Adverse effects

The most commonly reported side-effects of combined oral contraceptives are nausea, breast tenderness, headache and migraine, menstrual disturbances, mood changes including depression, fluid retention, libido changes and skin changes, including acne. However, every product is different – as is every patient – so attention should be drawn to the information provided by the manufacturer.

Serious reactions include venous and arterial thromboembolic events, stroke and hypertension.

A patient should be advised to stop taking the contraceptive and seek urgent medical help if they experience calf swelling, heat or pain in the calf, shortness of breath, chest pain or coughing up blood (haemoptysis).

They should be advised to reduce periods of immobility, for example after surgery and when travelling, and be encouraged to seek advice if they experience their first ever migraine or develop aura with an existing migraine condition.

Adverse effects should be recorded and reported using the Yellow Card scheme.