Microgynon is a type of oral hormonal contraceptive, a combined oral contraceptive pill to be precise. This most common type of female contraception is generally referred to as "the Pill". Microgynon contains two active ingredients (hence the name "combined pill"), namely ethinylestradiol and levonorgestrel. The synthetic versions of natural female sex hormones override a woman’s menstrual cycle thus preventing unwanted pregnancy.

Main points to consider

• Microgynon is often the first choice of NHS GPs because it is cheap and seeing as contraception is free of the NHS, cost is of concern to most NHS GPs who operate on a restricted budget.
• While Microgynon has a well-established safety profile and proven track record, many users are not comfortable taking it due to side effect and would like to switch to a newer, more refined pill.
• Microgynon is one of the older pills which means that its hormone concentration is higher than that of the older pills.

For further information please read the Patient Information Leaflet carefully and have a look at our Microgynon page

Dianette is a prescription-only medicine of the antiandrogens class. Dianette has been developed for women suffering from severe acne or hirsutism (excessive growth of facial/body hair) who are also seeking a hormonal contraceptive at the same time. As the name suggests, the active ingredients in antiandrogens counteract the effect of an excess in male sex hormones, which in women characterisitally cause acne and increased facial or body hair. Such a hormonal imbalance, which in many cases is a sign of polycystic ovary syndrome, can effectively be remedied which medicines such as Dianette. Its active ingredients cyproterone acetate (2 mg) and ethinylestradiol (35 micrograms) act in two ways – the former cancels out the effects of the androgens (acne, unwanted hair growth) and is also a synthetic derivative of a natural female sex hormone whereas the latter is a syntheticversion of estrogen, another female sex hormone. This combination overrides a woman’s menstrual cycle thus offering protection against unwanted pregnancy while also improving conditions such as acne or hirsutism, which for many affected women are a source of considerable stress and body confidence issues.

Main points to consider

• While technically speaking it is a type of female hormonal contraceptive, it should not be prescribed solely for this purpose

For further Information please read the Patient Information Leaflet carefully and have a look at our Dianette page

Cerazette is the name of a female hormonal contraceptive. It belongs to the group of progestogen-only medicines which are colloquially referred to as ‘mini pill’. Just like all the other contraceptive pills, Cerazette has to be prescribed by a doctor. Contrary to the combined oral contraceptive pills such as Microgynon or Yasmin, which are often simply known as ‘the Pill’, mini pills do not contain two, but one active ingredient, which is a synthetic form of a naturally occurring female sex hormone. Therefore, progestogen-only pills such as Cerazette are more gentle on the body as the dosage of hormones is much lower. This however implies means Cerazette must be taken everyday. This is different to a typical combined pill dosaging regime where hormones are taken for 21 days followed by a one week break. The medicine has a well-established safety profile and is generally well tolerated. The full list of side effects reported to date can be found in the patient leaflet of the drug, they are very similar to those of other hormonal contraceptives and include mood swings, spotting and acne.

Main points to consider

• To obtain constant reliable protection against unwanted pregnancy, Cerazette has to be taken at the same time every single day, even while you are having your monthly period.
• Certain medicines can impair the effectiveness of Cerazette, for instance certain antibiotics or barbiturates. It is therefore very important that you inform your prescribing doctor of any medicines you take before seeking a prescription for Cerazette.

For further Information please read the Patient Information Leaflet carefully and have a look at our Cerazette page

What is the NuvaRing?

The NuvaRing is a relatively new form of hormonal contraception and a good choice for women who have trouble remembering to take a pill every day. As the name suggests, the small device is ringshaped and inserted into the vagina where it stays for three weeks before it is removed and followed by a one week break. Each NuvaRing is made of a flexible plastic material and easy to insert – you should not be able to feel it once it is in place and it should not interfere with sexual intercourse or cause any discomfort. Approximately 1.5 million women worldwide use the NuvaRing as a means of convenient, safe and reversible hormonal contraception.

