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Oral Contraceptive Guide: Combined Pills

December 15th, 2021

How it prevents pregnancy

The pill prevents the ovaries from releasing an egg each month (ovulation). It also:

thickens the mucus in the neck of the womb, so it is harder for sperm to penetrate the womb and reach an egg
thins the lining of the womb, so there is less chance of a fertilised egg implanting into the womb and being able to grow

The pill is over 99% effective if used correctly.

Starting the combined pill

You can normally start taking the pill at any point in your menstrual cycle. There is special guidance if you have just had a baby, abortion or miscarriage. The guidance may also be different if you have a short menstrual cycle. Get advice from a doctor or nurse if you need it. You may need to use additional contraception during your 1st days on the pill – this depends on when in your menstrual cycle you start taking it.

Starting on the 1st day of your period

If you start the combined pill on the 1st day of your period (day 1 of your menstrual cycle) you will be protected from pregnancy straight away. You will not need additional contraception.

Starting on the 5th day of your cycle or before

If you start the pill on the 5th day of your period or before, you will still be protected from pregnancy straight away.

Starting after the 5th day of your cycle

You will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for 7 days.

If you start the pill after the 5th day of your cycle, make sure you have not put yourself at risk of pregnancy since your last period. If you're worried you're pregnant when you start the pill, take a pregnancy test 3 weeks after the last time you had unprotected sex.

What if I have missed 1 pill?

If you have missed 1 pill anywhere in the pack or started a new pack 1 day late, you're still protected against pregnancy.

You should:

take the last pill you missed now, even if this means taking 2 pills in 1 day
carry on taking the rest of the pack as normal
take your 7-day pill-free break as normal

You do not need to use extra contraception.

What if I have missed 2 or more pills?

If you have missed 2 or more pills anywhere in the pack or started a new pack 2 or more days late (48 hours or more), your protection against pregnancy may be affected.

You should:

take the last pill you missed now, even if this means taking 2 pills in 1 day
leave any earlier missed pills
carry on taking the rest of the pack as normal
use extra contraception, such as condoms, for the next 7 days

When you come to the end of your pill pack, after missing 2 or more pills:

if there are 7 or more pills left in the pack after the last missed pill – finish the pack, take your 7-day pill-free break as normal, or take your inactive pills before you start your next pack
if there are less than 7 pills left in the pack after the missed pill – finish the pack and start a new pack the next day; this means missing out the pill-free break or not taking your inactive pills

What if I'm not sure what to do?

If you're not sure what to do: