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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. The combined pill is prescribed after a video consultation that screens blood pressure, migraine type, smoking, age, weight and clot history every time, for first prescriptions, switches and repeats alike.
- What it is: a daily tablet of synthetic oestrogen and progestogen that stops the ovaries releasing an egg, thickens cervical mucus and thins the womb lining; taken for 21 days with a 7-day break, or continuously to skip bleeds.
- Effectiveness: over 99% with perfect use and about 93% as commonly used, the gap being missed pills, vomiting and late restarts; it gives no protection against sexually transmitted infections.
- Who should not take it: women who get migraine with aura, smoke and are over 35, have high blood pressure, a history of blood clots, certain cancers or liver disease, or are less than 6 weeks after giving birth and breastfeeding.
- Antibiotics: common antibiotics do not stop the combined pill working; the exceptions are rifampicin-type antibiotics, used mainly for tuberculosis. Vomiting within 3 hours of a pill counts as a missed pill.
- Emergency: call 112 for sudden swelling or pain in one leg, sudden breathlessness, chest pain, coughing up blood or stroke-like signs such as a drooping face, arm weakness or slurred speech: these can be signs of a blood clot.
If you take the combined pill and develop sudden swelling or pain in one leg, sudden breathlessness, chest pain, coughing up blood, or stroke-like signs such as a drooping face, arm weakness or slurred speech, call 112 now: these can be signs of a blood clot. Separately, if you get migraine with aura (visual disturbances or tingling before the headache), the combined pill is not suitable for you; book to discuss safer alternatives instead.
How an online consultation helps with the combined pill
- A real suitability check: The doctor screens you along the lines of the World Health Organization's medical eligibility criteria (blood pressure, migraine type, smoking, age and clot history) and will say no, and offer an alternative, if combined hormones are not safe for you.
- Starting and switching made clear: Exactly when protection begins, how to switch from another pill or method without a gap, and what to do in the first month.
- Repeats with a proper once-over: Renewals include a blood pressure update and a check for new risk factors: a review, not a rubber stamp.
- Pan-EU convenience: Prescriptions are sent to a local pharmacy, which also helps if you split your time between countries.
Can I get the combined pill prescribed online?
Yes, usually. A video consultation can often provide enough information to prescribe the combined pill safely: the doctor screens you against the WHO medical eligibility criteria, covering blood pressure, migraine type, smoking, age and clot history, before any prescription is sent to a local pharmacy.[1]
To renew or switch a pill you already take, you can also start with an Express Assessment for the contraceptive pill: a short online questionnaire that a licensed doctor reviews. If the doctor needs to speak to you, the video call is included.
How effective is the combined pill?
With perfect use, the combined pill is over 99% effective; as commonly used, it is around 93% effective, according to WHO figures.[3] The difference comes from missed pills, vomiting and drug interactions. Taken correctly every day, it prevents ovulation, thickens cervical mucus and thins the womb lining. It does not protect against sexually transmitted infections.
Making real-world use match perfect use
Real-world use is where effectiveness is won or lost. Tie the pill to an anchor habit (brushing your teeth, a phone alarm) and it behaves like the 99% figure; take it casually and it drifts towards 93%. Vomiting within about three hours, severe diarrhoea and a handful of interacting medicines also undermine it, which is why the consultation covers how you take it, not just what. For infections, condoms remain the answer; the pill contributes nothing there.
Benefits beyond contraception
Many women stay on the combined pill for reasons beyond pregnancy prevention: periods typically become more regular, lighter and less painful, premenstrual symptoms often soften, and some pills visibly improve acne. Used in a tailored regimen agreed with a doctor, it can also let you skip withdrawal bleeds. It is fully reversible, and fertility returns quickly after stopping. One reassurance backed by evidence rather than folklore: research has not found a consistent link between the combined pill and weight gain, though individual experiences differ and deserve discussion rather than dismissal.[5]
Who should not take the combined pill?
The combined pill is not suitable for women who have migraine with aura, smoke and are over 35, have ever had a blood clot or a known clotting disorder, have uncontrolled high blood pressure, certain liver conditions or a history of breast cancer, or are in the first weeks after childbirth.[1] A doctor screens for all of these before prescribing.
