The Guide to Choosing a Pill that won’t Result in a Billion Dollar Lawsuit or a Trip to A&E

The Guide to Choosing a Pill that won't Result in a Billion Dollar Lawsuit or a Trip to A&E

All are Not Created Equal

Alien girl holds pill or world in hands
Warning: Contains explicit content ♦ & is not to be used as medical advice ♥ Disclaimer here

Congratulations! You are nearly at the end of The Complete Guide to the Combined Pill. If you've read the rest of the guide you now have a good understanding of how they work and you've also checked out The Big List of Possible Side Effects from Combined Hormonal Contraceptives.

If you've reached this point you're probably thinking that these pills could be your choice of poison; you like the idea of having contraception that is totally removed from the moment of fuck*ng, you feel comfortable with the risks and you trust yourself to take them every day. Now you need to know which pills in this category are the best ones for you. There are different versions of the hormones... different doses... different phase patterns and regimes...

Trying to figure out which one you would prefer can be some confusing and tedious motherf*cking sh*t.

Get a list of the ones your prescriber will offer you and then use the information here to see which to consider or exclude.


Aside from the standard one phase pill types; you can get some that are multiphasic - meaning the pills contain varying doses of hormones throughout the month (such as Kariva or Cyclessa). This is an attempt to reduce side effects and unwanted withdrawal bleeds. In reality there is little evidence to suggest that adjusting the phases achieves any real benefits.

As the multi-phase pills have different doses you have to take them in the correct order throughout the month; which you could f*ck up... So they probably won't help with side effects and you also might take them in the wrong order and be less protected from pregnancy. Basically, fiddling around with phases is a bit pointless.


The other, more noteworthy, variable is the regime. The standard regime is 21 days on/7 days off, but there are also extended regimes, such as 24 days on/4 days off, or even 84 days in a row. Or you could take standard pill packets back to back and omit the breaks.

Get Regimented with your Combined Pill

Studies indicate that although there may be some slight advantages; a slight decrease in negative symptoms and perhaps less breakthrough bleeding, these are not massively significant.  Furthermore, the accumulative dose of hormones you ingest will usually be higher overall because you are having fewer or shorter pill breaks.

The main advantage of extended regimes is that you have fewer withdrawal bleeds ie lingerie-ruining-disruptions. Although many women like to have a monthly bleed to feel reassured that they are not pregnant; the bleeds you experience on the pill are not real periods and aren’t even necessarily a surefire sign that you’re not pregnant.

Red pants
Extending the regime of your pill could lead to fewer withdrawal bleeds, then you don't need to waste your time or your pants on those fake ass pill 'periods'

What are the main points to consider regarding extended regimes?

  • advantages: you could have fewer withdrawal bleeds and possibly fewer unwanted symptoms
  • disadvantage: you will usually be consuming a higher cumulative dose of synthetic hormones than you would if you stuck to the standard 21 days on/7 days off regime

Those are the options for how you take your pills. However, this decision could be affected by what hormones you decide you would prefer to swallow. All combined pills contain fake estrogen and progestogen but there are different types, some which are a little sketchy.


Most combined pills use ethinyl estradiol (this is the fake estrogen). The lowest dose of 20mcg is associated with the fewest major adverse events such as blood clots, as well as fewer headaches, less boob pain and less bloating. However, this low dose could result in more breakthrough bleeding or spotting. If you experience too much inconvenient bleeding and want to go up a dose the next stage would normally be 30-35mcg. Going up to 50mcg is not advisable due to safety concerns.

Small and large pills

With combined pills, as with most hormonal contraceptives, the main concern is the risk of blood clots (more specifically venous thromboembolism - or VTE - the formation of blood clots in a vein). There are many other health concerns of course, but none that can sneak up on you quite so suddenly.

In terms of risk of VTE; the lower the estrogen dose the better, but the newer generation progestins give a higher risk of VTE regardless of the estrogen dose. To clarify; if your pill contains an old type of progestin with a high dose of estrogen, this is still safer than a pill that has a new type of progestin with a low dose of estrogen.

