THE 24/4 Pills

The 24/4 pill is a low dose, combined oral contraceptive pill. It combines two types of hormones, an estrogen and a progestogen. The progestogen, which is called Drospirenone (DRSP®), offers benefits because it has a positive influence on skin and fluid retention.

This antiandrogenic property benefit (skin improvement) and antimineralcorticoid property benefit (reduced water reabsorption, hence no weight gain) are unique only to Drospirenone, and not any other progestogen.

This 24/4 pill has a different dosing regimen from most contraceptive pills – you take 24 active pink pills followed by 4 inactive white (placebo) pills. Due to the unique 24 + 4 dosing regimen, the hormone-free interval becomes shorter (less hormone fluctuations) and you benefit for longer from the positive effects of Drospirenone.

The 4 placebo pills will also help to improve compliance.

How effective are they?
If the 24/4 pill is used properly, it is 99.97% effective (0.3 in 1000 women will get pregnant per year). 

What are the Advantages?
The 24/4 pill has positive effects on the skin which means that it reduces the effect of male hormones (called androgens) in your body. It is also indicated for treatment of mild to moderate acne. The 24/4 pill also has positive effects on fluid retention. Drospirenone counteracts estrogen induced water retention that causes weight gain.

This 24 + 4 dosing regimen is designed to help reduce pre menstrual related symptoms such as breast tenderness, period pains and cramps which often occur with conventional 21 + 7 contraceptive pills.

Apart from pregnancy prevention, the latest 24/4 regimen oral contraceptive pill also offers women a wide range of additional health benefits such as treatment of symptoms of premenstrual dysphoric disorder (PMDD) – which is a severe form of premenstrual syndrome (PMS), and regulation of menstrual cycles. It is the first & only pill that is indicated for the treatment of PMDD.

What are the Disadvantages?
Some women may have minor side effects when they first start taking the 24/4 pill, but usually these subside during the first month of use. Side effects can include bleeding between periods (inter menstrual bleeding), headaches and breast tenderness. The symptoms should not persist for longer than 3 months. If you are worried about the side effects or if they persist for longer than 3 months, you can talk to your doctor about them.

Many women differ in their response to oral contraceptives depending upon their menses type (light flow, moderate flow, heavy flow), their body type (underweight, normal weight, overweight) and their ovarian hormone sensitivity (oestrogen-sensitive, androgen-sensitive, progesterone-sensitive). When choosing an oral contraceptive, consult with your doctor to find one that’s tailored to meet your individual needs.

For more information on the 24/4 pill, please consult your doctor.

About 100 million women worldwide use combination oral contraceptives (COCs).

The Combined Pill is packaged with either 21 or 28 pills per pack. The more common 21-pills pack contains only 21 active pills and requires women to take a 7-day break between packs. The 28-pills pack contains 24 active pills and 4 inactive placebo pills. These inactive pills are included to minimize the risk of women forgetting to start a new pack of pills on time after a 4-day break. This 7-day or 4-day period, when no active pills are taken, is called the “hormone-free interval” period.

The combined pill employs synthetic hormones that mimic the properties of natural estrogens and/or progesterone to ‘fool’ the female reproductive system. They provide constant levels of an oestrogen and/or progestin in the blood, thus suppressing the release of two natural hormones that will trigger the process of ovulation.

It is easier to inhibit follicular development and ovulation if the pill is initiated from the first day of the menstrual cycle. The later their initiation, the greater the chance of failure (“escape ovulation”). The effect of combination pill is temporary and is quickly and fully reversible.

The most used combination pill preparation worldwide is the monophasic one, where all pills have the same composition of oestrogen and progestogen dosing. In addition to the inhibition of ovulation, the constant level of an oestrogen and progestin in the body causes insufficient thickening of the endometrium, which prevents attachment of the egg.

Progestins also promote production of thick, opaque cervical mucus, which acts as a barrier to sperm, as sperm can only pass through clear, thin mucus. Progestin is also thought to produce changes in the fallopian tubes that impede movement of the egg toward the uterus.

Oestrogen and progestin may also alter the pattern of muscle contractions in the tubes and uterus. This effect may interfere with implantation.

You must see a doctor or nurse to be prescribed the pill; they will take your full medical history in order to find the pill which is best suited to your body. There are a number of different types of the combined pill. Not every type of pill will suit everyone so it is worth discussing different options with your doctor.

How effective are they?
If the combined pill is used properly, it is 99.97% effective (0.3 in 1000 women will get pregnant per year). ^1-6

What are the advantages?
The combined pill is one of the most effective reversible forms of birth control available to women today and is also the method used most widely. The pill contains hormones that prevent pregnancies in different ways, but a woman can get pregnant again once she stops using it.

In addition to protecting against unwanted pregnancy, the pill makes your periods more regular, reduces pre-menstrual complaints, period pains and cramps and gives you lighter periods. Some pills can have a positive effect on your skin and hair.

The pill also has been proven to have important health benefits. For example it improves symptoms of endometriosis and polyscystic ovarian syndrome, and it offers protection against ovarian cancer and cancer of the womb.⁹

What are the disadvantages?
Some women may have minor side effects when they first start taking the pill, but usually these subside during the first months of use. Side effects can include bleeding between periods, headaches and breast tenderness. Some brands of combined pills contain a higher dose of estrogen. If you are on this type of pill and are suffering from side effects, it might be helpful to ask your doctor if you can switch to a low-dose estrogen pill.

Very rarely, a few women might suffer from thrombosis, but this is very uncommon and much rarer than the risks of thrombosis unconnected with the use of hormonal contraception. The risk of thrombosis depends on a number of factors, including family history, age and body weight, and increases if a combination of risk factors are present.

The link between thrombosis and the pill is far less strong than for other risk factors, for example not using contraception and being at risk of pregnancy.⁹ Using the pill may contribute to a slight increase in the risk of having breast cancer but this risk is very small.¹⁰

Could this method suit me?
The pill might not be suitable for all women and there may be reasons why you cannot take the pill, such as a history of blood clots or high blood pressure, severe circulatory disease or heart disease. You also shouldn’t take the pill if you are breast feeding. Your doctor or healthcare professional will be able to assess your suitability and give you advice.

There are a number of different types of combined pills available. Additional benefits include regular periods, less or no pelvic cramps, lighter and shorter periods, improvements of premenstrual syndrome symptoms, and a positive effect on skin and hair.

Additional health benefits include a reduced risk of ovarian cancer and cancer of the womb and less frequent occurrence of benign breast tumours.⁷ There is a slightly increased risk of breast cancer, but this risk is very low.^9,10 Fertility will quickly return to normal when the pill is no longer taken.

Some women may experience mood swings, changes in sex drive, headaches, cyclical bloating or bleeding problems when taking the combined pill. These vary from woman to woman and according to the type of combined pill you are taking.