Long-term contraceptive tablets (also known as birth control pills) are a type of medication designed to prevent pregnancy using a combination of synthetic versions of naturally occurring hormones called oestrogens and progesterones. There are two main types of oral contraceptive tablets:

• Combined oral contraceptives (also called combined pill or COCs), which contain both hormones (oestrogen and progesterone) and are typically taken daily for 21 days followed by a 7-day pill free break in which bleeding (like a period) will occur. This cycle is repeated monthly.
• Progesterone only contraceptive pills (POPs) also known as the ‘mini-pill’, which contain only the progesterone hormone and need to be taken daily, without any breaks for them to work.

Combined contraceptive pills work in numerous ways to prevent pregnancy occurring. Firstly, they work to stop ovulation, which is when the ovaries release an egg each month. Without an egg to fertilise for the sperm, pregnancy cannot happen. Combined pills also work to thicken the mucus in the womb, thereby making it harder for sperm to pass through the womb to reach the egg. They also act by thinning the lining of the womb, thereby reducing the chance of a fertilised egg implanting into the womb and being able to grow.

Progesterone only pills work in a slightly different way to stop pregnancy occurring. Mainly they act by thickening the mucus in the cervix to stop sperm from reaching an egg. Desogestrel (Cerazette), which is a particular type of progestogen-only pill can also work to stop ovulation.

Combined oral contraceptives are over 99% effective at preventing pregnancy when taken correctly. This means that fewer than 1 in 100 who use the combined pill as contraception will get pregnant in 1 year.

Progesterone only pills are also more than 99% effective, when taken correctly. However, in reality with ‘typical use’ (i.e., the way it’s taken by a lot of women in real life), this medication is around 91% effective in preventing pregnancy. The effectiveness of treatment may decrease if it is not taken around the same time each day. If the traditional progesterone-only pill is taken more than 3 hours late – the desogestrel (Cerazette) pill is taken more than 12 hours late – it may not be effective.

Choice of which oral contraceptive you should use will depend on your health and lifestyle. Therefore, it is important to have a consultation with your doctor or nurse to decide which treatment would be more suitable for you.

Advantages of taking the combined pill

• Due to the 7-day pill break, it maintains a regular period pattern in most women
• It usually helps to make your bleeds regular, lighter and less painful
• It can help with secondary conditions such as acne and irregular periods
• It can also help reduce symptoms of premenstrual syndrome (PMS)
• It may protect against pelvic inflammatory disease
• It may reduce the risk of ovarian cysts, fibroids and non-cancerous breast disease

However, the combined pill may not be suitable for women who suffer from certain conditions, some of which include migraines, cardiovascular disease, blood clots and obesity. This medication should also not be used by individuals who are over the age of 35 and smoke.

Advantages of taking the progesterone only pill:

• May be more suitable for patients who prefer taking a pill everyday
• May be used for patients who cannot take oestrogen (hormone found in the combined pill and other contraceptives such as vaginal rings and contraceptive patches)
• There is no age restriction in who can take this medication
• May be used in patients who smoke or are breastfeeding

Again, the progesterone only pill may not be suitable for all patients and therefore it is important to consultation your doctor or nurse before starting treatment with any oral contraceptive pill to ensure the most suitable medication is prescribed for you.

There are various options available for long-term contraception, some of which include:

• Barrier Contraceptives such as condoms or diaphragms
• Hormonal Contraception which are available for women in the form of patches, injection, and implants
• Intrauterine Devices (IUD) also known as ‘the coil’ which is inserted into the vagina for 5-10 years and is around 99% effective
• Vaginal Rings
• Natural Family Planning
• Female or male sterilisation (vasectomy), which are permanent methods of contraception

Ultimately, the choice of contraceptive method is dependent upon the individual’s lifestyle, health status and personal preference.