What is the Best Contraceptive Pill for Me?

If you’re here, then you probably have some idea that not all pills are a good fit for everyone. You could pick at random, using trial and error to find the right one for you, but that can be frustrating and time-consuming. Instead, doing a bit of research can narrow down your options and give you the best chance of choosing a winner.

It may help to see what other people in the UK have chosen in the past. Here’s a graph showing which contraceptive pills were bought most often in the UK in 2015.

So what should you consider when making your choice? Well, there are a few different factors that can make a contraceptive pill more or less suitable. Keep in mind the following questions when choosing a pill:

• whether they are safe for someone with your medical history (see the rest of this section for details)
• how good you are at remembering to take pills every day at the same time (see our section on ‘mini pill vs combined pill’ for details)
• whether or not you want to take your pill continuously (see our section on ‘mini pill vs combined pill’ for details)

Oestrogen restrictions

Based on your current and previous medical history, some pills may not be safe for you to take. For example, pills containing oestrogen, also known as combined pills, may not be right for you if you:

• are over 35 and a smoker
• have high blood pressure
• have a history of blood clots
• have migraines with an aura
• have a history of heart problems
• are overweight
• are breastfeeding

If any of the above apply to you, then your best choice might be one of the mini pills that are available. These don’t have oestrogen in so the health risks listed above don’t apply.

Extra benefits of oestrogen

On the other hand, if you don’t have any of the pre-existing conditions listed above, but you do get:

• premenstrual syndrome
• polycystic ovary syndrome
• acne
• heavy periods
• endometriosis

Then, you might find a combined pill is a better choice because in these cases the oestrogen can actually improve your symptoms.

The pill after giving birth

Also, if you’re currently breastfeeding and it’s been less than 6 weeks since you gave birth, then combined pills may not be a suitable option, but mini pills are. This is because the oestrogen in the combined pill can come through in breast milk and affect your baby. Small amounts of progesterone do come through breast milk on the mini pill but this won’t affect your baby’s development.

Combined pills and mini pills work slightly differently, but they both include man-made hormones that make it much less likely you’ll have an unwanted pregnancy. This is done by making changes to your body which make it harder for sperm to reach an egg or harder for a fertilised egg to grow.

Combined pills work by:

• stopping ovaries from releasing eggs
• thickening the mucus at the neck of the womb
• thinning the lining of the womb

Mini pills work by:

• stopping ovaries from releasing eggs, but not always
• thickening mucus at the neck of the womb
• thinning the lining of the womb
• slowing down eggs travelling to the womb

Since both the mini and combined pills are effective it can be tricky to know which ones to go for. The table shows how they compare to one another.

There are a few reasons why you might pick the mini pill over the combined pill, including:

• you have a health condition that makes the combined pill unsafe for you
• you want to avoid oestrogen-related side effects
• you want to get your pill over-the-counter
• you are currently breastfeeding and it’s been less than 6 weeks since you gave birth

If you’re taking one of the mini pills Cerazette, Cerelle, Hana, Zelleta or Desomono then you only have a 12-hour window for taking your pill before it stops working. Other mini pills only have a 3-hour window before they stop working.

If you want a bigger window of opportunity to take your pill each day, you should think of starting a combined pill. If combined pills aren’t right for you because of your medical history, then go for Cerazette or Cerelle instead. See our page on forgetting the pill for more information.

Mini pills are meant to be taken continuously. They are prescribed for non-stop use, and this is how they are suggested to be used by their manufacturers.

The reasons you might choose the combined pill over the mini pill include:

• it gives extra benefits to acne and period-related health conditions
• it has a bigger window of opportunity for taking your pill, in case you’re prone to forgetting
• you want to avoid progesterone-only side effects

Combined pills can keep working even if you’re up to 24 hours late taking a dose every now and then. Although, they will stop working if you miss too many in a row.

Combined pills are usually taken for 3 weeks straight and then you take a week off and have a breakthrough bleed, a bit like a normal period. Some combined pills even come with a week of medication-free pills for you to take so you can keep track easier.

Not only is taking the combined pill continuously as safe and effective as taking it with the 7-day break, there is a significant improvement to menstrual bleeding. Research shows an average of 10.7 fewer bleeding days in the first 3 months when taking the combined pill continuously.

All combined pills are less likely to affect depression and anxiety because of the oestrogen they contain. Avoid mini pills if you can.

But, if you want to use a contraceptive pill and want to know what will give you the lowest chance of causing depression and anxiety or making them worse, then the best choice is probably a combined pill.

Like with depression and anxiety, all combined pills are less likely to cause mood swings because of the oestrogen they contain. Avoid mini pills if you can.

Research shows that combined pills with anti-androgenic progesterones (drospirenone or desogestrel) can help make mood swing side effects less intensive. Pills with these progesterones in include:

• Gedarel
• Lucette
• Marvelon
• Mercilon
• Yasmin

The best pills for acne are combined pills. Progesterone-only mini pills can make acne worse. Combined pills can improve acne because of the oestrogen they contain so high-oestrogen pills may give the biggest improvement, like:

• Norinyl-1, 50 micrograms
• Logynon, 30 to 40 micrograms
• TriRegol, 30 to 40 micrograms
• Cilique, 35 micrograms
• Lizinna, 35 micrograms
• Synphase, 35 micrograms

➤ See our page on the contraceptive pill and acne for more information.

