Written by Sobia Qasim, Reviewed by Usma Parveen - 12th February 2025

Which contraceptive pill is best?

Knowing which method of birth control is best for you can be tricky, especially if you don’t understand the differences between various forms of contraception. But making the right choice can help you to have a better experience and may speed up the process of accessing contraception.

Below, we discuss two of the most common forms of contraception for women - the mini pill and the combined pill. Keep reading to learn more.

Which is the best contraceptive pill?

Both types of contraceptive pills work similarly by using synthetic forms of your natural hormones to prevent your ovaries from releasing an egg. If there’s no egg, there’s nothing for the sperm to fertilise, so you can’t get pregnant. They’re known to be over 99% effective if you use them correctly, and you should also use condoms during sex to further protect yourself from the risk of pregnancy and against spreading or contracting sexually transmitted infections (STIs).

Additionally, both kinds of contraceptive pill can be less effective if you miss one or take it late, including if you vomit or have diarrhoea soon after taking the pill.

Despite these similarities, there are also key differences between the two types of contraceptive pill, and these differences can have a big impact on which pill is the right choice for you.

Progestogen-only pill (POP) or mini pill

The POP, as the name suggests, contains just one hormone - a synthetic form of progesterone. As mentioned, this is a highly effective kind of contraception, but it isn’t appropriate for everyone.

The mini pill might not be suitable for you if you’ve ever had:

A condition affecting your kidneys
Breast cancer
A stroke
A cardiovascular condition (i.e., a condition affecting your blood vessels or heart)
A liver condition.

OR if you take any of the following medicines:

St John’s wort
Lamotrigine
Griseofulvin
Tuberculosis medications
Epilepsy medications
HIV medications
Diuretics.

If any of these circumstances apply to you, it doesn’t necessarily mean that you can’t use the POP. However, you should speak to a pharmacist or doctor about the risks and your options so you can understand how your individual situation affects the right choice for your health.

It’s not all restrictions, though - in fact, the POP can be a great option for those who can’t use other kinds of hormonal contraception that contain oestrogen or synthetic forms of oestrogen. You can also begin taking the mini pill straight away after giving birth, even if you’re breastfeeding. You may need to use extra protection for a few days unless you started the pill in the first 20 days after having your baby.

Using the POP correctly involves taking one pill once a day at roughly the same time - for example, you might want to take it after brushing your teeth in the morning, or before going to bed. Once you’ve finished a 28-day pack of pills, you simply start the next one the following day without taking a break.

If you miss a pill by accident, you might still be protected against pregnancy. This depends on the specific type of mini pill you’re using. You should take the pill as soon as you remember and consult the patient information leaflet (PIL) that comes with your pills to find out if you need to take extra precautions against pregnancy.

In most cases, you can start taking the mini pill at any point in your cycle, though you should ask a pharmacist for advice if you’re switching from another form of hormonal contraception. However, you might not be protected against pregnancy straight away. Again, your PIL will have this information - but if you’re not immediately protected, all you need to do is use another form of protection such as condoms.

Like any medications, the POP can have side effects, including changes to your periods. This can affect flow and frequency, and may have some impact on other aspects of your health such as your mood, weight, skin and sex drive. There is a risk that benign ovarian cysts could develop when you’re taking the mini pill. These aren’t dangerous and often don’t need to be removed. There may also be a slight increase in the risk of developing breast cancer, but there isn’t yet enough evidence to be certain.

If you decide to stop taking the mini pill so you can try for a baby, it’s worth knowing that your fertility will usually take around a month to return to pre-pill levels.

Combined pill

Unlike the POP, the combined pill contains two hormones - progestogen and oestrogen, or synthetic alternatives. This can mean it’s the wrong choice for you if you’ve experienced side effects with oestrogen-containing contraception before.

The following factors may also mean the combined pill isn’t right for you:

Living with obesity
Smoking while aged 35 or over
A family history of blood clots
Taking tuberculosis medications
Circulatory problems including history of stroke, heart disease or high blood pressure
Taking medication for epilepsy
Migraines with aura
Receiving treatment for HIV
Breast cancer
Taking griseofulvin, lamotrigine or St John’s wort
Bile duct or gallbladder problems
Diabetes complications
Liver problems, including cancer or cirrhosis.

As with the POP, these factors don’t mean you definitely can’t take the combined pill. They simply mean you should take extra caution and ask for a pharmacist’s advice first.

Taking the combined pill can have some benefits beyond protecting yourself against the risk of pregnancy. There is also evidence to suggest that the combined pill can help with the symptoms of premenstrual syndrome (PMS), endometriosis, severe acne and polycystic ovary syndrome (PCOS). Seek a pharmacist’s advice if you’re thinking of taking the combined pill for this reason.

You’ll usually have to wait a duration to start using the combined pill again after giving birth, and that duration will be longer if you’re breastfeeding. You can use another method of contraception like condoms in the meantime, and for a short period after starting the pill to ensure protection.

There are two different kinds of combined pill, and the one you’re taking will affect how it works. Some combined pills are everyday (ED) pills. Your packet will come with a series of ‘dummy’ pills containing no hormones. Other pills are 21-day pills, where you’ll take a seven-day break after finishing a pack and before starting the new one. In each case, on the days where you’re not taking any hormones, you’ll typically experience a period-like bleed.

Like the mini pill, the combined pill can usually be started at any stage of the menstrual cycle. Depending on when in your cycle you start, you may need to use extra contraception for a short period to ensure protection.

As for side effects, the combined pill can cause changes to your periods, but these are usually temporary as your body adjusts to the medication. Other possible side effects include high blood pressure, headaches, dizziness, nausea or sore breasts, although it’s not clear if all of these are caused by the pill. For any side effects that last longer than three months, you should consult a pharmacist, as it may be that altering the way you take the pill could help.

In addition, taking the combined pill can increase your risk of developing blood clots, breast cancer or cervical cancer. However, research shows that the risk of breast or cervical cancer goes back to normal levels after you’ve stopped taking the pill for 10 years. Plus, the pill is known to lower the risk of womb, ovarian and bowel cancer.

Choosing between the two types of contraceptive pill isn’t always easy, but it can often depend on your personal and familial medical histories, as well as the side effects and risks associated with either pill. If you’re struggling to decide which pill is right for you, speak to a pharmacist about your options.

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