Contraceptive pill

How the pill works

The pill contains oestrogen and progesterone. These are hormones that ensure that:

• The ovaries do not release eggs, so you cannot get pregnant.
• The mucus at the entrance to the uterus becomes less permeable to sperm cells.

When you stop taking the pill, your body will resume releasing eggs.

How to take the pill

• Most pill strips in the Netherlands have 21 pills, and you will take a pill every day for 21 days. This is followed by a break for 7 days, during which you will get your period. During that week, you will not take a pill. After the break week, you will start a new strip, even if you are still losing a little blood. If you wait longer, you are not protected.
• There are also pill strips that have 28 pills. There is no break then. The last pills in these strips do not have hormones and are a different colour. In that final phase, you will get your period. Once you finish the strip, you will immediately start the next strip.

Reliability

If you take the pill correctly and on time the chances of becoming pregnant are minimal. You are then constantly protected even during the break week. The pill does not protect against sexually transmitted infections (STIs).

I want to start the pill

You can only take the pill with a prescription from the doctor. The pharmacy will not give you the pill without a prescription. If you have decided you want to start taking the pill, the doctor who prescribes the pill or the nurse who gives you the prescription will discuss the best time to start:

• If you start on the first day of your period (menstrual cycle), you are immediately protected from pregnancy. You will have your period once earlier than normal.
• If you start on another day of your menstrual cycle, you are not immediately protected from pregnancy. You must first take the pill for 7 consecutive days. Use a condom if you have sexual contact during these days.

What if I forget to take the pill

If you forget one pill but can still take it within 12 hours of the usual time, there is no risk and the pill is still reliable.

If you forget the pill for longer than 12 hours, the reliability depends on which week of your strip you are in.

Week 1, forgot one or more pills

• If you had sexual contact during this week or the break week, take a morning-after remedy (if still possible) and do a pregnancy test just to be sure; this is reliable three weeks after the last unprotected contact. Continue with the pill strip and use condoms for the first 7 days after forgetting. After those 7 days the pill will be reliable again.
• If you have not had any sexual contact during this week or the break week, continue the pill strip and use condoms for the first 7 days after forgetting. After that the pill will be reliable again.
• The above advice also applies if you started your new strip too late.

Week 2, forgot one or more pills (max. 4 pills)

You can continue taking the pill as usual. You are not at risk of getting pregnant if you finish the rest of the strip without mistakes.

Week 3, forgot one or more pills

Finish the strip and immediately start a new strip. Then you are not at risk of becoming pregnant. No break week in this case.

If you forget the pill often

If you forget the pill often, another contraceptive method may be more suitable. You can always contact your GP or the Centre for Sexual Health to discuss other options.

Vomiting and diarrhoea

If you vomit or have diarrhoea within 4 hours of taking the pill, the pill will not be reliable. The best thing to do is to take an extra pill from a spare strip. Then continue with the current strip. If that isn’t possible, follow the steps for forgetting the pill above. If you have sexual contact on those days and the 7 days after, use condoms just to be sure.

What if I get pregnant anyway

If you become pregnant after forgetting the pill, consider whether you want to continue the pregnancy and discuss your options with your GP or the Centre for Sexual Health.

Side effects

The symptoms you may experience are usually temporary. If you suffer a lot or experience other side effects, contact your GP or visit the Centre for Sexual Health.

• blood loss (spotting) in the first months of taking the pill
• headaches or tight breasts
• emotional or depressed feelings
• mild weight gain due to fluid retention

Risks

The pill generally poses little risk to your health. People taking the pill have a slightly higher (but still relatively small) risk of:

• Thrombosis (clot in a blood vessel) and other cardiovascular diseases. If you smoke and are over 35, this risk increases slightly.
• Breast cancer if you use the pill for a long time.

What if I need to take medicine

If a doctor wants to prescribe other medication, tell them you are on the pill. Some medicines can reduce the effectiveness of the pill. Hypericum (St John's wort), which can be bought without a prescription, can also reduce the pill's effectiveness. You should then take extra measures to make sure you don't get pregnant. Discuss this with your GP, pharmacy or the Centre for Sexual Health.

Delaying my period

If you take the pill, you can delay your period. This is easiest with the 21-day pill strips where each pill has the same composition. Once you finish the strip, you will immediately start the next strip. This will postpone the break week for a few days or weeks, or you can skip the break week altogether by finishing the next strip completely.

Some pill strips have different conditions:

• With a three-stage pill, you can only delay menstruation if you continue with the pills from the last stage of the strip. Talk to your GP or the Centre for Sexual Health about how to do this.
• If you take the Yaz 24+4 pill, you can postpone your period by skipping the last 4 (differently coloured) pills of the strip and continuing immediately with a new strip.
• If you take the Qlaira pill and want to delay your period, do so in consultation with the doctor who prescribed this pill.

There is no problem in postponing the break week for a few months. After a few months of postponement there is a chance of interim bleeding. This is not serious. You are still protected from pregnancy as long as you keep taking the pill.