The screening mirrors the WHO's medical eligibility criteria for contraception, which grade every health factor from category 1 (no restriction) to category 4 (unacceptable risk).[1] In plain language, the framework works like this:
Swipe sideways to compare →
| Your situation | Likely first step | Suitable for online care? | When referral or in-person care is needed |
|---|---|---|---|
| Healthy non-smoker under 35, normal blood pressure, no migraine or clot history | Combined pill prescribed after screening (WHO category 1–2: safe for most) | Usually yes | Only if the screening uncovers something new |
| Migraine without aura, a family history of clots, or a raised BMI | Often still usable with caution (WHO category 2: benefits generally outweigh risks), with alternatives discussed | Often yes | If several of these stack up, an oestrogen-free method is usually the safer offer |
| Smoker aged 35 or over, or blood pressure raised | Risks usually outweigh benefits (WHO category 3): the doctor offers an oestrogen-free method instead | Yes, for the alternative method | Raised blood pressure needs treating, in person where needed |
| Migraine with aura, a previous clot or clotting disorder, certain liver conditions or breast cancer history, or the first weeks after birth | Combined pill not prescribed (WHO category 4: unacceptable risk); progestogen-only or non-hormonal options instead | Yes, for the alternatives; not for the combined pill itself | Any clot or stroke signs: call 112 immediately |
Not sure which row fits you? A doctor can tell you in one consultation.
See available times →None of it is box-ticking: each question maps to a real risk, and answering accurately is what keeps this method safe. If the combined pill is not right for you, the progestogen-only pill avoids oestrogen altogether, while the vaginal ring and patch carry the same combined hormones and the same screening; the doctor will walk you through the options.
Blood clots: the honest picture
Blood clots on the combined pill are rare, but real, and you deserve the numbers framed straight. The European Medicines Agency's review of combined hormonal contraceptives found a few extra clot cases per 10,000 women per year compared with non-users, with the exact figure depending on which progestogen the pill contains, and pregnancy itself raises clot risk more than the pill does.[2] For scale: in the EMA's figures, around two in 10,000 women who are not using hormonal contraception develop a clot each year; on a levonorgestrel-type pill this rises to roughly five to seven in 10,000. That is still rare, and lower than the clot risk of pregnancy itself.[2] Risk is highest in the first year of use and after a break of a month or more, and rises further with long immobility, major surgery, obesity and a family history of clots. Rare does not mean never: learn the warning signs in the red box below, and tell any doctor treating you that you take the pill.
What the doctor checks in an online combined pill consultation
The consultation is short and structured, and every item below exists because it changes the decision. The doctor will check:
- A recent blood pressure reading, every time: raised blood pressure plus oestrogen multiplies heart-attack and stroke risk silently, so no responsible prescriber skips it, online or off. A pharmacy machine or a home monitor is fine, and most pharmacies across Europe will measure it while you wait. The combined pill is not prescribed without a reading.
- Migraine, and specifically aura: you will be asked about visual disturbances, zigzag lines or tingling before headaches, because migraine with aura rules out combined hormones (WHO category 4) and points to an oestrogen-free method instead.[1]
- Clot (VTE) screening: any previous blood clot, a known clotting disorder, clots in close family members, recent major surgery, long immobility and planned long-haul flights all shape the decision.
- Smoking and age: smoking from age 35 shifts combined hormones into the risks-outweigh-benefits category.[1]
- Weight, childbirth and breastfeeding: BMI feeds into clot risk, and the first weeks after birth are the wrong time for oestrogen because natural clot risk peaks then.
- Other conditions and medicines: certain liver conditions, a history of breast cancer, diabetes with complications, and enzyme-inducing medicines (some epilepsy treatments, St John's Wort) that can stop the pill working properly.
- How you actually take pills: routines, time zones and past missed-pill patterns, because real-world effectiveness is decided there.
For first-timers, the doctor also previews the first three months: spotting between periods, tender breasts and mild nausea are common while your body adjusts, and usually settle by the third pack. Problems that persist mean a review and often a simple brand change, not giving up on the method. For renewals, the appointment is quicker: blood pressure, any new migraine features, new medicines, smoking and clot events since last time, then the renewal is issued. Most women settle into a quick review about once a year, and it is the moment to raise anything that has niggled: bleeding patterns, mood, skin, libido. Side effects you have been quietly putting up with are worth two minutes of a doctor's time.
