What's the difference between the combined pill and the mini pill?

Normally referred to as simply “the pill”, the oral hormonal contraceptive pill remains one of the most popular forms of birth control worldwide. And despite its overarching term, there are actually two different kinds of pill; the combined pill and the mini-pill.

What's the difference between the combined pill and the mini pill?

One common myth is that the mini pill simply contains lower doses of the ingredients in the combined pill. However, the actual difference between the two is that the combined pill contains two different kinds of hormones (oestrogen and progestogen) while the mini pill only contains progestogen. For this reason, the mini pill is also commonly referred to as the progestogen-only-pill or POP.

Aside from the ingredients they contain, the two kinds of pill also differ in the way in which you use them. While the combined pill is designed to be taken one-a-day for 3 weeks, followed by a 7 day pill-free break, the mini pill is to be taken one-a-day, every day. So during the 7 day break on the combined pill, you will have a period but because there’s no break on the mini-pill you will likely notice irregular menstrual cycles and probably no periods at all.

Advantages of the combined pill

When taken correctly, the combined pill is over 99% effective at protecting against pregnancy. However, based on “typical use” (the way in which it’s taken in real life, rather than in a perfect world), the effectiveness is actually around 92%.

As well as being a highly effective method of preventing pregnancy, the combined pill can also help to regulate your periods and make them lighter and less painful. It can also reduce PMS (premenstrual syndrome) symptoms such as mood swings, headaches and bloating.

The combined pill also decreases your risk of ovarian and endometrial cancers by preventing ovulation and some types of combined pill (Clairette, Dianette) can also help to improve acne or greasy skin.

Advantages of the mini pill

Despite the hormone ingredients being slightly different, the mini pill is just as effective at preventing pregnancy as the combined pill. Because they don’t contain oestrogen, they rely solely on the progestogen to do this. By thickening the cervical mucus and thinning the lining of the uterus, the mini pill is able to prevent pregnancy without stopping ovulation.

The main benefit to the mini pill is that it’s suitable for those who cannot tolerate oestrogen and it can also be used while breastfeeding (which the combined pill cannot). It can also be taken by those with health problems (like high blood pressure or high risk of blood clots) and can be taken at any age.

Disadvantages of the combined pill

Although it’s a highly popular choice, that doesn’t mean that the combined pill comes without downfalls. Like most hormonal contraceptives, the pill can cause some unwanted side effects such as weight gain, nausea, breast tenderness, spots and depression. Not everyone who takes the pill will experience these though and it may be that certain brands of the pill could suit you better than others.

The combined pill also increases your risk of blood clots, heart attack and stroke, however the risk is very small and all contraceptive pills contain further information on this.

Disadvantages of the mini pill

Again, the mini-pill can come with side effects, however you may find that there are more with this type than with the combined pill. Some women experience irregular menstrual bleeding, decreased libido, acne and increased amount of hair on the face, chest and back.

The mini-pill is also probably not the best contraceptive option for those who are not diligent about taking the pill at the exact same time every day. While there is a leeway of a day or two with the combined pill (as long as you then take an extra pill to make up for the missed dose), the mini-pill must be taken at exactly the same time every day. 

If you miss the exact time by more than 3 hours then you may find that you are not protected against pregnancy and you may need to use additional contraception (like condoms). 

While both types of pill have their advantages and disadvantages, both offer effective pregnancy prevention. It’s about working out which type of pill (and indeed, which particular brand) suits your body best. Although, it’s also important to note that no pill provides any protection against STI’s (such as Chlamydia or HIV) and you should therefore always take extra measures to ensure you are looking after your sexual health.