
- UK Microgynon, Yasmin, Logynon, Marvelon · US
- Routes
- Oral
- Dosage forms
- Tablet
- Also known as
- the combined pill, COC, the pill, combined oral contraceptive, Microgynon, Yasmin, Logynon, Marvelon
- Usual preparations
- Oral tablets. (summary of the cited reference, not a prescription)
- Monitoring
- A clinician checks suitability and blood clot risk factors before prescribing. Blood pressure can rise in a small number of people. If side effects are still a problem after about three months, the NHS says to speak to a pharmacist or doctor, and a different pill may help.
Availability by country
| Country | Status | Note | Source |
|---|---|---|---|
| UK | Prescription only | UK |
Legal status differs between countries and can change; each row cites the document it was taken from and applies only to the country named.
What it is used for
- Contraception: preventing pregnancy, which the NHS says the combined pill does with over 99% effectiveness when always used perfectly
- Making periods regular, lighter and less painful, which the NHS says it usually does
- Easing the symptoms of premenstrual syndrome (PMS) and endometriosis, where the NHS says it may help
How it works in the body
The combined pill contains two hormones, oestrogen and progestogen. It mainly works by stopping the ovaries releasing an egg each month. It also thickens the mucus made by the cervix, which makes it harder for sperm to pass.
Common side effects
- Bleeding between periods or changes to periods are common in the first few months.
- Headaches, mood changes, nausea and sore breasts are also listed.
- The NHS says there is no evidence that the pill causes weight gain or changes sex drive.
Serious: seek help
- A blood clot in the leg or lung, a clot causing a heart attack, or a clot causing a stroke is a possible risk, which the NHS describes as very small.
- For a possible clot in the lung, the NHS says to call 999 or go to A&E for sudden difficulty breathing, chest or upper back pain, a very fast heartbeat or fainting.
- Coughing up blood is also listed as a symptom of a clot in the lung, and the NHS says to call 999 or go to A&E for coughing up more than a few spots or streaks of blood, or coughing up blood with difficulty breathing, a very fast heartbeat or chest pain.
- Throbbing pain, usually in the calf or thigh, with swelling in one leg can be a clot in the leg, and the NHS advises getting medical help as soon as possible, for example through an urgent GP appointment or NHS 111.
- The UK medicines regulator found that pills containing drospirenone, gestodene or desogestrel carry a higher relative risk of clots than those containing levonorgestrel, norethisterone or norgestimate.
- Taking the pill can cause high blood pressure in a small number of people, which a GP can check.
- The NHS says the pill can slightly increase the risk of breast and cervical cancer and can lower the risk of womb, ovarian and bowel cancer.
Cautions and interactions
- The pill is not suitable for everyone, and a clinician checks risk factors, including those for blood clots, before prescribing.
- Conditions that may make it unsuitable include a history of blood clots, migraine with aura, breast cancer, liver cancer or severe cirrhosis, complications of diabetes and heart problems.
- The NHS also lists obesity, and smoking at older ages, as reasons the pill may not suit someone.
- Some medicines can make the pill less effective, including some used for TB, epilepsy or HIV, and the herbal remedy St John's wort.
- The NHS names the antibiotics rifampicin and rifabutin as ones that can reduce its effectiveness.
- It does not protect against sexually transmitted infections, so condoms are still needed for that.
Interactions
Check interactions
Taking Combined oral contraceptive pill with other medicines? Add them to the checker to see what the official sources say about each pair: the mechanism, general management and monitoring, never a bare "safe".
Interactions documented in the official sources cited on each card. The list covers the medicines represented on this site and is not exhaustive; how the interaction data is compiled.
No pair records for this medicine are in the sources currently represented by Anatomy Nexus. Absence from this list does not mean no interaction exists.
Same-class and related medicines
Same class: Combined hormonal contraceptives
Medicines that share the class of Combined oral contraceptive pill. They are separate medicines with their own licences, doses and interactions, not alternative names for Combined oral contraceptive pill.
Related medicines
Medicines often discussed alongside Combined oral contraceptive pill: used together, compared with it, or acting on the same problem by a different route.
Key facts
| Fact | Detail |
|---|---|
| Also called | The pill, the combined pill, COC (combined oral contraceptive) |
| Hormones | Oestrogen and a progestogen |
| Main action | Stops the ovaries releasing an egg |
| Effectiveness | The NHS says over 99% effective when always used perfectly |
| Protects against STIs? | No; condoms are still needed for that |
| Main serious risk | Blood clots; sudden difficulty breathing or chest pain needs 999 or A&E |
| Where to get it | Sexual health clinics, GP surgeries, young people's services, some pharmacies |
What is the combined pill?
The combined pill is a hormonal contraceptive, often just called the pill. It contains two hormones, oestrogen and a progestogen. The emc lists UK brands as ethinylestradiol, an oestrogen, combined with a progestogen. Microgynon and Logynon contain levonorgestrel, Marvelon contains desogestrel, and Yasmin contains drospirenone.
The same two kinds of hormone are also given as a skin patch or a vaginal ring. The NHS says the pill is available from sexual health clinics, GP surgeries and young people's services. Some pharmacies can also supply it, without a prescription and free of charge, after a consultation with a pharmacist.
How does it work, and how well?
The pill mainly works by stopping the ovaries releasing an egg each month. It also makes the mucus from the cervix thicker, which makes it harder for sperm to pass. The NHS says the combined pill is more than 99% effective at preventing pregnancy when always used perfectly. Missed pills, vomiting or severe diarrhoea can make it less effective.
Some medicines and herbal remedies can also stop the pill working properly. The pill does not protect against sexually transmitted infections, so condoms are still needed for that.
