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Combined oral contraceptive pill

Commonly known as ‘the pill’

Key points about combined oral contraceptive pill

The combined oral contraceptive pill (also called 'the pill') is used to prevent pregnancy.
Find out how to take it safely and possible side effects.

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The combined pill, also called ‘the pill’, contains the hormones oestrogen and progestogen. It's a pill or tablet that you take every day to stop getting pregnant. It works by stopping ovulation (which is when an egg is released from your ovary). The combined pill is also used to treat heavy menstrual (period) bleeding (also called menorrhagia). It makes the lining of your uterus thinner which makes your periods lighter.

The combined pill is one of the more reliable forms of contraception

If used correctly, the pill is 99% effective in preventing pregnancy.
However, most of us are not perfect, and sometimes we forget to take it every day, so in real life it's usually only 92% effective. This means that about 8 out of 100 people who use the pill each year will get pregnant.
To make sure the pill works best, you need to take it every day, whether you have sex on that day or not. Learn more below about how to take the combined pill.
It's important to know what do you if you miss a dose. See below what should I do if I miss my dose?.
It's also important to remember that if you're sick (vomit) soon after taking your pill, or have diarrhoea (runny poo), the pill may not be absorbed and may not work. See below – what if I have diarrhoea (runny poo) and vomiting (being sick)?

Note: The combined pill isn't suitable for everyone. There's information below about who cannot take the combined pill.
There are 2 types of oral contraception available in Aotearoa New Zealand. The combined pill has the hormones oestrogen and progestogen. This page covers information about the combined pill. There is also a progestogen-only pill (or mini pill), which contains only progestogen. Read more about the progestogen-only pill.

Examples of the combined pill

There are a variety of brands and strengths of the pill available in Aotearoa New Zealand. They contain different combinations of oestrogen and progestogen.
Your doctor will help you decide the best combination for you.
If you experience side effects, you may need to try a few different types before you find one that suits you.

Some brands of the pill can be purchased from your pharmacy without a prescription if you meet the criteria. See below: Can the combined pill be purchased without a prescription?

Examples of the combined pill
Brevinor® Brevinor-1® Levlen ED® Lo-Oralcon 20 ED® Mercilon® Microgynon 20® Microgynon 30®	Microgynon 50® Monofeme® Norimin® Oralcon 30 ED® Yasmin® Yaz®

Supply issues (August 2024)

Brevinor 1/28: There's a supply issue with Brevinor 1/28. You will only be able to collect 1 pack at a time. This is so the current supply of Brevinor 1/28 can be made to last until another product is available. Alyacen 1/35 will be funded from 1 October 2024. Read more about the Brevinor 1/28 supply issue(external link).
Norimin: There's a supply issue affecting Norimin tablets. You can only collect 1 pack at a time. This is so the supply of Normin can be made to last until Norimin is widely available again. Read more about the Norimin supply issue(external link).

Pros	Cons
✔ You can choose to have a period each month or not. ✔ It doesn’t interfere with having sex. ✔ Your periods are likely to be regular, shorter, lighter and less painful. ✔ It can be taken up to the time of menopause by a healthy non-smoker. ✔ It may help with premenstrual syndrome symptoms, improve acne and reduce symptoms of endometriosis. ✔ It may reduce the risk of endometrial cancer, ovarian cancer and colorectal cancer. ✔ May help with symptoms of polycystic ovary syndrome such as acne, excessive hair growth and irregular periods.	✘ It needs to be taken each day at the same time of the day, whether you have sex on that day or not. ✘ It doesn't protect against sexually transmitted infections (STIs), so it’s also important to use condoms. ✘ It may cause irregular bleeding for a few months after starting. As long as you haven't missed any pills, it will still be working. If the bleeding continues, talk to your healthcare provider. ✘ It's not suitable for everyone.

Pros

Cons

✔ You can choose to have a period each month or not.

✔ It doesn’t interfere with having sex.

✔ Your periods are likely to be regular, shorter, lighter and less painful.

✔ It can be taken up to the time of menopause by a healthy non-smoker.

✔ It may help with premenstrual syndrome symptoms, improve acne and reduce symptoms of endometriosis.

✔ It may reduce the risk of endometrial cancer, ovarian cancer and colorectal cancer.

