Indications, efficacy, side-effects, and risks

• Women wishing to control their fertility or menstrual cycle and who have no contraindications to its use (see UK Medical Eligibility Criteria for Contraceptive Use (UKMEC)).

Women wishing to use CHC for menstrual control should be informed that this is outside the product licence (with the exception of Qlaira®).

A Cochrane review comparing the combined patch, ring and pill has concluded that these methods have similar efficacy.

• Perfect use: (following directions for use) the failure rate is 0.3%
• Typical use: (actual use including inconsistent or incorrect use) is 9%.

Women should be informed of the typical use failure rate

The Faculty have recommended caution in women greater than 90kg using the CTP due to concerns over efficacy. This is independent of BMI. These women should consider alternative methods of contraception other than the CTP.

The Faculty have recommended caution in women greater than 90kg using the CTP due to concerns over efficacy. This is independent of BMI. These women should consider alternative methods of contraception other than the CTP.

Common side effects

• Nausea
• Headache
• Mastalgia
• Skin reactions including photosensitivity
• Chloasma
• Reduced menstrual loss
• Unscheduled bleeding
• Amenorrhoea
• Contact lenses may irritate

Less common side effects

• Changes in libido
• Mood changes (no evidence causes depression)
• Chorea
• Hypertension
• Impairment of LFTs
• Hepatic tumours

Further information comparing the side effects of the combined hormonal methods. is available in the FSRH Clinical Guideline: Combined Hormonal Contraception (January 2019, Amended October 2023) 

At first prescription of CHC all women should be informed that:

• CHC use is safe for the majority but can be associated with rare but serious harm.
• Venous thrombo-embolism (VTE):
• There is a small increase in the risk of VTE with CHC use.
• This risk is highest in the first 4 months of CHC use.
• It reduces but remains stable thereafter.
• The risk returns to that of non-users within weeks of discontinuation. (see table below).
• When counselling women it is important to emphasise that while some progestogens within CHCs may be associated with a higher risk of VTE than others, the risk of a venous thrombosis in women who use the CHC is very small – smaller than that associated with pregnancy and the puerperium.

• There may be a small increase in the risk of heart attack with CHC use. (see UK Medical Eligibility Criteria for Contraceptive Use (UKMEC)).
• There may be an increased stroke risk, particularly in migraine sufferers with associated aura (see UK Medical Eligibility Criteria for Contraceptive Use (UKMEC))
• Any increased risk of breast cancer is likely to be small (RR 1.24) and returns to no increased risk 10 years after stopping COC. Users of COCs have not been found to be associated with increased mortality from breast cancer.
• There may be a very small increase in the risk of cervical cancer that increases with increasing duration of use. This returns to that of never-users 10 years after stopping CHC.
• Use of COC is associated with a reduced risk of ovarian and endometrial cancer that continues for several decades after stopping.

Key symptoms that should prompt women to seek urgent medical review
► Calf pain, swelling and/or redness
► Chest pain and/or breathlessness and/or coughing up blood
► Loss of motor or sensory function

Key symptoms that should prompt women to seek medical review
► Breast lump, unilateral nipple discharge, new nipple inversion, change in breast skin
► New onset migraine
► New onset sensory or motor symptoms in the hour preceding onset of migraine
► Persistent unscheduled vaginal bleeding

New medical diagnoses that should prompt women to seek advice from their
contraceptive provider (and review of the suitability of CHC)
► High blood pressure
► High body mass index (>35 kg/m2 )
► Migraine or migraine with aura
► Deep vein thrombosis or pulmonary embolism
► Blood clotting abnormality
► Antiphospholipid antibodies
► Angina, heart attack, stroke or peripheral vascular disease
► Atrial fibrillation
► Cardiomyopathy
► Breast cancer or breast cancer gene mutation
► Liver tumour
► Symptomatic gallstones