The combined pill: what to know if it is not suitable

The pill uses hormones to prevent ovulation, thicken cervical mucus and change the womb lining. Common ingredients include ethinylestradiol with a progestogen such as levonorgestrel. Different formulations have different hormone doses and schedules, so a brand name alone is not enough to judge suitability.

It can make bleeding more predictable and may ease painful periods or symptoms associated with Endometriosis, Polycystic Ovary Syndrome or Ovarian Cysts. It does not protect against sexually transmitted infections.

Arrange a contraceptive review if you have migraine with aura, a history of blood clots, high blood pressure, certain liver conditions, smoke, have recently given birth or take medicines that may interact. A clinician can check your blood pressure, medical history and preferences.

If the combined pill is unsuitable, discuss a progestogen-only method, an intrauterine option, an implant, an injection, condoms or non-hormonal choices. If you miss pills, vomit soon after taking one or start a medicine, ask promptly whether backup contraception is needed.

Seek urgent help for sudden chest pain, trouble breathing, coughing blood, one-sided leg swelling or pain, sudden weakness, difficulty speaking, or a severe unusual headache. Contact a clinician for persistent mood changes, troublesome bleeding or symptoms that began after starting the pill.

Ask: Is the combined pill appropriate with my medical history? Which medicines interact with it? What should I do after a missed pill? Which option suits my bleeding pattern and pregnancy plans? How can I recognise a serious side effect?