The combined oral contraceptive pill is the most popular contraception in Australia. It’s less invasive than implants or devices that need to be fitted in the arm or uterus, making it an attractive option for many women.
There are more than 30 types of oral contraceptive pills. Different types and brands of contraceptive pill contain different types and doses of synthetic oestrogen and progesterone.
But brand names such as Microgynon, Levlen, Yaz, Brenda and Norimin give little indication of the ingredients, dose or who should use them.
When looking for the right pill, women want to weigh up the cost, safety, efficacy and side effects of the pill. Some women might also be seeking non-contraceptive benefits, such as treatment for acne, pre-menstrual syndrome, heavy or painful periods, endometriosis, or polycystic ovarian syndrome.
And at less than A$120 a year (A$20 a year for concession card holders), they are the cheapest.
The newer and more expensive pills claim to be superior in reducing acne, PMS or menstrual bleeding, which is why they end up being prescribed. But all contraceptive pills have these advantages, and the evidence for supporting one over the other is limited or conflicting.
You’ll pay up to A$360 per year for non-PBS prescriptions.
Healthy women often take the pill for many years, so its safety profile needs to be excellent. The risk of breast cancer is slightly increased while on the pill, resulting in an extra 1.5 women per 10,000 women getting breast cancer. But the pill actually protects against endometrial and ovarian cancer.
Taking the pill doubles the risk of venous thromboembolism (or VTE, where clots develop in the brain, legs or lungs), but it’s still less than the risk of developing VTE in late pregnancy.
Pills with newer generation progesterones potentially double the risk of venous thromboembolism. Yaz Flex – commonly prescribed for its convenient dosing dispenser (Clyk) and its reportedly low risk of weight gain and mood swings – contains one of these newer progesterones. It’s therefore not recommended as a “first use pill”.
The oestrogen dose in the pill is also responsible for the very slightly increased risk of strokes and heart attacks.
The risks of VTE, strokes and heart attacks are also affected by a woman’s background risk of these conditions. Women may not be able to take the pill if they have a history of heart disease, breast cancer, liver disease, VTE or migraines with aura; are over 50 or over 35 and smoke; have a BMI over 35; or have a family history of VTE.
The pill’s failure rate of 9% is high compared to long-acting reversible (LARC) forms of contraception, such as IUDs and arm implants. This means nine out of 100 women becoming pregnant after a year on the pill, compared with less than one women with an IUD or arm implant.