The basics you should know before starting the contraceptive pill

Before starting the contraceptive pill and using Contro’s service, it is important that you understand what this method of birth control is, how it works and the advantages and risks you should be aware of. To make this simple, we’ve broken down the key facts you need to know into bitesize chunks, so you can feel confident that you understand the contraceptive pill, and that it is the method of birth control for you.

Types of the contraceptive pill


1. The combined pill

Commonly known as ‘the pill’, the combined pill contains artificial versions of the female hormones oestrogen and progesterone. These hormones are naturally produced in the ovaries. There are 3 main types of combined pill:

Monophasic 21-day pills: Every pill in these packs have the same amount of hormones in it. This is the most common type of contraceptive pill.
Phasic 21-day pills: Each pack contains different coloured sections of pills. The pills in each section contain different amounts of hormones, so it is important they are taken in the correct order.
Every day pills: Each pack contains 21 active pills and 7 inactive or sugar pills, which must be taken in the correct order.

2. The progestogen-only pill

Only contain an artificial version of the hormone progesterone.

How does the pill work

A woman can become pregnant when a man’s sperm reaches one of her eggs. Here’s how the two types of pill work to prevent this from happening:

Combined pill:

This pill prevents the ovaries from releasing an egg each month during ovulation. Additionally it makes it harder for the sperm to reach the egg by thickening the mucus in the neck of the womb, while also thinning the lining of the womb so a fertilised egg cannot implant.

Progestogen-only pill:

This pill prevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg. Certain types of the progestogen-only pill will also prevent ovulation.

How to take the pill

Before beginning your prescribed contraceptive pill, it is important that you read the provided instruction booklet specific to that brand, and understand the instructions provided to you by the doctor. Failure to take the pill correctly can reduce its effectiveness as a method of birth control.

Combined pill:

21 day pills are used by taking one pill at the same time for 21 days until the pack is finished. You then have a 7 day break where you bleed, and start the next pack on the eighth day.
Every day pills are used by taking one pill in the correct order for each day of your 28 day cycle. During the 7 days of inactive pills you will bleed. The next pack is started on the eighth day.

Progestogen-only pill:

There are 28 pills in a pack of progestogen-only pills. One pill must be taken everyday within either 3 hours or 12 hours of the same time each day. There is no break between packs when taking progestogen-only pill, so when you finish the pills in one pack, you start the next pack the next day.

Read the information booklet received with your specific brand of pill to determine the timeframe you need to take each pill within. It can vary from brand to brand.

How to start the pill

You can start both types of pill at any time during your menstrual cycle. However read below to check whether you will be protected from pregnancy straight away. There will be additional guidance given to you by your doctor and the instruction booklet if you have just had a baby, an abortion or a miscarriage. Please note that the below can vary if you have a short menstrual cycle (23 days or less).

Combined pill:

If you start the combined pill within the first 5 days of your cycle (of your period), you are protected straight away. If you start after the first 5 days you will require additional contraception, such as condoms, for the next 7 days.

Progestogen-only pill:

If you start the progestogen-only pill within the first 5 days of your cycle, you are protected immediately from pregnancy. However if you start the pill on any other day of your cycle, you will need to use additional contraception until you’ve taken the pill for 2 days.


The pill is 91%-99% effective. With perfect use, the pill is 99.7% effective. This means that less than 1 out of 100 women who take the pill would become pregnant in 1 year.

In order to reach maximum effectiveness, you will need to take the pill around the same time everyday, you should not miss a day, and you must start each new pack on time.

Brands of contraceptive pill and generics

There are over 30 different brands of contraceptive pills available in South Africa, each with various generic versions. Generics are copies of branded-drugs which have the same dosage and use as the original drug. Check out our blog on why you should choose a generic birth control. (ADD LINK)

What to do if you’ve missed a pill

Missing pills can reduce the effectiveness of the contraception, however if you miss a day or take the pill late on the same day, the likelihood of you becoming pregnant is very low, especially if you haven’t had sexual intercourse in the last 24-48 hours. If you’ve missed a pill, you should take the last pill you missed straight away, even if this means taking two pills in one day. Then carry on taking the rest of the pack as normal.

If you’ve missed two pills and you’re on a combined pill, you should repeat the above and use extra contraception for the next 7 days. You may need emergency contraception if you’ve missed 2 pills in the first week of your cycle and had unprotected sex in the last 7 days.

Depending on which type of progestogen-only pill you are on, if you’re more than 3 or 12 hours late taking your pill, you won’t be protected against pregnancy. You should repeat the above, use additional contraception for the next 2 days and seek emergency contraception if you’ve had unprotected sex in the time since you missed your pill.

If you’ve been vomiting or had diarrhoea, you may need emergency contraception or another form of contraception.

Read the instruction booklet included with your birth control, or speak to a GP, contraception nurse or your Contro Partner Doctor if you have any concerns regarding missed pills.

Who can take the pill

You should not take the pill if you:
Are pregnant
Are very overweight
Take certain medicines, including ARVs and Rifampicin
Smoke and are older than 35

You also should not take the pill if you have, or have had:
Thrombosis in a vein
A stroke
Heart disease or heart abnormalities
Breast cancer
Diabetes with complications or for the past 20 years
Severe migraines
Disease of the gallbladder or liver

One of our Partner Doctors or a GP will be able to advise you on whether the contraceptive pill is suitable if you think any of the above apply to you during your consultation.

Advantages of taking the contraceptive pill

It usually makes your bleeds regular, lighter and less painful
It can reduce PMS symptoms
It can reduce acne
It does not interrupt sex
It can stopped at any time
It can reduce the risk of certain cancers, including of the colon, womb and ovaries
It can reduce the risk of fibroids and ovarian cysts

Disadvantage of taking the pill

It can cause unwanted side effects at first (see below)
It can increase your blood pressure
It does not protect you from sexually transmitted diseases (see below)
It has been linked to increased risk of serious health conditions such as breast cancer
Risk of blood clots (combined pill only)

Side effects

Short term, minor side effects may include headaches, dizziness, nausea, breast tenderness and mood swings. If these symptoms persist after 3 months you can work, you should contact you doctor to find an alternative brand of pill that works for you. If you are signed up to Contro, we can put you in touch with your assigned Partner Doctor to run through your options.


It is important to note that the contraceptive pill does not protect you from sexually transmitted diseases, known as STDs. It’s recommended that you and your partner get tested before engaging in any form of sexual activities, and use a condom when you do. We know this is an inconvenience and often costly, which is why we’re working hard to bring you home testing STD kits so you can get tested in the comfort of your own home.

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