The Contraceptive Pill
The pill is one of the most familiar ways to prevent pregnancy, and for good reason. Taken correctly it is highly effective, it is easy to stop and start, and it puts you in control of your own cycle. There is not one single pill, though. There are two main types, and knowing the difference helps you have a better conversation with a doctor about what suits you.
This page walks through how each type works, how to take it, how well it works in real life, the side effects that are worth knowing about, and what to do on the day you forget one. It is general information, not personal medical advice, so the final call on which pill is right for you should always be made with a doctor.
The two types of pill
When people say "the pill" they usually mean one of two things: the combined pill or the progestogen-only pill (often called the mini pill). Both are taken by mouth, both are prescription medicines in South Africa, and both are very effective when used well. What differs is the hormones inside them.
The combined pill
The combined pill contains two hormones, an oestrogen and a progestogen, which are similar to the ones your body already makes. It works mainly by stopping ovulation, so no egg is released for sperm to fertilise. It also thickens the mucus at the neck of the womb, which makes it harder for sperm to get through. Most combined pills come in a pack where you take a pill every day for 21 days and then have a 7 day break (or take dummy pills), during which you usually get a bleed.
The progestogen-only pill (the mini pill)
The mini pill contains just one hormone, a progestogen, and no oestrogen. It works mostly by thickening cervical mucus, and some types also stop ovulation. Because there is no oestrogen, it can be a sensible option for women who cannot take the combined pill, for example some women who are breastfeeding, women over 35 who smoke, or women with certain other health conditions. The mini pill is taken every single day with no break, so there is no pill-free week.
How effective is it?
With perfect use, meaning a pill taken correctly every day, both types of pill are more than 99 percent effective. In everyday life, where people occasionally forget a pill, take it late, or have a stomach bug that stops it being absorbed, the real-world figure sits a bit lower. The single biggest thing you can do to keep it working is to take it at around the same time each day.
The mini pill can be less forgiving on timing than the combined pill, particularly the older progestogen-only types, so building a daily habit matters. Linking it to something you already do every day, like brushing your teeth or setting a phone alarm, makes a real difference.
One important point: the pill protects against pregnancy, not against sexually transmitted infections. Only condoms do that, so if STIs are a concern, use condoms as well.
When does the pill start working?
This depends on when in your cycle you begin. As a general guide, both the combined pill and the mini pill take about 7 days to become fully effective. During those first 7 days it is wise to use extra protection, such as condoms, unless your doctor has told you otherwise.
If you start the combined pill on the first day of your period, it can protect you straight away. Starting at other points in your cycle usually means that 7 day wait. Because the exact rule depends on the pill and your situation, follow the instructions that come with your specific pack and check with the prescribing doctor if you are unsure.
Taking it day to day
The routine is simple once it becomes a habit. You take one pill a day, ideally at a similar time. For the combined pill you follow your pack, take the 7 day break where the pack allows it, and expect a withdrawal bleed during that break. For the mini pill you take one every day with no break at all.
A few practical things can throw the pill off. Severe vomiting or diarrhoea can stop it being absorbed properly, in which case you may need to treat it like a missed pill. Some other medicines can interact with it too, so always tell any doctor or pharmacist that you are on the pill. If you are ever in doubt, using condoms as a backup while you sort it out is the safe move.
Side effects worth knowing about
Most women get on well with the pill, but like any medicine it can cause side effects, especially in the first few months as your body settles. These often ease with time.
- Spotting or irregular bleeding between periods, more common early on
- Tender or sore breasts
- Headaches
- Feeling nauseous
- Mood changes
- A change in sex drive
Many women also find the pill has upsides beyond contraception, such as lighter, more regular and less painful periods, and clearer skin. Everyone reacts differently, and if one pill does not agree with you, there are usually other options to try. That is a normal part of finding the right fit, so mention any troublesome side effects to your doctor rather than simply stopping.
There are also rarer but more serious risks to be aware of, particularly with the combined pill, including a small increased risk of blood clots. This is one of the main reasons a proper medical assessment matters before you start, so the doctor can weigh it up against your own health and history.
Who the pill may not suit
The pill is safe for most women, but not everyone, and the combined pill in particular has some clear situations where it may not be the right choice. A doctor will ask about these before prescribing.
The combined pill may not suit you if you have migraines with aura, high blood pressure, a history of blood clots, or if you smoke and are over 35. In several of these cases the mini pill, which contains no oestrogen, may still be a suitable alternative, but that is exactly the kind of decision that needs a doctor's input rather than guesswork. Being upfront about your full medical history, including any conditions in your close family, helps the doctor recommend the safest option for you.
This page is general information and is not a substitute for medical advice. Which method is safe and right for you is a decision to make with an HPCSA-registered doctor.
What to do if you miss a pill
Missing a pill happens to almost everyone at some point. What to do depends on which pill you take and how late you are, so the golden rule is to check the leaflet that comes with your specific pack. As a general guide:
- Combined pill, one pill late or missed: take it as soon as you remember, even if that means two pills in one day, and carry on as normal. You are usually still protected.
- Combined pill, two or more missed: take the most recent missed pill now, continue the pack, and use condoms for the next 7 days. Depending on where you are in the pack, emergency contraception may be worth considering, so get advice.
- Mini pill, more than a few hours late: the window is tighter. Take it as soon as you remember and use condoms for the next 2 days.
If you have had unprotected sex around the time of the missed pills, speak to a doctor or pharmacist promptly about whether emergency contraception is needed. When in doubt, use a backup method and get advice, it is always better to check.
Is the pill right for you?
The pill is a great fit for many women, but it is one option among several. If you would rather not think about a daily tablet, the weekly patch or the longer-lasting injection might suit you better. It can help to compare them side by side on our choosing contraception page before you decide.
If you think the pill could be the one for you, you can start an online consultation from home. You complete a private medical questionnaire, an HPCSA-registered doctor reviews it, and if the pill is appropriate it is prescribed and dispensed by a registered pharmacy partner and delivered to you. Our online service covers the pill, patch and injection. For IUDs or implants you will need to see a clinic in person, since those are fitted by a nurse or doctor.
Start a contraception consultation
You can also read more about how getting contraception online works before you begin.