Reviewed by Usama Ali, MPharm (GPhC: 2224726). Last reviewed: April 2026.
There is no single best pill. The right contraceptive pill for you depends on your medical history, your body, and what matters most to you. Through the NHS Pharmacy Contraception Service, you can access a free phone consultation with a clinician who will help you find the right fit.
There is no single best pill. The right contraceptive pill for you depends on your medical history, your body, and what matters most to you. Some people want predictable periods. Some want help with acne or bloating. Some need to avoid oestrogen. Some just want the widest possible window for taking it each day.
Through the NHS Pharmacy Contraception Service, you can access a free phone consultation with a clinician who will help you find the right fit. This guide walks you through the same thinking your clinician uses, so you go into your appointment with a clearer picture of your options.
Every contraceptive pill available in the UK falls into one of two categories.
The combined pill contains two hormones: an oestrogen (usually ethinylestradiol) and a progestogen. You usually take it for 21 days, then have a 7 day break during which you get a withdrawal bleed. It is over 99% effective with perfect use.
The mini pill (also called the progestogen only pill) contains just one hormone. Most types are taken every day without a break. It is also over 99% effective with perfect use.
Neither type protects against sexually transmitted infections. If you need STI protection, use condoms as well.
For a detailed guide on each type, read our guides on the combined pill and the mini pill.
| Combined | Mini pill | |
|---|---|---|
| Contains | Oestrogen + progestogen | Progestogen only |
| How to take | 21 days on, 7 days off | Every day (varies by type) |
| Periods | Regular, predictable bleed | May become irregular or stop |
| Blood clot risk | Small increased risk | No increased risk |
| BP check needed | Yes | Not usually |
| Breastfeeding | Not in first 6 weeks | Safe from birth |
| Smokers over 35 | Not suitable | Suitable |
| Migraine with aura | Not suitable | Suitable |
| BMI over 35 | Not suitable | Suitable |
| Acne | May improve | Depends on type |
| PCS age limit | Up to 49 | Up to 54 (49 for Slynd) |
Before prescribing any pill, your clinician checks your suitability using the UK Medical Eligibility Criteria (UKMEC). This is the same framework used by GPs and sexual health clinics. The main factors are:
Your medical history, including any history of blood clots, stroke, heart disease, liver conditions, or breast cancer.
Your blood pressure. For the combined pill, a recent reading is required. A reading at or above 140/90 mmHg means the combined pill would not normally be prescribed. The mini pill does not usually require blood pressure checks.
Your BMI. A BMI of 35 or above is a reason not to prescribe the combined pill. The mini pill is suitable at higher BMIs.
Whether you smoke. If you smoke and are 35 or over, the combined pill is not recommended. The mini pill is still an option.
Your migraine history. Migraine with aura (visual disturbances or tingling before a migraine) is a reason not to prescribe the combined pill at any age, because it increases the risk of stroke. Migraine without aura is generally acceptable under 35 but is reviewed individually. The mini pill is suitable for people with migraine with aura.
Whether you are breastfeeding. The combined pill is not recommended in the first six weeks after birth if breastfeeding, because the oestrogen can reduce milk supply. The mini pill is safe from birth.
Your current medications. Some medicines reduce the pill's effectiveness, including certain epilepsy medicines, rifampicin, rifabutin, some HIV treatments, and the herbal remedy St John's Wort.
Your age. Through the NHS Pharmacy Contraception Service, the combined pill is available up to and including age 49. The mini pill is available up to 54 for most types, or up to 49 for Slynd (drospirenone).
If any of the above mean the combined pill is not suitable for you, your clinician will recommend the mini pill instead. If none apply, both types are options and the choice comes down to which suits your body and lifestyle best.
There are four types of mini pill available through the NHS Pharmacy Contraception Service. Your clinician will choose based on your circumstances.
Desogestrel 75 micrograms is the most commonly prescribed mini pill in the UK and is usually the first choice. It stops ovulation in most cycles and has a 12 hour timing window. The most common side effect is irregular bleeding, particularly in the first few months. Brands include Cerelle, Cerazette, Feanolla, Zelleta, and unbranded generic desogestrel. Read our guide on Cerelle vs Cerazette for more on the differences between brands.
Slynd (drospirenone 4 milligrams) is a newer mini pill. It also stops ovulation and has a 24 hour timing window. You take 24 active pills followed by 4 inactive pills per pack. Drospirenone has anti-androgenic properties (which can help with acne) and anti-mineralocorticoid properties (which can reduce bloating and fluid retention). It is not suitable if you have kidney problems, are at risk of high potassium levels, have Addison's disease, or take potassium raising medications. Available up to age 49 through the PCS.
Norgeston (levonorgestrel 30 micrograms) is a traditional mini pill. It does not reliably stop ovulation and works mainly by thickening cervical mucus. It has a strict 3 hour timing window. It is sometimes used during breastfeeding or where the patient has tolerated it well previously.
Noriday (norethisterone 350 micrograms) is also a traditional mini pill with a 3 hour timing window. Less commonly prescribed now because of the stricter timing and less reliable ovulation suppression.
For most people, desogestrel is the starting point. If there is a clinical reason to consider an alternative, your clinician may discuss Slynd, Norgeston, or Noriday.
For a full guide to all types, read what is the mini pill.
If your clinician confirms that oestrogen is safe for you, the combined pill opens up more choices. Not all combined pills carry the same level of risk, and your clinician will usually start with the safest option.
