COMBINED PILL, PATCH & RING.

SIDE EFFECTS &  SAFETY INFO.

The pill, the patch, the ring.

Combined hormonal contraception is used by millions of women in the UK. When used correctly it’s super-reliable at protecting against pregnancy. For some women it has other benefits too, like helping with acne, or making periods lighter or more regular. 

This type of birth control is generally very safe. But there is some info you should be aware of before using it.

Side effects of combined hormonal contraception.

 

Some side effects are quite common when using hormonal contraception.

A lot of the time, milder side effects don’t stick around for too long. It can take a few weeks or a month or two for your body to adjust to the pill, patch or ring you’re using. After that, a lot of the time, side effects will pass.

But if you do get side effects that linger or cause a nuisance, sign in to your account and tell our prescriber, or let your doctor know. They can probably switch you to something else that works better.

Finding the right birth control can be a little bit trial and error. Because there are so many options, it might take a while to find and settle on the best one.

Our bodies change over time too and react differently to hormones. So what was perfect for you five years ago might not be today.

It’s really important to be aware of the risk of serious side effects. If you notice any signs of these, which we’ll go into more detail about below, don’t hang around – go to hospital and get medical attention right away.

Not all hormonal contraceptives are the same. This is a generalised guide to side effects and combined hormonal birth control. But the best guide to your specific pill, patch or ring will be in the paper insert you get in the pack.

 

Serious contraception side effects

You should go to hospital or see a doctor about these immediately.

  • Any signs of a blood clot in the leg (DVT or deep vein thrombosis). A swelling in one leg, or in a vein in the leg; accompanied by: pain or tenderness; feeling hot to the touch; or discolouration (the skin turning pale or red or blue).
  • Any signs of a blood clot in the lung (PE or pulmonary embolism). Feeling breathless; faster breathing; sudden cough with no apparent cause (that may contain blood); sharp pain in the chest that is worse with deeper breathing; feeling very dizzy or lightheaded; very fast or irregular heartbeat; or severe abdominal pain.
    • Any signs of a blood clot in the eye (retinal thrombosis). Sudden loss of vision; or blurring of vision that is deteriorating into loss of vision. 
    • Any signs of a heart attack. Chest pain; feeling pressure or heaviness in the chest; feeling a squeezing or fullness in the chest, arm or under the breastbone; choking or indigestion feeling; discomfort that spans out from the chest to the jaw, windpipe, arm, stomach or back; sweating, feeling or being sick or dizzy; feeling very weak, anxious and short of breath; very fast or irregular heartbeat.
  • Any signs of a blood clot in the brain (stroke). Feeling a weakness or numbness on one side of the body in the face, arm or leg; feeling confused or having difficulty speaking or understanding; sight problems; coordination or balance problems; fast onset of a severe headache; fainting or falling unconscious.
  • Any signs of a severe allergic reaction (anaphylactic shock). Sudden drastic drop in blood pressure; breathing problems; swelling around the face, lips or throat.
    • Any signs that may indicate breast cancer. Dimpling in the skin; changes in the nipple; or lumps you can see or feel.
    • Any signs of severe liver problems (hepatitis). Severe pain in the abdomen; yellow skin or eyes (jaundice).
  • Very high blood pressure.
  • Seizures, fits or convulsions.
  • A migraine for the first time, or a severe long lasting headache that is much worse than usual.

Side effects of contraceptive pills

The side effects below are either common (happen in up to one in 10 users) or very common (happen in more than one in 10 users) in women using combined hormonal contraception:

  • Headache
  • Stomach ache or digestion problems 
  • Irregular periods or spotting (this usually settles down after a few months, and is more likely if you miss a pill or dose, or take the pill different times)
  • Painful periods.

