How it works

The combined pill contains man-made versions of two hormones, oestrogen and progestogen. Together they stop your ovaries releasing an egg each month. They also thicken the mucus at the neck of the womb, which makes it harder for sperm to get through, and thin the lining of the womb.

Taken correctly, it's over 99% effective. In everyday life, when pills sometimes get missed or taken late, it's around 91% effective, which means about 9 in 100 people using it get pregnant each year.

How to take it

Most combined pills come in packs of 21. You take one a day for 21 days, then stop for 7 days, when you'll usually have a bleed. Start your next pack on day 8, even if you're still bleeding.

Every day (ED) pills have 21 active pills and 7 inactive ones, so you take a pill every day and never stop. A few newer pills use other patterns, such as 24 active pills and 4 inactive ones.

You don't have to have a monthly bleed

The bleed in your pill-free week isn't a real period, and there's no health reason to have one. Clinical guidance says it's safe to take packs back-to-back or shorten the break. This can mean fewer bleeds, and a lower chance of pregnancy from starting a pack late. Ask the pharmacist before you change how you take yours.

Starting the pill

Start on day 1 to 5 of your period (day 1 is the first day of bleeding) and you're protected straight away.
Start on any other day and use condoms for the first 7 days.
Zoely and Qlaira are different: you're only protected straight away if you start on day 1. Otherwise use condoms for 7 days (Zoely) or 9 days (Qlaira).

If you're switching from another method, or you've recently had a baby, the rules are different. The pharmacist will tell you exactly what applies to you.

Missed pills and sickness

A combined pill counts as missed once it's more than 24 hours late. Missing one pill is usually fine: take it as soon as you remember, even if that means two in one day. Missing two or more, or missing pills next to your break, can mean you need condoms for a while or emergency contraception.

Missed one? Find out what to do

Answer three questions and get the advice for your exact situation, including whether you need emergency contraception.

Use the missed pill tool

If you're sick or have diarrhoea

If you vomit within 3 hours of taking your pill (4 hours for Zoely or Qlaira), take another one straight away.
If diarrhoea lasts more than 24 hours, keep taking your pills, and use condoms until 7 days after it stops.

Benefits and risks

Benefits

Doesn't interrupt sex.
Often makes bleeds lighter, more regular and less painful.
Can ease premenstrual symptoms.
Lowers the risk of cancer of the womb, ovaries and bowel.
You can stop at any time, and your fertility returns quickly.

Risks and side effects

A very small increased risk of blood clots.
A small increased risk of breast and cervical cancer, which returns to normal 10 years after stopping.
It can raise your blood pressure.
Headaches, feeling sick, sore breasts, mood changes or spotting. These usually settle within 3 months.
It doesn't protect against sexually transmitted infections.

Get urgent help if you notice

Pain or swelling in one leg, especially the calf.
Chest pain, sudden breathlessness, or coughing up blood.
A sudden, severe headache, changes to your vision, or migraines with aura that are new.

These can be signs of a blood clot or stroke. Stop taking the pill and call 999 or go to A&E.

Who it isn't suitable for

The combined pill isn't safe for everyone. It's usually not suitable if you:

are 35 or over and smoke, or stopped smoking less than a year ago
have a BMI of 35 or more
have had a blood clot, have a parent or sibling who had one, or have an inherited clotting condition
get migraines with aura
have high blood pressure, heart disease, or have had a stroke
have or have had breast cancer
have certain liver, gallbladder or serious kidney disease
have diabetes with complications
are breastfeeding a baby under 6 weeks old

Some medicines stop the pill working, including some medicines for epilepsy, HIV and tuberculosis, and the herbal remedy St John's wort. Always tell the pharmacist what else you take.

If the combined pill isn't right for you, the mini pill often is.

Brands

There are a lot of combined pill brands, but many contain exactly the same hormones at the same doses. Rigevidon, Microgynon 30 and Levest, for example, are interchangeable. If you're already on a pill, find it in our list and book from there.

See every combined pill

Based on NHS guidance and clinical guidelines from the College of Sexual and Reproductive Healthcare (CoSRH, formerly FSRH). Last updated September 2026. This page is general information, not a substitute for a consultation.

The combined pill