How does it work?

NuvaRing acts in the same way as the combined oral contraceptive pill. It contains the synthetic equivalents of two female sex hormones that regulate a woman’s menstrual cycle which are released gradually and constantly. As a result, the natural monthly cycle and its processes such as ovulation are overridden and therefore inhibited. Furthermore, the hormones affect the quality of the mucus in the neck of the womb (cervix) which makes it less likely for sperm to get through the cervix. Because the hormones are released into the bloodstream directly via the walls of the vagina rather than via the stomach, the hormone dosage can be much lower compared to the Pill for example.

Main points to consider

• While the contraceptive ring is a very safe and convenient form of contraception, you should remember that it does not protect against sexually transmitted diseases.
• Do not use the NuvaRing if you are pregnant or breastfeeding.
• It is also unsuitable for obeses patients or women who have got a family history of DVT (deep vein thrombosis) or other blood clotting disorders.
• If you smoke or are over the age of 35, please consult your doctor for other suitable contraceptives.

Side effects

Generally speaking, the NuvaRing is very well tolerated, however some women experience increased vaginal discharge or infection. Although the hormone concentration is low so as to be gentle on the system, their effects can lead to acne, mood swings and in some cases depression. If you experience any unwanted effects while using NuvaRing or if you have any concerns regarding its use, please contact your prescribding doctor for further advice.

What is Evra?

If you are one of the many women wishing to use hormonal contraception without having to remember to take a pill each day, Evra could be right for you. The patch has been available in the UK for nearly 10 years and according to estimated figures, approximately 1% of women using contraception take advantage of the benefits Evra has to offer. The patch is small and discreet and offers continuous protections against unwanted pregnancy.

How does Evra work?

Evra works in the same way as the NuvaRing or the combined oral contraceptive Pill by releasing synthetic versions of two female sex hormones into the bloodstream via the skin. Ethinylestradiol and Norelgestromin override the natural menstrual cycle and suppress ovulation, which means the ovaries do not release any eggs. Furthermore, the hormones in Evra change the quality of the womb lining and the cervical mucus which makes it more difficult for a fertilised egg to nest (if despite Evra’s action and egg should be released, which is very unlikely) and for sperm to get into the womb. The patch is worn for 3 weeks in a row followed by a seven day break before a new patch is applied.

Main points to consider

• Evra does not protect against sexually transmitted infections
• If you are breastfeeding or have given birth recently, please consult your doctor to find out which contraception is right for you
• If you weigh more than 15 stone (90kg), Evra may not be effective and you will need to revert to other means of contraception
• Evra may increase the risk of blood clotting disorders and deep vein thrombosis. If you smoke, have a family history of these conditions or if you need to wear a cast or are bedbound/in hospital for an extended period of time, please inform the respective healthcare provider that you are using Evra as you may need to stop treatment temporarily.
• While the patch is designed to stay on for three weeks despite swimming or any activity involving sweating, it may come off which can on occasions go by unnoticed. Please check that your patch is in place regularly, so in the event that it does come off, you’ll be able to act immediately in a bid to preserve the cotraceptive effect.

Evra Side Effects

Any medicine can have potential side effects and Evra is no exception. Generally speaking however, it is very well tolerated and side effects are mild and rare. If you are concerned at all, please speak to your prescribing doctor.

This combined contraceptive pill contains two types of female sex hormones, oestrogen and progestogen.

How does the pill work?

The hormones contained in the combined contraceptive pill stop you getting pregnant by working in three ways: by preventing an egg being released from your ovaries; by making the fluid (mucus) in your cervix thicker, which makes it more difficult for sperm to enter the womb; and by preventing the lining of your womb thickening enough for an egg to grow in it.

How effective is the pill?

The Pill is the most effective form of contraception, barring sterilisation. If taken correctly, the pill offers 99% protection against unwanted pregnancy, which means that each year statistically less than 1 out of 100 women will become pregnant despite correctly taking the pill.

