Reviewed by Usama Ali, MPharm (GPhC: 2224726). Last reviewed: April 2026.
The combined pill is a daily contraceptive pill containing two hormones: oestrogen and progestogen. It is one of the most widely used forms of contraception in the UK. Unlike the mini pill, which contains only progestogen, the combined pill uses both hormones to prevent pregnancy.
The name "combined pill" comes from that combination. In everyday conversation, many people simply call it "the pill." Around 3.1 million women in England use a hormonal contraceptive method, with the combined pill being one of the most popular choices (FSRH, 2023).
The combined pill prevents pregnancy in three ways. It stops your ovaries from releasing an egg each month. It thickens the mucus at the cervix, making it harder for sperm to reach an egg. And it thins the lining of the womb, reducing the chance of a fertilised egg implanting.
When taken correctly, the combined pill is more than 99% effective, meaning fewer than 1 in 100 people would become pregnant over a year. With typical use, where pills are occasionally missed or taken late, effectiveness is around 91% (FSRH, 2023).
The combined pill does not protect against sexually transmitted infections. If you need STI protection, use condoms as well.
Most combined pills follow a 21/7 pattern: you take one pill a day for 21 days, then have a 7 day break. During the break you will usually get a withdrawal bleed. This is not a true period. It is caused by the drop in hormones during the break. After 7 days, you start the next pack.
Some brands come in 28 day packs where the last 7 pills are inactive placebo tablets. The effect is the same, but there is no gap between packs, which some people find easier to remember.
You can also take the combined pill continuously (back to back) to skip the withdrawal bleed. The FSRH guideline supports this as safe for most people. Your pharmacist can advise whether this suits you.
"A lot of people don't realise you can safely skip the break and run packs together," says Usama Ali, MPharm (GPhC: 2224726), pharmacist at Contraception Direct. "If the withdrawal bleed is inconvenient or you get headaches during it, running packs continuously is worth discussing with your pharmacist."
The combined pill has a wider timing window than most mini pills. If you miss a pill by less than 24 hours, you are still protected. If you miss it by more than 24 hours, follow the missed pill guidance in your patient leaflet or speak to your pharmacist.
Combined pills are grouped by the type of progestogen they contain. All contain an oestrogen (usually ethinylestradiol) but the progestogen varies. Your pharmacist will usually start with the safest option and only suggest a different type if there is a clinical reason.
| Progestogen | UK brands | Blood clot risk | Notes |
|---|---|---|---|
| Levonorgestrel | Microgynon 30, Rigevidon, Levest, Ovranette | Lowest among COCs | Usually first choice. Most safety data available. |
| Norethisterone | Loestrin, Brevinor | Similar to levonorgestrel | Alternative if levonorgestrel does not suit. |
| Norgestimate | Cilest | Similar to levonorgestrel | Alternative first-line option. |
| Desogestrel | Gedarel, Marvelon | Slightly higher | May suit those with oily skin or excess hair. |
| Gestodene | Femodene, Millinette | Slightly higher | Good cycle control. |
| Drospirenone | Yasmin, Lucette | Slightly higher | Anti-androgenic (may help acne). Can reduce bloating. |
Through the NHS Pharmacy Contraception Service, your pharmacist supplies the best value product that meets your clinical need. If you are prescribed a levonorgestrel pill, you may receive Microgynon, Rigevidon, or another equivalent brand. They contain the same active ingredients at the same dose.
The combined pill is suitable for most people aged 16 to 49 through the NHS Pharmacy Contraception Service. Your pharmacist will check your medical history, take a blood pressure reading, and calculate your BMI before supplying it.
The combined pill is not suitable if you have a history of blood clots (DVT or PE), experience migraine with aura at any age, smoke and are 35 or over, have a BMI of 35 or above, have blood pressure at or above 140/90 mmHg, are breastfeeding in the first 6 weeks after birth, or have certain liver or heart conditions.
These are based on the UK Medical Eligibility Criteria (UKMEC), the same framework used by GPs and sexual health clinics. If the combined pill is not suitable for you, the mini pill is often a good alternative because it does not contain oestrogen.
Beyond preventing pregnancy, the combined pill can make your withdrawal bleeds lighter, more regular, and less painful. Many people take it specifically for this reason. It can also reduce symptoms of premenstrual syndrome.
Some people find that pills containing drospirenone or desogestrel help with acne or oily skin, as these progestogens have anti-androgenic properties. This is not a licensed indication for most combined pills, so your pharmacist will not prescribe a combined pill solely for acne, but it can be a welcome side benefit.
You can take packs back to back to skip the withdrawal bleed entirely, which is supported by current FSRH guidance as safe for most people.
Like all hormonal contraception, the combined pill can cause side effects. Common ones include nausea, headaches, breast tenderness, mood changes, and breakthrough bleeding. These usually settle within the first two to three months as your body adjusts.
The combined pill carries a small increased risk of venous thromboembolism (blood clots). For pills containing levonorgestrel, the risk is approximately 5 to 7 per 10,000 users per year, compared to about 2 per 10,000 in non-users (FSRH, 2023). Pills containing desogestrel, gestodene, or drospirenone carry a slightly higher risk of around 9 to 12 per 10,000 users per year.
To put that in context, the risk of blood clots during pregnancy is considerably higher, at around 29 per 10,000. The risk from the combined pill is real but remains low for most people. Your pharmacist will assess your individual risk factors before supplying it.
If side effects persist beyond three months, your pharmacist can discuss switching to a different brand or type. Not everyone suits the first pill they try, and switching is common.
While serious side effects are rare, you should seek urgent medical attention if you experience any of the following while taking the combined pill: painful swelling in one leg (especially the calf), sudden chest pain or difficulty breathing, a severe or unusual headache, sudden changes in your vision, or collapse.
These could be signs of a blood clot and need immediate assessment. Call 999 or go to A&E. Do not wait for a GP appointment.
You can get the combined pill from your GP, a sexual health clinic, or a pharmacy through the NHS Pharmacy Contraception Service. All routes are free.
With Contraception Direct, you book a free phone consultation with a pharmacist. You will need a recent blood pressure reading (taken within the last 12 months). Your pharmacist checks your suitability, discusses your options, and posts your pill in discreet packaging. Most deliveries arrive within 1 to 3 working days.
Not sure whether the combined pill or the mini pill is right for you? Read our guide on which contraceptive pill is right for me or book a consultation and your pharmacist will talk it through with you.