No contraceptive pills cause weight loss. Contraceptive pills can’t help people lose weight, no matter which hormones they have or what the dose is. Some contraceptive pills cause temporary mild weight gain as a side effect, but this will only last while you’re using them. This is because the hormones in the pill can cause you to retain water.

Since the water retention is caused by oestrogen, especially with low progesterone, the best way to avoid water retention is a low-oestrogen pill or mini pill. Yasmin and Eloine can also be good choices for avoiding water retention since their progesterone, drospirenone, acts as a diuretic, meaning it helps you lose the extra water through peeing.

➤ See our page on the contraceptive pill and weight gain for more information.

The best pills for people aged 50 to 55 are mini pills. The mini pill also has a lower risk of blood clots which can be more likely for women over 40.

All combined and mini pills can be safe for people over 40, as long as they don’t have pre-existing conditions that make them unsafe (see our section ‘let's find the best contraceptive pill for you’ for details). The combined pill is not suitable for people over 50 and the mini pill is not right for anyone over 55.

Combined pills also come with some extra benefits during perimenopause. See the section below on ‘the best contraceptive pill during perimenopause’ for details.

The best pills for perimenopause can be high-oestrogen combined pills, because they have some added benefits for women over 40, especially related to perimenopause:

• Norinyl-1, 50 micrograms
• Logynon, 30 to 40 micrograms
• TriRegol, 30 to 40 micrograms
• Cilique, 35 micrograms
• Lizinna, 35 micrograms
• Synphase, 35 micrograms

The oestrogen in combined pills can help improve bone density and reduce hot flushes which can both be caused by perimenopause. Like with acne, high oestrogen pills might show the biggest improvement.

Be aware though, combined pills come with a slightly increased risk of blood clots and many older people already have an increased risk.

Premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) are conditions that cause a number of unpleasant symptoms at certain times during the period cycle. Some contraceptive pills can improve these symptoms for some people.

The combined pill containing both oestrogen and progesterone can help improve polycystic ovary syndrome (PCOS). The best kinds of combined pill for PCOS are ones with lower oestrogen doses and progesterones that are less likely to have an androgenic effect (increase in male hormones). Progesterones with less androgenic effect include those containing drospirenone or desogestrel, like:

• Gedarel
• Lucette
• Marvelon
• Mercilon
• Yasmin

There is some evidence showing that mini pills may be slightly better at improving endometriosis than combined pills. Unlike with PCOS, it seems like progesterone pills that are more androgenic (increase in male hormones) work best for improving endometriosis, including:

• Levonorgestrel
• Gestodene

So the best choice of pills for endometriosis will be mini pills containing one of the progesterones listed above, like Norgeston.

Or, if you want a combined pill then choose one that includes levonorgestrel, gestodene or desogestrel.

All contraceptive pills can improve heavy periods. This is because they all contain progesterone which thins the lining of the womb, making periods lighter.

Although you can take any pill to improve periods, the mini pill is usually the first choice. This is because the mini pill is taken continuously and so there is no need for a break period that can cause bleeding. Although combined pills can also be taken continuously, they usually aren’t. See the section on ‘mini pill vs combined pill’ for more information.

All pills can cause side effects but they are mostly mild and go away after a while. Different pills have different oestrogens and progesterones and different people react differently to them.

It’s impossible to know how you will react to different hormones so the only way to find out is to try and see. If you do get side effects from one pill, a doctor or nurse can help you switch to a pill with different hormones to see if that helps.

If you want to avoid oestrogen-related side effects, like:

• breast tenderness
• nausea
• headaches

Choose a mini pill like:

• Cerazette
• Cerelle
• Hana
• Norgeston
• Noriday

Or a low-oestrogen combined pill, like:

• Eloine
• Femodette
• Gedarel 20
• Mercilon
• Millinette 20
• Sunya

Combined pills can have anywhere from 20 to 50 micrograms of oestrogen in but mini pills don’t have any. Low or no oestrogen pills come with a lower risk of oestrogen-related side effects but they also have less of the positive effects on acne or period-related health problems.

If you want to avoid progesterone-only side effects, like:

• mood swings
• acne

Choose any combined pill. Some side effects of progesterone are worse when progesterone is used by itself. This means that they are more likely in mini pills because the oestrogen in combined pills makes them less likely.

➤ For more information see our page on contraceptive pill side effects.

The best contraceptive pill will be one that:

1. is safe for you based on your medical history
2. suits your lifestyle based on how strict your routine has to be and whether you want to take breaks
3. matches up with what you expect in terms of extra benefits and side effects

For example, if you want a pill that will improve acne, you’re worried about gaining weight, and you don’t want a break in your cycle, then you could think about using Microgynon continuously. Microgynon has oestrogen which can improve acne, but it doesn’t have too much. Although mini pills are normally for continuous use, you can do this with Microgynon too.

Another example would be if you’re over 35 and smoke but you’re worried about forgetting your pill and you get heavy periods, Cerelle or Cerazette would be good choices. They are both suitable for women over 35 who smoke and although they have a smaller window of opportunity than combined pills, it’s still larger than other mini pills at 12 hours. Plus, mini pills can help with heavy periods, especially when taken continuously.