How to take the pill

To prevent pregnancy, you should follow the packet instructions. Check with your doctor or family planning nurse if you are not sure about how to take the pill.

For 21 day pills requiring a break

Take the Pill every day for 21 days

Most brands come in strips of 21 pills, each marked with a day of the week.

• Take your pill at the same time every day.
• Start by taking a pill marked with the correct day of the week.
• Follow the direction of the arrows on the strip. Take one pill each day, until you have finished all 21 pills.
• Swallow each pill whole, with water if necessary. Do not chew the pill.
• Then have seven pill-free days
• Start over with a new pack after 7 days.

For 28 day pills

Take the Pill everyday without a break

• Take your pill at the same time every day.
• Start by taking a pill marked with the correct day of the week.
• Follow the direction of the arrows on the strip. Take one pill each day, until you have finished all 28 pills.
• Swallow each pill whole, with water if necessary. Do not chew the pill.

Main points to consider:

• The Pill is a reliable contraceptive and may reduce your risk of cancer of the ovary and womb if used in the long term.
• The Pill will not protect you against sexually transmitted diseases.
• This medicine can increase your risk of problems such as blood clots and breast cancer.
• Some women should not take the Pill because of current medical problems or illnesses. Please read the patient leaflet located inside the treatment box.
• To prevent pregnancy it is important to take the Pill as instructed and start each pack on time. Make sure that you understand what to do if you miss a pill or if you think you are pregnant.

Unlike the more popular combined pill, the mini-Pill only contains one hormone – progestogen. Progestogen is manufactured to be similar to the female hormone progesterone. The mini-Pill is far less popular due to a stricter dosing regime and lower comparative effectiveness.

How does the mini-Pill work?

The effects of the mini-Pill are similar to the combined oral contraceptive pill. It prevents pregnancy as it:

• Thickens the mucus around the neck of the womb, preventing sperm from entering
• Makes the lining of the womb thinner, so the environment is not ideal for fertilisation
• Sometimes prevents you from ovulating (releasing an egg), so there is no egg for sperm to fertilise.

How do I take it?

Take the Pill everyday without a break

• Take your pill at the same time every day.
• Start by taking a pill marked with the correct day of the week.
• Follow the direction of the arrows on the strip. Take one pill each day, until you have finished all 28 pills.
• Swallow each pill whole, with water if necessary. Do not chew the pill.

It is very important you take the mini-pill at the same time every day – it does not matter what time you take your pill in the day, but you should stick to the same time and never be more than 3 hours late in taking your pill. You take the mini-Pill everyday without a break, and you continue to do so even when you are menstruating.

Main points to consider:

The mini-Pill is not ideal if:

• You are likely to forget to take your pill everyday at the same time
• Your job requires shift work or moving across time zones
• You are overweight – the pill is not effective if you weigh more than 70 kg or 11 stone

Diarrhoea and vomiting can prevent the mini-Pill from working effectively. If you experience any of these you must continue to take your pill as normal and use a condom during illness and for 2 days after illness clears.

What if I miss a pill?

It is important you take your Pill everyday to ensure it is working properly. The best advice is to make it part of your daily routine by taking it at the same time everyday. Many women find that setting themselves a daily reminder on their phone helps.

For the mini-Pill

If you are taking Femulen, Micronor, Norgeston or Noriday and you forget to take your pill, you are still protected against pregnancy provided you take your pill within the 3 hour window. For example if you normally take your pill at 1pm, you have up to 4pm to remember to take your pill.

If you are taking Cerazette and you forget to take your pill you are still protected against pregnancy provided you take your pill within a 12 hour window.

For the combined contraceptive pill

If you are taking the combined contraceptive pill and you forget to take your pill you are still protected against pregnancy provided you take your pill within a 12 hour window.

For both types of pill

If you completely miss the window of opportunity, take your pill as soon as you remember and then continue to take your pills as normal. Make sure you use a barrier method of contraception and check the patient leaflet as to how long you should do this for. If you are unsure, contact your doctor for further advice.