The pill when you travel or live between EU countries
Brand names change at borders; the hormones do not. If your usual pill is unavailable, the doctor prescribes an equivalent formulation from what your local pharmacy stocks. Practicalities that save trouble: keep pills in their original packaging when flying, photograph your prescription, and when crossing time zones keep dosing to roughly the same 24-hour rhythm; set the alarm to your home-time interval and shift it gradually. Long-haul flights deserve one extra thought: immobility adds to clot risk, so drink water, move about hourly, and mention planned long flights or surgery at your consultation. If you run out while away, a video consultation from wherever you are can arrange a supply after the usual checks; that is rather the point of an online service.
If you think you might be pregnant
Take a test before starting or continuing the pill. If it is positive, stop the pill and book a consultation: taking it unknowingly in very early pregnancy has not been shown to cause harm, but you should switch promptly to antenatal care. If you are fully breastfeeding in the first weeks after birth, combined hormones are not recommended; the progestogen-only pill usually is.[1]
Treatment options
What you can do yourself
Take the pill at the same time every day, anchored to an existing habit. If you miss one pill, take it as soon as you remember and carry on; you stay protected. If you miss two or more, take the most recent missed pill, use condoms for seven days, and seek advice about emergency contraception if you have had sex around the missed pills.[4] Vomiting within about three hours of a pill, or severe diarrhoea, counts as a missed pill. Keep a note of any new medicine you start, and mention the pill whenever you are prescribed something else. One myth worth retiring: common antibiotics do not stop the combined pill working. The exceptions are rifampicin-type antibiotics, used mainly for tuberculosis, and the illness itself is the bigger threat, because vomiting and severe diarrhoea days count as missed pills.
Prescription treatment
A prescription is never issued without a consultation. When the screening is clear, the doctor will usually prescribe a pill built around levonorgestrel or a similar progestogen at the lowest effective oestrogen dose, because these carry the lowest clot risk: a deliberate first choice, not a default.[2] Starting on the first day of your period protects you immediately; starting at any other time means condoms for the first seven days. Switching from another method is timed so protection never lapses, usually by starting the new pack without a gap, with exact day-by-day instructions for your situation. Repeat prescriptions are issued online with periodic reviews of your blood pressure, headaches, weight and smoking, and if anything has changed, the doctor may recommend a different method rather than simply reissuing the same one.
When the vaginal ring is prescribed online, and when you need in-person care
The doctor prescribes online: first starts, brand switches and renewals when the eligibility screening is clear and a recent blood pressure reading is in hand; equivalent formulations when you are travelling or your usual brand is unavailable locally; and a planned move to the progestogen-only pill, ring or patch when a different method fits you better.
In-person care: when screening places you in a WHO category where risks outweigh benefits (migraine with aura, a previous clot or clotting disorder, smoking over 35, uncontrolled high blood pressure, certain liver conditions or breast cancer history, or the first weeks after birth), the doctor offers a safer method instead of the prescription.[1] The doctor will treat high blood pressure first, in person when needed. A new breast lump, yellowing of the skin or eyes, or severe abdominal pain with a chance you could be pregnant needs in-person assessment promptly. And possible clot or stroke signs mean 112 now, not a booking.
When to get in-person care
Call 112 immediately if you develop possible clot or stroke signs while using combined hormonal contraception: sudden swelling or pain in one leg, sudden breathlessness, chest pain that worsens when breathing in, coughing up blood, weakness of the face or arm, slurred speech, a sudden severe headache unlike your usual ones, or sudden loss of vision. See a doctor promptly in person (not online) for a new breast lump, yellowing of the skin or eyes, or severe abdominal pain with a chance you could be pregnant.
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Speak to a licensed doctor about the combined pill:
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a short safety check: blood pressure, migraine, smoking, clot risk; a prescription only if it is safe for you, honest alternatives if not; if your doctor decides you need to be seen in person, you get a full refund.
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Frequently asked questions about the combined pill
What is the combined pill, and how does it work?
The combined pill is a daily contraceptive tablet containing two hormones, an oestrogen and a progestogen. It prevents pregnancy mainly by stopping the ovaries releasing an egg each month, and also by thickening the mucus at the neck of the womb so sperm cannot pass and thinning the womb lining. Most packs are taken for 21 days followed by a 7-day break, and many brands can be taken continuously.
How effective is the combined pill?