What do you need to know about the estrogen options?

  • broadly speaking the lower the dose of fake estrogen; the safer
  • the dose can be increased to reduce unwanted symtoms such as breakthrough bleeding
Broken Fence
Breakthrough Bleeding Breaks Out Again: The case of the unpredictable pill


They can be split into ‘old’ vs ‘new’ (first and second generation vs third and fourth generation).

The newer generation progestins were created with the hope of causing fewer undesirable symptoms. In general, they tend to be less androgenic, meaning they should cause less weight gain, unwanted hair growth and acne than the older types. However these benefits may be marginal and evidence of this reduction in androgenic side effects is fairly scarce. What is certain is that they increase the risk of VTE; to roughly 40 cases in every 100,000 women per year (the risk with older progestins is half of this).

 Bayer violated its duties under FDA regulations and state law by selectively presenting data as to thromboembolic events, which did not adequately inform FDA, doctors or consumers of the ... risks.

- Dr. David Kessler, former head of the FDA

Bayer are the company that make Yaz and Yasmin (containing drospirenone - new generation progestin). In the US there have been over 13,000 cases filed against them for the harm caused by these pills, and there have been at least 100 alleged deaths. Bayer are accused of presenting misleading data about the real health risks of these pills. They have paid out over $1.6 billion in settlements, whilst still purporting that they have done nothing wrong.


Levonorgestrel: Includes Microgynon, Rigevidon, Logynon, Seasonale

The most widely prescribed contraceptive progestin worldwide. Tends to be more androgenic than the other common second generation progestins.

Norethindrone acetate is also commonly prescribed: Includes Loestrin

Others include: norethindrone/norethisterone, ethynodiol diacetate, norgestrel, norethynodrel, medroxyprogesterone acetate, chlormadinone acetate and lynestrenol1 3 4


Norgestimate: Includes Cilest, Ortho Cyclen

Overall a slightly higher VTE risk than the second generation progestins, but lower risk than the other common third/fourth generation progestins (Norgestimate is sometimes classified as second generation).18 19 21

Desogestrel: Includes Cerazette, Marvelon, Mercilon

Gestodene: Includes Femodette

Drospirenone is fourth generation: Includes Yasmin, Yaz

Fewer symptoms related to water retention, and greater improvement in acne compared to levonorgestrel (second generation). Drospirenone may cause higher potassium levels, so women with kidney, liver, or adrenal disease are advised not to use it.

Others include etonorgestrel, cyproterone acetate, dienogest, nestorone, nomegestrol acetate and trimegestone.

A recent large scale study has found that the combination of levonorgestrel (an old generation fake progestogen) with 20mcg of fake estrogen is associated with the lowest incidence of serious adverse events (pills such as Lybrel, Alesse and Levlite). In other words these pills result in fewest hospital admissions compared with all other types of combined pills. 

Two Pills

Which pill is the right one for you then?

There is not necessarily one clear answer to the question which (combined) pill is the right pill. Because although safety would seem the obvious priority for many; the risk factors are fairly small and so it is up to the individual to assess how much they are willing to risk in order to have some fuss free sex.

There is unfortunately no magic formula for finding out which pill is going to give you the best skin and the biggest tits, without killing off your sex drive or turning you insane.

Your best bet is to go to your prescriber, armed with knowledge and questions, then take the plunge.

Finally, please heed this warning:

If you are currently on the pill and feeling a little less enthusiastic about it now you know what it truly does to your body - do not stop taking it without a plan. By all means, stop taking the little blighters at any damn time you wish; but DO NOT CARRY ON MERRILY F*CKING WITHOUT A NEW CONTRACEPTIVE PLAN because sperm are sneaky and if you give them half a chance they're up in your fallopian tubes sniffing out an egg before you've even had a chance to say 'No, you can't stay for breakfast".

Fried egg
How do you like your eggs in the morning? I like mine unfertilised

♦ Over to You ♦

Have the differences in pills ever been explained to you before? Is there anything else you want to know about taking the combined pill? Leave your thoughts and any other comments below and please share and spread the love!

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