Combined hormonal contraception

Combined oral contraception is now available as oral, transdermal, vaginal and injectable preparations. Only the pill and patch are currently marketed in the UK. Most of the data come from the oral preparation - the combined pill - which has been marketed for over 40 years and is used by millions of women. Used perfectly combined hormonal contraception is highly effective (failure rate 1 in 1000) as it works by inhibiting ovulation. In typical use, however, mistakes are made and pill failure rates are around 8%. Serious cardiovascular side effects - heart attack, stroke and venous thromboembolism (VTE) - are rare. The risk of VTE varies with the type of progestogen. Breast and cervical cancer are both increased among users although the absolute risk is small. Prescribing should not be over-medicalized.