What are the benefits and side effects?
The NHS says the pill usually makes periods regular, lighter and less painful, and that it may help with premenstrual syndrome and endometriosis. Bleeding between periods or changes to periods are common in the first few months. Headaches, mood changes, nausea and sore breasts are also listed.
The NHS says there is no evidence that the pill causes weight gain or changes sex drive. Taking the pill can cause high blood pressure in a small number of people. The NHS says the pill can slightly increase the risk of breast and cervical cancer and can lower the risk of womb, ovarian and bowel cancer. If side effects are still a problem after about three months, the NHS says to speak to a pharmacist or doctor, and a different pill may suit better.
Blood clots: what to know and where to go
The NHS lists the possible risks as a blood clot in the leg or lung, a clot causing a heart attack, or a clot causing a stroke. It describes the risk as very small, and a clinician checks risk factors before prescribing. The UK medicines regulator found that pills containing drospirenone, gestodene or desogestrel carry a higher relative risk than those containing levonorgestrel, norethisterone or norgestimate.
For a possible clot in the lung, the NHS says to call 999 or go to A&E for sudden difficulty breathing, chest or upper back pain, a very fast heartbeat or fainting. Chest pain that is worse on breathing in, and coughing up blood, are also listed as symptoms. The NHS says to call 999 or go to A&E for coughing up more than a few spots or streaks of blood, or coughing up blood with breathing difficulty or chest pain. A clot in the leg can cause throbbing pain, usually in the calf or thigh, and swelling in one leg. The NHS advises getting medical help as soon as possible, for example through an urgent GP appointment or NHS 111.
Who may not be able to use it?
The NHS says the combined pill is not suitable for everyone. Its list of conditions that may make it unsuitable includes a history of blood clots, migraine with aura, breast cancer, liver cancer or severe cirrhosis, complications of diabetes and heart problems. It also lists obesity, and smoking at older ages.
Some medicines can make the pill less effective, including some used for TB, epilepsy or HIV, and St John's wort. The NHS names the antibiotics rifampicin and rifabutin.
Frequently asked questions
Does the combined pill protect against sexually transmitted infections?
No, the NHS says the combined pill does not protect against sexually transmitted infections, so condoms are still needed for that. Sexually transmitted infections, or STIs, are infections that pass from person to person through sexual contact.
Can the combined pill be obtained without seeing a GP?
The NHS says it is available from sexual health clinics, GP surgeries and young people's services. Some pharmacies can supply it without a prescription and free of charge after a consultation with a pharmacist, though not every pharmacy offers this.
What are the warning signs of a blood clot?
A clot in the lung can cause sudden difficulty breathing, chest pain that is worse on breathing in, and coughing up blood. The NHS says to call 999 or go to A&E for sudden difficulty breathing, chest or upper back pain, a very fast heartbeat or fainting. A clot in the leg can cause throbbing pain, usually in the calf or thigh, and swelling in one leg, and the NHS advises getting medical help as soon as possible, for example through an urgent GP appointment or NHS 111.
Does the combined pill cause weight gain?
The NHS says there is no evidence that taking the pill makes a person put on weight or changes sex drive. Headaches, mood changes, nausea and sore breasts are among the listed side effects. If side effects are still a problem after about three months, the NHS says to speak to a pharmacist or doctor, and changing pill may help.
Which medicines can stop the combined pill working?
The NHS says some antibiotics, such as rifampicin and rifabutin, can reduce its effectiveness. Medicines used for TB, epilepsy or HIV, and St John's wort, are also named as able to make the pill less effective.
Does the combined pill change the risk of cancer?
The NHS says the pill can slightly increase the risk of breast cancer and cervical cancer, and can lower the risk of womb, ovarian and bowel cancers. The NHS says the breast and cervical cancer risk goes back to normal about 10 years after stopping the pill.
Connected pages in detail
What each linked page on Anatomy Nexus covers, in a line, for Combined oral contraceptive pill.
Conditions
- Deep vein thrombosis A blood clot in a deep vein, most often of the calf or thigh.
- Pulmonary embolism Blockage of a pulmonary artery by a clot that has travelled from a vein, usually in the leg or pelvis.
- Stroke Sudden loss of brain function because blood supply to part of the brain is interrupted, by a blocked artery (ischaemic.
- High blood pressure (hypertension) Persistently raised arterial pressure, usually defined as 140/90 mmHg or more in the clinic (135/85 on home readings).
- Migraine A recurrent headache disorder with attacks of moderate to severe throbbing pain, typically one-sided, lasting 4 to 72 hours.
- Breast cancer A malignant tumour arising from the cells that line the ducts or lobules of the breast.
- Cervical cancer A malignant tumour of the cervix, the neck of the uterus, that develops almost always from persistent infection with high-risk types of human…
- Endometriosis A chronic condition in which tissue similar to the lining of the uterus (the endometrium) grows outside the uterus, most often on the ovaries.
Symptoms
- Chest pain Pain or pressure anywhere between the neck and the upper abdomen.
- Shortness of breath The sensation of not getting enough air.
- Swelling (oedema) Excess fluid in the tissues.
- Heavy periods Menstrual bleeding that is heavier or lasts longer than usual and gets in the way of daily life.
- Unusual vaginal bleeding Bleeding from the vagina at a time when a period is not due: between periods, after sex.
Medications
- Estradiol (oestrogen) The main natural oestrogen, given as tablets, patches, gel, spray or vaginal preparations to replace what the ovaries no longer make after the…
Drug classes
- Combined hormonal contraceptives Combined hormonal contraceptives contain both an oestrogen and a progestogen, and include the combined pill, a skin patch and a vaginal ring.