The below side effects are normally classed as common (seen by up to one in 10) in women using combined contraception:

  • Migraine (tell your doctor if this is your first migraine or feel like it’s worse than normal)
  • Swelling in the hands and feet
  • Depression or mood changes
  • Anxiety, nervousness or feeling dizzy
  • Sleeping problems
  • Bloating, constipation, flatulence
  • Acne
  • Rash
  • Muscle spasms
  • Pain in the arms, legs or back
  • Painful breasts
  • Urinary tract infection
  • Thrush
  • Discharge from the vagina
  • Lack of periods
  • Weakness
  • Increase in weight.

Uncommon (less than one in 100 users) side effects in women using combined contraception may include:

  • Breast issues such as discharge, fullness or tenderness
  • Allergic reaction 
  • Abnormal smear test results
  • Tingling or loss of sensation
  • Skin colour changes
  • Skin irritation
  • Thinning hair or excessive hair growth
  • Appetite changes
  • Fluctuating weight
  • Changes in libido
  • Dry eyes
  • Sight problems
  • Palpitations
  • Flushing
  • Pain in the muscles
  • Dry vagina
  • Cysts on the ovaries. 

The following side effects may be considered rare (affecting less than one in 1,000 users) in women using combined contraception:

  • Breast lumps
  • Loss of libido
  • Giddiness
  • Increased heartbeat
  • Pancreatitis
  • Sweating more than usual
  • Photosensitivity

Additional side effects (the frequency of these might not be stated or known) may include:

  • Lower breast milk production
  • Inability to wear contact lenses
  • Red painful swellings on the legs
  • Changes in blood triglyceride or cholesterol levels
  • Sweating during the night.

The risk of a blood clot inside a year is a little higher in women who are using the pill (around 5-7 out of 10,000 women) than it is in women who aren’t taking hormonal birth control (around 2 in 10,000 women).

If you’re concerned about side effects, speak to a doctor or pharmacist. If you’re having milder side effects and want to talk to someone about switching treatment, you can easily do this by signing in to your EveAdam account and leaving the prescriber a message.

Side effects of the contraceptive patch

Because they contain very similar active ingredients, the reported side effects of the combined pill (listed above) and the contraceptive patch are also likely to be similar too, although the frequency might be different. 

There are also additional side effects that relate to the application of the patch, such as:

  • Irritation on the skin where the patch has been placed
  • Or other problems where the patch has been.

Women who use the contraceptive patch are at a slightly increased risk of having a blood clot in a year (about 6-12 in 10,000) compared to women using the combined pill (around 5-7 in 10,000) or not using hormonal contraception at all (around 2 in 10,000).

Check the leaflet for further details of side effects.

Side effects of the contraceptive ring

The hormones in the vaginal ring for birth control are very similar to the combined pill. There may be some variations in frequency, but many of the reported side effects of the pill listed above will also apply to the contraceptive ring.

Some side effects that are specific to the contraceptive ring are more to do with how it is applied, and may include:

The ring falling out (common)
Genital itching (common)
Discomfort in the vagina (common)
Pain or discomfort during sex (umcommon)
Pain when passing urine (uncommon)
Or vaginal injury (frequency unknown)
The risk of having a blood clot within a year is slightly higher (approximately 6-12 out of 10,000 users) with the ring than it is with some types of pill (approximately 5-7 out of 10,000 users).

More details can be found in the leaflet that comes with your ring.

combined contraception contraindications.

 

The combined contraceptive pill isn’t suitable for everyone. 

You shouldn’t use it if:

  • you’ve ever had a blood clot, whether it was in the leg (DVT) or the lung (PE)
  • you have a condition that affects how your blood clots, such as a protein deficiency, antithrombin-III deficiency, Factor V Leiden or antiphospholipid antibodies
  • you’re going to be immobile for an extended period or are about to have an operation
  • you’ve had a heart attack or stroke before
  • you have or have had angina or a transient ischaemic attack before
  • you have or have had before severe diabetes that has harmed your blood vessels, very high blood pressure, or very high cholesterol or triglycerides
  • you have hyperhomocysteinaemia (very high levels of amino acid in the blood)
  • you have cancer that can react to sex hormones, such as womb or breast cancer
  • you get migraines with aura or have gotten them before
  • you have liver cancer or have recently had a condition affecting the liver 
  • you are taking certain antivirals for hepatitis C
  • you are allergic to any of the ingredients listed in your pill
  • you have or have had unexplained vaginal bleeding
  • you’re pregnant, trying to get pregnant or are breastfeeding.