✔ May help with symptoms of polycystic ovary syndrome such as acne, excessive hair growth and irregular periods.

✘ It needs to be taken each day at the same time of the day, whether you have sex on that day or not.

✘ It doesn't protect against sexually transmitted infections (STIs), so it’s also important to use condoms.

✘ It may cause irregular bleeding for a few months after starting. As long as you haven't missed any pills, it will still be working. If the bleeding continues, talk to your healthcare provider.

✘ It's not suitable for everyone.

You will need to take 1 pill each day, at about the same time each day.

Usually a pill packet has 21 ‘active’ hormone pills and 7 non-hormone pills.
The non-hormone pills are also called sugar pills. See below – what are sugar pills?

When taking the pill, you don't need to have a period every month. The following 3 options give you some choice. The most effective option is option 3 below, where you take the hormone pills continuously (the ‘not have a period’ option).

With every option you need to take 1 pill each day, at roughly the same time.

Ways to take the pill
Option 1: To have a period each month Take the hormone pills for 21 days, THEN take the non-hormone (sugar) pills for 7 days. Repeat this every month. Your period will start while you're taking the sugar pills.
Option 2: To have a period every few months Take the hormone pills for 21 days, then go straight on to taking the hormone pills from a new packet, missing the 7 sugar pills. When you want to have a period, take the sugar pills for 7 days, then start the hormone pills again from a new packet.
Option 3: To not have a period (also called continuous regimen) Take the hormone pills for 21 days and then go straight on to taking the hormone pills from a new packet. Do not take the 7 sugar pills. Repeat this every month. This means you won’t get your period. This way of taking the pill is the best way to protect you from pregnancy. Note: This is the most reliable way of taking the pill.

Ways to take the pill

Option 1: To have a period each month

Take the hormone pills for 21 days, THEN take the non-hormone (sugar) pills for 7 days. Repeat this every month. Your period will start while you're taking the sugar pills.

Option 2: To have a period every few months

Take the hormone pills for 21 days, then go straight on to taking the hormone pills from a new packet, missing the 7 sugar pills. When you want to have a period, take the sugar pills for 7 days, then start the hormone pills again from a new packet.

Option 3: To not have a period (also called continuous regimen)

Take the hormone pills for 21 days and then go straight on to taking the hormone pills from a new packet. Do not take the 7 sugar pills. Repeat this every month. This means you won’t get your period. This way of taking the pill is the best way to protect you from pregnancy.
Note: This is the most reliable way of taking the pill.

What are sugar pills?

Some packs of the combined pill have 21 active pills and 7 non-active sugar pills. The non-active sugar pills are also called non-hormonal placebo or reminder pills. These pills are meant to help you remember to take your pill every day and start your next pack on time.

Taking the sugar pills will trigger bleeding, like a period. You are still protected from pregnancy during this time.
The hormone-free days must not be longer than 7 days. At the end of the hormone-free days, start a new pack.
Always start your new pack of pills on time, even if your period hasn’t ended. Your period should stop in a few days. If you don’t have a period, start your new pill pack and see your healthcare provider.

If you miss 1 pill

If you forget to take a pill, take it as soon as you remember, and take the next one at the normal time (even if this means taking 2 pills together). If you miss 1 pill, you are still protected from pregnancy.

If you miss 2 or more pills

Take a pill as soon as you remember and the next one at the normal time (even if this means taking 2 pills together). Depending on how you're taking the pill, you might need to take other steps to protect yourself from pregnancy.

It can be complicated working out what to do if you have missed some pills, so if you're not sure what to do ask your doctor, nurse or pharmacist as soon as you can.

Vomiting and ongoing diarrhoea can stop your body absorbing your pill, which may stop it from working.

If you vomit within 2 hours of taking a pill, take another pill as soon as possible.
If you have ongoing vomiting or bad diarrhoea lasting 24 hours or more, contact your healthcare provider for advice.

Most people who want to can take the pill, but it's not suitable for everyone.

You should NOT use the pill if you:

are over 35 years of age and smoke
are overweight (BMI >35)
have gallstones
have breast cancer or have had breast cancer in the past
have diabetes with complications
have high blood pressure
are about to have major surgery
have had a heart attack, stroke or blood clot in legs or lungs
have parents, brothers or sisters who have had a blood clot in their legs or lungs
are pregnant, have had a baby within the last 3 weeks or started breastfeeding within the last 6 weeks
are taking certain medicines such as lamotrigine, over-the-counter preparations or herbal remedies.

