The pill, explained

The pill is one of the most used methods of contraception. It works well when you take it every day. This guide from Network One Health explains the two types, how to start, and what to do when things do not go to plan.

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Two types of pill

The combined pill contains two hormones: an oestrogen and a progestogen. Most packs have 21 to 24 hormone pills, followed by 4 to 7 days of inactive pills or no pills.

The mini-pill contains only a progestogen. Its full name is the progestogen-only pill. You take it every day with no break. It can suit women who cannot take oestrogen, including women who are breastfeeding.

Your clinician will help you decide which type fits your health.

How well it works

Out of 100 women using the pill for a year, about 9 get pregnant with typical use (South African guideline; WHO 2025 estimates 7 in 100). With perfect use, fewer than 1 does (both sources agree). The difference comes mostly from missed pills.

The pill does not protect against STIs or HIV. Use condoms as well if you may be at risk.

Starting the pill

You do not have to wait for your period to start. You can start on any day, as long as your clinician is reasonably sure you are not pregnant. Starting on the day of your visit is sometimes called a quick start.

Combined pill

• If you start within 5 days of the first day of your period, you are protected straight away.
• If you start on any other day, use condoms or do not have sex for the next 7 days.

Mini-pill

• If you start within 5 days of the first day of your period, you are protected straight away.
• If you start on any other day, use condoms or do not have sex for the next 2 days.

If you have just had a baby, tell your clinician. The combined pill is not used in the first weeks after birth, especially if you are breastfeeding.

What you might notice

• Combined pill: periods often become lighter, more regular and less painful. It may help with acne.
• Mini-pill: irregular bleeding or spotting is more common.
• Weight: the South African guideline states that weight gain is not a side effect of either type of pill.
• Other side effects: some women notice nausea, breast tenderness or headaches.

If one pill does not suit you, there are many others. Ask about switching rather than stopping.

If you miss a combined pill

These rules are for pills with 30 to 35 micrograms of oestrogen, which covers most combined pills. Check your pack or ask your pharmacist.

You missed 1 or 2 hormone pills, or started a pack 1 or 2 days late

• Take a hormone pill as soon as you remember.
• Keep taking one pill a day. This may mean taking 2 pills in one day.
• You do not need extra protection.

You missed 3 or more hormone pills in a row, or started a pack 3 or more days late

• Take a hormone pill as soon as you remember. Keep taking one pill a day.
• Use condoms or do not have sex until you have taken hormone pills for 7 days in a row.
• If you missed the pills in the third week, finish the hormone pills in your pack. Then start a new pack the next day. Skip the inactive pills.
• If you missed the pills in the first week and had sex without a condom, think about emergency contraception.

Low-dose pills (20 micrograms of oestrogen or less)

• Missed 1 pill: follow the “1 or 2 pills” rules above.
• Missed 2 or more pills: follow the “3 or more pills” rules above.

You missed an inactive pill

• Throw the missed inactive pill away. Carry on with one pill a day.

If you miss a mini-pill

A mini-pill is “missed” if you take it more than 3 hours late. For mini-pills containing desogestrel 75 micrograms, it is missed if you take it more than 12 hours late.

If you have periods (including if you are breastfeeding):

• Take one pill as soon as you remember. Then keep taking one pill a day.
• Use condoms or do not have sex for the next 2 days.
• Think about emergency contraception if you had sex without a condom.

If you are breastfeeding, have no periods, and your baby is under 6 months old:

• Take one pill as soon as you remember. Then keep taking one pill a day.
• You do not need extra protection.

Once your baby is 6 months or older, follow the rule for women who have periods.

Vomiting and diarrhoea

• You vomit within 2 hours of taking a hormone pill: take another hormone pill.
• You have severe vomiting or diarrhoea for more than 24 hours: keep taking your pills if you can.
• It carries on for 2 days or more: follow the missed pill rules above.

Other medicines

Some medicines can make the pill work less well. These include:

• some HIV medicines, such as efavirenz, nevirapine and ritonavir-boosted medicines
• some epilepsy medicines
• the TB medicines rifampicin and rifabutin

If you take any of these, ask your clinician about a method that is not affected. Common antibiotics do not affect the pill. Always tell your clinician about every medicine you take.

When to see a clinician

• You think you might be pregnant
• You missed pills and had sex without protection
• Bleeding is heavy, or carries on for a long time
• You start a new medicine for HIV, TB or epilepsy
• You are 35 or older and you smoke, or you get migraines
• You take the combined pill and get a painful swollen leg, chest pain, sudden breathlessness, a severe headache or changes in your sight. Go to the emergency unit at your nearest hospital straight away.

Where to get the pill

The pill is available at public clinics in South Africa. You can ask for up to a year’s supply, so you do not run out.

What to expect at Network One Health

At Network One Health, we talk through your health and your routine before suggesting a pill. If it does not suit you, switching is a normal conversation.

Booking and questions: WhatsApp Noma on 065 072 5315.

Emergencies: If you think you have a medical emergency, go to the emergency unit at your nearest hospital or call 10177.