How to choose the right contraception

What it is

The combined oral contraceptive pill is one of the most reliable methods of contraception - if used properly. It contains two synthetic hormones, an oestrogen and a progestogen. It's taken every day for 21 days, and then a seven-day pill-free interval occurs, during which a progestogen withdrawal-bleed (similar to a period) usually occurs. As long as you have taken the pills as prescribed, you're still protected against pregnancy during this seven-day break. Some brands contain seven inactive pills, so you don't have to remember when to restart each pack after your pill-free break. These are known as 'every day (ED) packs'.

How it works

The combined pill prevents pregnancy by:

• stopping egg follicles ripening in the ovaries
  
• stopping eggs being released (ovulation)
  
• thickening cervical mucus so that sperm cannot swim through as easily
  
• thinning the lining of the womb, making it less able to support an early pregnancy
  
• possibly slowing transport of sperm and eggs within the Fallopian tubes

As long as you remember to take it exactly as prescribed, the combined oral contraceptive pill has a failure rate of less than 1%.

Pros

• An easily reversible form of contraception.
  
• Makes monthly bleeds more regular, reduces blood loss, and protects against anaemia, painful bleeds and pre-menstrual syndrome.
  
• Women taking the pill are less likely to develop fibroids, and it helps some women with endometriosis, by stopping ovulation.
  
• May reduce the risk of cancer of the womb, ovaries, colon and rectum.

Cons

• Must be taken on time, as directed.
  
• May fail if absorption is reduced by vomiting, diarrhoea or interaction with certain drugs, including broad-spectrum antibiotics.
  
• In some women, there may be a delay in conception after stopping the pill.
  
• May dampen libido both while you take them and for some time afterward, according to recent studies
• Unsuitable for women with blood-clotting problems.
  
• Unsuitable for women over the age of 35 who smoke.
  
• Must be stopped six weeks before a major operation.
  
• Has been linked, in some women, with increased blood pressure, blood clots and jaundice.
  
• Can cause side-effects in some women, such as weight gain, nausea, headaches, breast soreness, loss of sex drive, mood changes, intolerance to contact lenses, breakthrough bleeding and vaginal discharge.
  
• May increase the risk of breast cancer - while taking the pill and during the 10 years after stopping its use. However, once women have stopped taking the pill for ten or more years, no significant extra risk of breast cancer remains. This increased risk is thought to be very small.

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