Your healthcare provider will be able to work out whether the pill is safe for you.

Most people who take the pill don't notice any side-effects. However, a small number of people feel sick, have headaches or find their breasts are sore when they take the pill. These side effects usually go away within days or weeks of starting the pill. If they continue, there are many different brands of pill you can try to see if there's one that may suit you better.

Increased risk of blood clots

People taking the pill have a small increased risk of developing a blood clot (thrombosis). Blood clots can cause blockages in veins (causing deep vein thrombosis or pulmonary embolism) or in arteries (which can cause heart attacks or strokes).

This may occur at any time but the risk of blood clots is highest during the first year after starting the pill or when restarting after a break of 4 weeks or more.
You're at increased risk if you have, or have had, blood clots (thrombosis) before or have thrombophilia (eg, antiphospholipid syndrome). Other things that increase your risk are major surgery, long periods of sitting (eg in a wheelchair or during long-distance travel), injury, after pregnancy, smoking, obesity, and older age. See the section above about who can't take the pill.
Seek immediate medical attention if you have a hot, swollen or painful leg, and/or if you experience chest pain, cough or shortness of breath.

Other side effects

Side effects	What should I do?
Breast tenderness Headaches Mood changes Skin changes	These may go away with time. If they don't get better, tell your healthcare provider.
Breakthrough bleeding (bleeding that occurs on and off) or spotting	This may go away with time. If not, tell your healthcare provider.
Severe stomach pain Signs of liver problems such as dark-coloured urine (pee), yellow skin and eyes Severe headache or loss of vision or fainting or numbness	Tell your doctor immediately or phone Healthline 0800 611 116.
Signs of blood clots such as swelling, pain or change in colour in one or both legs, chest pain, difficulty breathing or shortness of breath. Read more about hormonal contraceptives and blood clots(external link).	Tell your doctor immediately or phone Healthline 0800 611 116.

Some brands of the pill can be purchased from your pharmacy without a prescription if you meet the criteria.

Your pharmacist will ask some questions about your health and other medicines you're taking. If you're breastfeeding you can be given a progesterone-only pill. For some situations, the pharmacy will refer you back to your healthcare provider. If you don't know if you're eligible for over the counter contraceptive, talk to your pharmacist.

There may be a charge for your prescription and appointment.

When can the pill be purchased without a prescription?

You can get the pill from your pharmacy if you've had a prescription from your doctor within the last 3 years and you are 1 of the following:

from Aotearoa New Zealand and have run out of your contraceptive pill
from overseas and have run out of your contraception pill
collecting the emergency contraceptive pill and have used the contraceptive pill before
wanting to restart the contraceptive pill and have used it before
wanting the contraceptive pill after having a baby and have used it before.

Who can't purchase the pill without a prescription from their pharmacy?

There are some cases where the pill can't be purchased without a prescription from your pharmacy, such as:

If you're under the age of 16 years.
If you're using the pill for the first time.
If you have risk factors that need medical supervision.

Language resource

Here's some information about the contraceptive pill in English(external link), Arabic(external link), Chinese(external link), Hindi(external link), Vietnamese(external link)

The mini-pill
Progestogen-only oral contraceptive pill

The following further reading gives you more information about the pill.

Learn more about the pill:
Combined oral contraceptive pill(external link) Sexual Wellbeing Aotearoa
Taking your pill continuously(external link) Sexual Wellbeing Aotearoa
Combined oral contraceptive pill(external link) Health New Zealand | Te Whatu Ora

Learn more about the risks of the pill:
Hormonal contraceptives and blood clots(external link) Medsafe, NZ
Oral contraceptives and blood clots(external link) Medsafe, NZ

Medsafe datasheets on specific brands of the pill
Brevinor(external link) Brevinor-1 21 Day(external link) Brevinor-1 28 Day(external link) Levlen ED(external link) Marvelon(external link)	Mercilon(external link) Microgynon 20(external link) Microgynon 30(external link) Microgynon 50(external link) Monofeme(external link) Norimin(external link) Yasmin(external link) Yaz(external link)