Women who are considering taking the combined oral contraceptive pill (COC) should be counselled in a number of areas:

Potential harms and benefits, including

• the COC is > 99% effective if taken correctly
• small risk of blood clots
• very small risk of heart attacks and strokes
• increased risk of breast cancer and cervical cancer

Advising on taking the pill

Guidance relating to taking the pill is dependent on the regimen that has been prescribed:

• Monophasic 21 day pills require 21 days of administration, followed by 7 days off
• Phasic 21 day pils require all 21 pills to be taken in the correct order
• Everyday pills require one pill to be taken each day. The packets include 21 active pills and 7 inactive pills
• Tailored regimes can also be discussed with the women. This is because there is no medical benefit from having a withdrawal bleed. Options include:
  • never having a pill-free interval or 'tricycling' - taking three 21 day packs back-to-back before having a 4 or 7 day break
• Pill should be taken at the same time every day

Rules for starting the pill

There is specific advice to give patients regarding starting taking the pill:

• If the patient starts her pill on the first day of her period (up to 5 days), she will be protected from pregnancy immediately
• If the patient starts at any other time in her cycle, she will need to use condoms for 7 days.
• New mothers can begin to take the pill 21 days after giving birth, providing they are not breastfeeding.