The first choice combined pills contain ethinylestradiol (a type of oestrogen) with levonorgestrel. These have the most safety data and the lowest risk of blood clots among combined pills (FSRH, 2023). They provide good cycle control and predictable withdrawal bleeds. Examples include Microgynon 30, Rigevidon, and Ovranette.
Combined pills containing ethinylestradiol with norgestimate or norethisterone carry a similar risk profile and may suit people who experience side effects on levonorgestrel pills.
Combined pills containing ethinylestradiol with desogestrel or gestodene are sometimes considered for people who want improved skin or fewer side effects such as oily skin or excess hair. They are effective and well tolerated, but carry a slightly higher risk of blood clots compared with levonorgestrel pills. Your clinician will weigh this against the benefit.
Combined pills containing ethinylestradiol with drospirenone (such as Yasmin or Lucette) can help with acne, bloating, and PMS because of drospirenone's anti-androgenic and anti-mineralocorticoid properties. They carry a higher blood clot risk than levonorgestrel pills, so they are not the usual first choice, but they can be appropriate when the benefit justifies it.
Your clinician will always start with the safest effective option and only consider a different pill if there is a clear clinical or quality of life reason to do so.
For a full guide, read what is the combined pill.
| Pill type | Brands | Hormones | Timing window | Acne | Bloating | Blood clot risk | PCS age limit |
|---|---|---|---|---|---|---|---|
| Combined pill | Microgynon 30, Rigevidon, Yasmin, Lucette | Oestrogen + progestogen | Up to 24 hours | May improve | Drospirenone types may help | Small increased risk | Up to 49 |
| Mini pill (desogestrel) | Cerelle, Cerazette, Feanolla, Zelleta | Progestogen only | 12 hours | May occasionally worsen | No specific benefit | No increased risk | Up to 54 |
| Slynd (drospirenone) | Slynd | Progestogen only | 24 hours | Anti-androgenic, may help | May reduce fluid retention | No increased risk | Up to 49 |
| Traditional mini pill | Norgeston, Noriday | Progestogen only | 3 hours | No benefit | No specific benefit | No increased risk | Up to 54 |
If acne or skin concerns are important to you, a combined pill containing desogestrel or drospirenone may help, as these have less androgenic activity. On the mini pill side, Slynd (drospirenone) is the only progestogen only option with anti-androgenic properties. Other mini pills may occasionally worsen acne. Mention acne during your consultation so your clinician can factor it in.
Drospirenone (available as the mini pill Slynd, or in combined pills like Yasmin) has anti-mineralocorticoid properties that can counteract water retention. No other currently available progestogen has this effect. If bloating is a significant concern for you, let your clinician know.
The combined pill is often more helpful for heavy or painful periods, as it tends to make them lighter, shorter, and less painful. Some people take it specifically for this reason. You can also run packs back to back to skip periods entirely, which is safe and supported by FSRH guidance. If your periods are the main issue, discuss this during your phone consultation.
If you struggle to take a pill at the same time every day, the timing window matters. Slynd has the widest at 24 hours. The desogestrel mini pill gives you 12 hours. The combined pill and traditional mini pills (Norgeston, Noriday) are less forgiving at 3 hours.
Only the mini pill is suitable while breastfeeding. The combined pill is not recommended during the first six weeks after birth because oestrogen can reduce milk supply. Any type of mini pill can be used safely from birth.
Some medicines speed up how your liver processes the pill, making it less effective. These include certain epilepsy medicines (such as carbamazepine and phenytoin), rifampicin, and St John's Wort. Your clinician will check everything you are currently taking.
If you take lamotrigine for epilepsy, the combined pill can reduce lamotrigine levels in your blood, which may affect seizure control. In this case the mini pill is usually preferred.
If you have a current or past meningioma (a type of brain tumour), desogestrel should be avoided. Your clinician will discuss alternative options.
If you take a weight loss injection such as semaglutide (Wegovy, Ozempic), there is a potential for reduced absorption of oral medications. Your clinician can advise you on this.
Neither type of pill protects against sexually transmitted infections. If you need STI protection, use condoms as well.
Your clinician works through the same steps outlined above, tailored to you.
They review your medical history, check your eligibility under the PCS, and rule out any reasons not to prescribe. For the combined pill, they need a recent blood pressure reading and your height and weight to calculate your BMI.
They then narrow down the options to a safe shortlist based on your health. From there, they talk through your preferences, your lifestyle, and any specific concerns (acne, bleeding patterns, timing, side effects) to arrive at the best fit.
"People often come in thinking there's one perfect pill," says Usama Ali, MPharm (GPhC: 2224726), pharmacist at Contraception Direct. "There isn't. But by the end of the call, we've usually narrowed it down to one or two options that fit your body, your health, and your routine. That's what the consultation is for."
If one pill does not suit you after a trial period, your clinician can help you switch. Many people try more than one pill before finding what works best. Ready to find the right pill? Book your free consultation.
If your phone consultation shows that neither the combined pill nor the mini pill is suitable, or if you want a method you do not have to think about every day, your clinician can discuss alternatives and refer you to the appropriate service.
Long acting reversible contraception (LARC), such as the implant, injection, IUD, or IUS, is more effective than the pill in typical use because it does not rely on daily pill taking. These are not available through our service but can be accessed through your GP or a sexual health clinic.
Your clinician will never leave you without advice. If the pill is not right for you, they will explain why and help you find the right next step.
References
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