It’s important to tell your prescriber about your medical history during consultation. There are some conditions that may mean you can’t take the combined pill, and some others that mean you can take the pill but only under close supervision.

It’s very important for the doctor, pharmacist or clinician you’re consulting with to know if you have any of the following, or if you find that any of the following get worse while you’re taking the pill:

  • heart, circulation or clotting problems
  • high blood pressure
  • diabetes
  • liver or gallbladder problems
  • Crohn’s disease or ulcerative colitis
  • lupus
  • porphyria
  • migraines
  • epilepsy
  • depression
  • high cholesterol or triglycerides
  • been told you need an operation
  • any problems that have happened during pregnancy or using hormonal treatment before, like jaundice, itching, blisters or severe headaches
  • kidney problems
  • haemolytic uraemic syndrome
  • sickle cell anaemia
  • varicose or inflamed veins.

Make sure you tell the prescriber if you smoke or are overweight, because your risk of blood clots is likely to be higher.

Contraceptive patch contraindications

The contraceptive skin patch has very similar hormonal properties to the combined pill. This means that if you have any of the conditions listed above, that make the combined pill unsuitable for you, the contraceptive patch is likely to be unsuitable as well.

In addition to this, it’s important for your prescriber to know if you have any skin problems, as this may affect your use of the patch. 

If you weigh over 90kg, the patch may not be as effective, so it’s important to let your prescriber know about this too. 

Contraceptive ring contraindications

The same contraindications and warnings apply to both the contraceptive ring and the combined pill.

In addition to the above, it’s important for your prescriber to know if you have: 

  • any condition that may make inserting and retaining the ring more difficult, such as constipation or a prolapsed cervix
  • pain during sex
  • an increased or frequent need to go to the toilet
  • or pain when urinating.

COMBINED HORMONAL CONTRACEPTION AND OTHER MEDICINES​.

 

Some medicines may interact with combined hormonal contraceptives, and make them less effective. Some other medications may increase the risk of side effects of hormonal contraception. So it’s really important to let your prescriber know about any medication you’re taking, have recently taken, or are advised to start. 

Similarly, if you receive treatment from a care provider other than the person prescribing hormonal contraception, it’s important to tell them about the birth control you’re using just in case this affects your treatment.

It’s particularly important for your prescriber to know if you’re taking:

  • epilepsy medicines (topiramate, carbamazepine, phenytoin, fosphenytoin, oxcarbazepine, felbamate, primidone, eslicarbazepine acetate, rufinamide)
  • bosentan
  • rifampicin and rifabutin
  • HIV treatments
  • ombitasvir/paritaprevir/ritonavir and dasabuvir, or boceprevir and telaprevir (for the treatment of hepatitis C infections)
  • aprepitant and fosaprepitant
  • griseofulvin
  • modafinil
  • barbiturates 
  • St. John’s Wort
  • metoclopramide
  • charcoal
  • colesevelam
  • paracetamol
  • etoricoxib
  • vitamin C (ascorbic acid)
  • antifungals such as itraconazole, ketoconazole, voriconazole, fluconazole
  • atorvastatin and rosuvastatin.

Combined hormonal birth control may interfere with the function of:

  • ciclosporin
  • omeprazole
  • lamotrigine
  • prednisolone
  • selegiline
  • theophylline
  • voriconazole
  • tizanidine 
  • paracetamol and aspirin
  • clofibric acid
  • morphine
  • temazepam 
  • insulin or other diabetic medicines.

Before taking your consultation with EveAdam, you’ll be asked to provide details of any medications you’re currently using in your medical profile. It’s important to list any and all of these before starting your plan, and to keep this updated once your plan has begun, to help our prescribers make sure the birth control you’re using is safe.