Combined and Mini Pill Contraceptives

Combined and Mini Pill Contraceptives

What is the difference between the combined pill and mini pill?

The combined oral contraceptive is an oral tablet used by millions of women all over the world as one of the most effective regular forms of contraception. It is also effective for other hormone related issues and can help to control acne (especially one that is aggravated by menstrual cycle), relax and reduce period cramps and regulate an irregular menstrual cycle.

This type of pill contains both oestrogen and progestogen and it is taken for 21 days with a 7-day break (i.e. you stop during the week of your period). Most women will be offered the combined pill first as it is generally tolerated very well, readily available (many brands and types) and easy to take.

The mini pill is progestogen (progesterone) only tablet and like the combined oral contraceptive it is over 99% effective at preventing pregnancy. The mini pill is particularly useful for women that have experienced oestrogen-based side effects in the past (i.e. migraines) and for those women that cannot take oestrogen containing products such as the combined pill. The mini pill is just as effective at preventing pregnancy as the combined pill. The mini pill also doesn’t require the patient to stop for 7 days. It is taken at the same time every day without a break.

Combined Pill Brands in the UK

Acnocin, BiNovum, Brevinor, Cicafem, Cilest, Clairette, Cyproterone, Dianette, Femodene, Femodette, Loestrin, Logynon, Marvelon, Mercilon, Microgynon, Norimin, Norinyl-1, Ovysmen, Qlaira, Synphase, Triadene, Trinovum, Yasmin, Zoely

Mini Pill Brands in the UK

Cerazette, Norgeston, Aizea, Micronor, Nacrez, Desomono, Desorex, Noriday, Cerelle, Zelleta

How do the two types of pill work?

Combined Pill

The combined pill can be started at any point during a woman’s menstrual cycle once prescribed. It’s immediately effective at preventing pregnancy if taken on the first to fifth day of your menstrual cycle. If it is started after the 5th day then an additional barrier contraception will be needed for the first 7-14 days to ensure full protection. If taken properly and started the optimal time (day 1-5) the combined pill is 99% effective at preventing pregnancy.

There are some brands including Zoely and Qlaira that differ from the usual routine of combined pills. These brands contain 28 pills and are taken throughout the month making these a good option for women that are not good with a 21/7 split routine.

The combined pill:

• Stops ovulation (eggs from being released by the ovaries)
• Thickens mucus in the cervix. This prevents sperm from being able to reach the womb.
• Makes the womb wall thinner. During pregnancy the wall needs to be built up to ensure the egg can plant on the side. With thinner walls the egg cannot do this.

Advantages of the combined pill:

• Can be taken at any time of the day and not limited to the same time every day.
• It can regulate your menstrual cycle and make periods lighter. It will also ease some of the the symptoms associated with your period such as cramping, pain and nausea.
• Can treat Polycystic ovary syndrome (PCOS). Hormonal contraceptives can help to control the symptoms of PCOS and help with weight gain and unwanted hair growth.

Missing a pill

If you miss taking a combined pill the action you take will depend on how many you have missed and where you are in your cycle.

1. One missed tablet or started new pack one day late:

• Take your pill as soon as possible (even if it means taking 2 in the same 24hour window)
• Continue your month as normal from this point onwards. You will still be protected from pregnancy as if you hadn’t missed a pill.

2. You have missed two or more tablets or have started the new pack two or more days late:

• Take the last missed pill as soon as possible (even if it means taking 2 in the same 24hour window)
• You will need to use addition barrier methods of contraception or avoid intercourse until you have started your next pack.

3. If there are six or fewer tablets left in the pack:

• Finish the pack as normal and start the new pack the next day without having a 7day break
• Use additional barrier methods of contraception or avoid sex until you have started your next pack after the seven-day break.

4. If there are seven or more tablets left in the pack

• Finish the pack as normal and take your 7day break before starting the next pack.
• Use additional barrier methods of contraception or avoid sex until you have started your next pack after the seven-day break.

Mini Pill

If started on day one of your menstrual cycle, the mini pill will immediately protect against pregnancy. If the pill is started any time after this, additional barrier protection will be required for 7 days before the pill is 99% effective.

The mini pill:

• Thickens mucus in the cervix, preventing the sperm from being able to reach their target, the womb.
• Thins the womb wall preventing a fertilised egg from embedding and starting a pregnancy.
• Mini pills containing Desogestrel such as Cerazette and Cerelle, can also prevent the process of ovulation (stopping the release of an egg from the ovaries)

Certain medicines can affect the effectiveness of the mini pill. Antibiotics, certain herbal medication and some weight loss medicines can interfere with how well the pill is absorbed into the blood and if you are taking these for a short time you should also use a barrier method of contraception during and for 7 days after stopping. Vomiting and diarrhoea can also affect absorption of both types of pill and additional barrier protection should be used.

Advantages of the mini pill:

• More accessible: Women that are overweight, have high blood pressure, high blood clot risk, smokers, aged 35+, breastfeeding or are overweight
• Very well tolerated. Progestogen only pill users experience less unwanted effects compared to combined pill users.
• Easier to take. Unlike the combined pill you do not need to stop taking the mini pill during the week you have your period. It’s taken throughout the whole 28 days.
• Reduces preperiod symptoms like bloating, headaches, nausea, mood swings and irritability.

Missing a pill

Most progestogen only pills have to be taken within a certain time frame every day. If one is missed or taken late then this could affect how well it works.

• 3 hour mini pills – Such as Femulen, Micronor, Norgeston and Noriday need to be taken within a 3 hour window every day. If this is missed then it is recommended to restart as soon as possible and use a barrier method of contraception for at least 7 days after.
• 12 hour mini pill – i.e. those containing desogestrel such as Cerazette and Cerelle can be taken within a 12-hour time frame every day. If this is missed then it is recommended to restart as soon as possible (even if it means taking 2 pills in the same 24 hour window) and use a barrier method of contraception for at least 7 days after.

For further health advice you can visit the NHS choices website for up-to-date recommendations.