If you have missed more than one pill in your pack, please contact your doctor for further advice.

If have been sick/ I am suffering from diarrhoea

If you vomit or have very bad diarrhoea within 2 to 3 hours after taking your Pill, it is likely you will not have absorbed the dose fully. Try taking another tablet , preferably the last one in your pack. If illness persists for longer than 12 hours check the patient leaflet for further information.

Can I delay my period with the Pill?

When you take the Pill you do not have a normal period. What you do get is something called “withdrawal bleeding”. Withdrawal bleeding is similar to a period, but most women find it is lighter and last less time. The Pill is therefore, often beneficial to women who normally experience very heavy and uncomfortable periods.

Taking the 21 day Pill with a 7 day break allows the body to simulate a natural cycle, and many women find this reassuring. It is possible however, to run two or more pill packs together so you do not experience withdrawal bleeding. You may experience some spotting, but this is nothing to worry about.

What side effects are caused by the pill?

The contraceptive Pill may cause:

• Fatigue
• Change in sex drive (increased or decreased libido)
• Hypertension
• Headaches
• Weight gain/water retention
• Depression/Mood swings
• Migraine

For a complete list of side effects consult the patient leaflet.

As the Pill can alter blood pressure, it is important that you have your blood pressure monitored regularly while you take the Pill.

Which medications interact with the Pill?

Some medicines interact with the Pill and prevent it from working properly. Advise your doctor of all medications you take before going on the Pill. Medications may interfere with the effectiveness of the Pill are:

• some medicines used to treat epilepsy
• griseofulvin (an anti-fungal medicine)
• phenylbutazone (an anti-inflammatory medicine)
• certain antibiotics
• certain sedatives (called barbiturates)
• St. John’s Wort (a herbal remedy).

Changing from another type of oral contraceptive

21-day pill

If you are taking a 21-day contraceptive pill finish that pack and then start taking your new pill the next day. Do not leave a gap between packs. Start with a pill marked with the correct day of the week. By starting in this way you will have contraceptive protection at once. You may not have a period until the end of the first pack of your new pill, but this is not harmful. You may have some bleeding on pill-taking days, but do not worry.

Everyday combined pill (28-day pill)

Your new pill pack should be started after taking the last active tablet from the Everyday pill pack. The first pill from your new pack is taken the next day which means that you do not leave a gap between packs. Start with a pill marked with the correct day of the week. Return to your pharmacist any remaining inactive tablets from your old Everyday pack. By starting in this way you will have contraceptive protection at once. You may not have a period until the end of the first new pill pack but this is not harmful. You may have some bleeding on pill-taking days, but do not worry.

Mini pill (progestogen-only pill)

The first Microgynon 30 tablet should be taken on the first day of the period, even if you have already taken a mini pill on that day. Return to your pharmacist any mini pills left in your old pack. Start with a pill marked with the correct day of the week. Follow the instructions as before (see "Taking your first pack of Microgynon 30"). By starting in this way you will have contraceptive protection at once.

Contraindications

The Pill increases the risk of a blood clot such as in the legs (Deep Vein Thrombosis), lungs (Pulmonary Embolism), a stroke or heart attack.

Your risk of Deep Vein Thrombosis, Pulmonary Embolism, stroke and heart attack is increased if you:

• are a smoker
• are overweight with a BMI above 35
• are over 35 years of age
• suffer from migraines with aura
• have high blood pressure
• have had a blood clot in the past or if the condition runs within your family
• you have mobility problems

The risk of catching STIs

The Pill cannot prevent you from catching sexually transmitted infections. Only a barrier method (male or female condom) can stop you from getting STIs such as Chlamydia, Gonorrhoea, Herpes, Syphilis and HIV. If you frequently change sexual partners, you should always use a condom. If you and your partner want to stop using condoms you should both get tested for sexually transmitted diseases before doing so.