The combined pill, patch and ring

The combined pill, skin patch and vaginal ring all contain two hormones: oestrogen and progestogen. They mainly prevent pregnancy by stopping ovulation, which is when an ovary releases an egg. In US information, the hormones are called estrogen and progestin. All three are types of combined hormonal contraception.

How you use each method

These methods also thicken the mucus in the cervix (the opening of the womb), which makes it harder for sperm to get in. They thin the womb lining too.

You swallow the pill, stick the patch on your skin, and put the ring into your vagina yourself. Each product comes with its own instructions. ACOG describes rings you replace with new ones and a type you can reuse, so follow the instructions for your own ring.

Using the method correctly matters. For the combined pill, the NHS says it is more than 99% effective if you always use it correctly, and 91% effective if you don’t. CDC measures this a different way. It reports a typical-use failure rate of 7% for the pill, patch and ring. These estimates differ, and they can’t tell you exactly how well you will be protected.

Bleeding and pill breaks

Combined methods can make bleeding lighter and shorter and ease cramps. With some pill packs, you bleed during a break with no hormones, or while taking dummy pills. This bleed is part of how the product works.

Your clinician may suggest changing the pattern of breaks between suitable pill packs. This could mean shorter breaks, fewer breaks, or none at all. It can mean fewer headaches and less bleeding during breaks. ACOG also describes using some patches and rings without a break. Ask your prescriber what suits your exact product. Then follow the leaflet and the plan you agreed, rather than changing the pattern yourself.

Side effects people report include headaches, feeling sick, sore breasts and bleeding between periods. The patch can irritate the skin, and the ring can irritate the vagina. Ask for advice if a side effect gets in the way of daily life.

When oestrogen may be unsuitable

Combined methods slightly raise the risk of blood clots, heart attack and stroke. If you have ever had migraine with aura, you should not use these methods. Aura means warning signs before a migraine, such as flashing lights. Before you choose a method, tell the clinician about any migraine warning signs, past blood clots, stroke, heart disease or high blood pressure.

Smoking and age matter together. The NHS says the combined pill may not be suitable if you are aged 35 or over and smoke. Talk about this with your clinician, even if you feel healthy.

After giving birth, whether you can use these methods also depends on your risk of blood clots and on breastfeeding. UK and US guides give different advice on when to start. Ask your own maternity or contraception clinician to confirm your plan. Oestrogen may affect how much milk you make.

Some medicines and herbal remedies affect how well the combined pill works. Take a list of everything you use, including things you buy without a prescription, to a pharmacist or prescriber. Ask about interactions before you make any changes.

The pill, patch and ring don’t protect against STIs (sexually transmitted infections). You can use condoms as well to help protect against HIV and other STIs. Ask about condoms if you need protection from infections.

Symptoms that need medical help

Call 999 now (UK) or 911 (US), or your local emergency number, for severe difficulty breathing, chest or upper-back pain, or collapse. Do not wait for leg symptoms. Call the same number for sudden face drooping, weakness or numbness in an arm, or difficulty speaking, even if these symptoms stop. In the US, also call 911 or go to the emergency department for sudden breathlessness or coughing up blood.

Contact an urgent GP service or NHS 111 today (UK), or your doctor or urgent care service (US and elsewhere), for new leg pain and swelling, especially on one side.

Get urgent help now from your GP or NHS 111 (UK) for sudden breathlessness or coughing up blood. In the US, call 911 or go to the emergency department for these symptoms. Elsewhere, contact your local urgent medical service now. Severe difficulty breathing, chest or upper-back pain, or collapse needs emergency help as above.

If bleeding changes or other side effects are bothering you, book an appointment. In the UK, see your GP or a sexual health clinic. In the US and elsewhere, see your doctor or a contraceptive service. Ask about your options before you change the method you were prescribed.