With perfect use the combined pill is over 99% effective, meaning fewer than 1 in 100 women become pregnant in a year. As commonly used, with occasional missed or late pills, vomiting or late restarts after the break, it is around 93% effective, or about 7 in 100. It gives no protection against sexually transmitted infections, so condoms are still needed for that.
Who should not take the combined pill?
The combined pill is not suitable for women who get migraine with aura, who smoke and are over 35, who have high blood pressure, a personal or strong family history of blood clots, a BMI of 35 or more, certain cancers or liver disease, or who are less than six weeks after giving birth and breastfeeding. For these women a progestogen-only method, the coil or the implant is usually the right alternative.
Can I get a combined pill prescription online in Europe?
Yes, after a consultation, which is the point: a prescription is never issued without one. A licensed doctor screens you against WHO-style eligibility criteria (blood pressure, migraine type, smoking, age, weight and clot history), and if the combined pill is safe for you, sends a prescription you can use at a pharmacy near you, for a first supply, a brand switch or a repeat.
Why do you need a blood pressure reading?
Raised blood pressure quietly increases the risk of the rare but serious complications of the combined pill, so a recent reading is part of a safe prescription. A pharmacy machine or a home monitor reading from the last few months is enough; if you have none, the doctor tells you how to get one quickly before the prescription is issued.
What are the side effects of the combined pill?
Common side effects of the combined pill in the first three months are nausea, breast tenderness, headaches, mood changes and breakthrough bleeding, which usually settle; it does not cause weight gain in trials. Benefits include lighter, less painful, more predictable periods, less acne for many women and a lower long-term risk of ovarian and womb cancer. Serious side effects, blood clots above all, are rare.
How big is the blood clot risk really?
Small, but not zero. The European Medicines Agency's review found a few extra clot cases per 10,000 women per year on combined pills compared with non-users, depending on the progestogen, and pregnancy raises clot risk more than the pill does. The risk is highest in the first year and in women with other risk factors, which is exactly what the screening is for.
What should I do if I miss a pill?
One missed combined pill: take it as soon as you remember, take the next at the usual time, and you remain protected. Two or more missed: take the most recent missed pill, use condoms for the next seven days, and if the missed pills were in the first week of the pack and you had unprotected sex, consider emergency contraception; if in the last week, skip the break and run straight into the next pack.
When does the combined pill start protecting me?
Start the combined pill on the first day of your period and you are protected straight away. Start at any other time in your cycle and you need condoms or no sex for the first seven days of active pills. When switching from another method, the doctor explains whether extra precautions are needed, which depends on the method you are leaving.
Do antibiotics stop the combined pill working?
Mostly no: common antibiotics do not reduce the combined pill's effectiveness. The exceptions are rifampicin-type antibiotics, used mainly for tuberculosis, and some epilepsy and HIV medicines. Being ill matters more: if you vomit within about three hours of a pill or have severe diarrhoea, treat those days as missed pills and use condoms for seven days.
Can I take the combined pill continuously and skip my periods?
Yes. Taking the combined pill back to back, without the 7-day break or with a shortened break every few packs, is safe, widely recommended and reduces the bleeding, headaches and mood dips that come in the hormone-free week. Some spotting is common at first. The doctor can advise on a regimen that suits your brand and your plans.
How long can I stay on the pill, and will it affect my fertility?
You can take the combined pill until 50 if you remain healthy and a non-smoker, with a review of blood pressure and risk factors at each repeat. It has no effect on future fertility: ovulation returns within a few weeks of stopping, and some women conceive in the first cycle, so start another method straight away if you are not planning a pregnancy.
What if I travel or move within Europe while on the combined pill?
Keep taking the combined pill at the same time by your body clock when crossing time zones, and carry enough packs for the trip plus a spare. Brand names change between countries, so take your current pack or a note of the hormones and doses with you; the doctor can check that a replacement available where you are matches, and prescribe it after a short review.
Sources & further reading
- Medical eligibility criteria for contraceptive use, 5th edition, WHO, World Health Organization, 2015.
- Combined hormonal contraceptives: benefit-risk review, EMA, European Medicines Agency, 2014.
- Family planning/contraception methods: fact sheet, WHO, World Health Organization, 2023.
- Combined oral contraception (the pill), HSE, Health Service Executive Ireland, accessed August 2026.
- Combination contraceptives: effects on weight (CD003987), Cochrane, Cochrane Collaboration, 2014.
- Combined pill, NHS, National Health Service (UK), accessed October 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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