Types of Contraceptive Pills (Morning After Pill) and How Do They Work?

Contraceptive pills are one of the most effective methods of preventing pregnancy. They are taken orally and considered safe, simple to use and affordable. They’re also easily reversible – you just have to stop taking them if you want to get pregnant. 

The article discusses the different types of oral contraceptive pills available in this article.

This article is part of a comprehensive set of articles on Contraceptive Pills.

Types of contraceptive pills

There are two types of contraceptive pills – combination contraceptive pills and the progestin-only pill which is also known as the ‘minipill’.

Combination pills

Combination pills are contraceptive pills that contain both estrogen and progestin hormones. They come in packs that have active and inactive pills. Microgynon, in Singapore, is one of the famous brands for combined pills, besides other brands such as Yaz and Yasmin.

Women who are on conventional packs usually take 21 active pills followed by 7 inactive pills, or 24 active pills followed by 4 inactive pills. Menstruation usually happens when the inactive pills are being taken. 

There is also the continuous or extended cycle pack. Women who are on extended cycle packs usually take 84 active pills followed by 7 inactive pills. Because menstruation occurs when the inactive pills are taken, this means that she will have her period only 3 to 4 times a year. 

Combination contraceptive pills can also be categorized into monophasic or multiphasic pills. In monophasic combination pills, the amount of hormones in each active pill is the same. The amount of hormones varies in active multiphasic combination pills. 

Because the amount of hormones in combination pills can vary, women who are more sensitive to them may opt for low dose pills. However, compared to higher dose pills, low dose pills may result in more bleeding between periods. 

How does the combination pill work? 

The combination pill prevents pregnancies in 3 ways. Firstly, it stops the woman’s ovaries from releasing an egg every month. 

It also prevents pregnancy by causing the cervical mucus to thicken. This makes it difficult for the sperm to travel through to the uterus to fertilize the egg if ovulation occurs. 

Lastly, the combination pill causes the endometrium to become thin. This prevents the woman’s egg to implant on the uterus lining if for some reason ovulation and fertilization did occur. Because implantation does not happen, the pregnancy is unable to move on to the next stage.

For more on how contraceptive pills prevent pregnancy, read ‘How Do Contraceptive Pills Work?’

Who can take the combination pill? 

While oral contraceptives are generally safe for the majority of women, there are instances when they are not recommended. As such, a medical professional will ask you about medications you are on as well as your medical history before finding a suitable treatment for you. 

The combination pill might not be suitable for you if: 

• You are over 35 years of age and smoke.
• You have just given birth.
• You have diabetes and diabetes-related complications.
• There is poorly managed high blood pressure.
• There is a history of breast cancer, stroke or heart disease.
• There is a history of migraines with aura.
• There is a blood clotting disorder.
• There is a history of pulmonary embolism or deep vein thrombosis.
• There is unexplained uterine bleeding.
• There is gallbladder disease. 
• You will be immobilized for an extended period of time due to surgery.
• You are on St. John’s wort, anti-tuberculosis agents or anticonvulsant medications.

Progestin-only pills

As the name suggests, progestin-only pills contain only progestin without estrogen. All pills in the pack are active pills and have the same amount of progestin. Because there are no inactive pills, women on the minipill may, or may not menstruate when they are on it. 

Progestin-only pills are a great option for women who are unable to take estrogen for health or medical reasons. 

How does the progestin-only pill work? 

Progestin-only pills work the same way combination pills do – by preventing ovulation, thickening the cervical mucus, and thinning the uterus lining. 

They are, however, less effective in preventing ovulation as consistently compared to combination pills. This may be the fact that it may be harder to keep on schedule when taking progestin-only pills. 

Who can take the progestin-only pill? 

The progestin-only pill may not be suitable for you if: 

• You have liver disease
• You experience unexplained uterine bleeding
• You have breast cancer
• You are on anti-tuberculosis agents or anticonvulsant medications. 

For more on the minipill, read ‘Progestin Only Birth Control Pills: Usage and Side Effects’.

Pros and cons of the combination pill

Like all contraceptive methods, the contraceptive pills too, come with their own advantages and disadvantages. 

Pros

• It can help with menstrual cramps and premenstrual syndrome (PMS).
• It can help with acne.
• It can help make periods shorter, lighter as well as more predictable for women who have heavy and/or irregular periods. 
• The reduction of heavy bleeding also means that it can help with period-related anaemia. 
• It can help relieve endometriosis symptoms. 
• It can help reduce unwanted hair growth due to polycystic ovary syndrome (PCOS)
• The use of combination pills has been linked lower risk of ovarian and endometrial cancers.

Cons

• The effectiveness of the pill is reduced if they are skipped or taken late. 
• They do not protect against sexually transmitted infections (STIs). 
• They may increase the risk of heart attack, stroke and high cholesterol.
• There is an increased risk of blood clots.
• There is an increased risk of breast cancer and cervical cancer for women who are on the combination pill, but this risk declines when the pill is stopped. 
• You may experience side effects such as breast tenderness, irregular bleeding, weight gain, depression, nausea, and headaches. These side effects, however, should settle in a couple of months after you start taking the pill. 

Pros and cons of the progestin-only pill

Advantages and disadvantages of the minipill include:

Pros

• The progestin-only pill might be better if you have risks related to the combination pill, such as migraines, blood clots, heart disease and high blood pressure. 
• You can take them even if you are breastfeeding. 
• It can help lower the risk of endometrial cancer.

Cons

• The progestin-only pill must be taken every day at the same time. You will have to use a backup contraceptive method if you are more than 3 hours late in taking the pill. 
• Similar to the combination pill, it does not prevent STIs. 
• You may experience side effects such as breast tenderness, weight gain and depression. 
• There is an increased risk of an ectopic pregnancy if you do get pregnant when on the minipill. 

For more on side effects of oral contraceptives, read ‘Side Effects and Risks of Contraceptive Pills – Explained’

Conclusion

If you’re thinking about using contraceptive pills, Ova offers online sexual health consultation. Whether you need to use it to prevent pregnancy, regulate your periods or help with conditions such as PCOS, our licensed medical professionals will be able to help you. 

And because we’re direct telemedicine providers, you can speak to us from the comfort and privacy of your home and we’ll send the pills right to your doorstep, discreetly.