The combined oral contraceptive pill (COCP) has been available in the UK since the early 1960s.

Since then it has gone through several incarnations. These are referred to as ‘generations’, of which there are four.

The main difference between them is the type of progesterone which is used. Whilst this may vary, the field of oestrogen hormones used is much smaller, with the most common of these being either ethinylestradiol or estradiol.

Combined hormonal contraception can also be used in the form of a vaginal ring, such as NuvaRing; or a skin patch, such as Evra. Both of which are classed as third generation contraceptives.contraceptive pills generation

What are the benefits of 2nd, 3rd or 4th generation pills?

Generally, second generation pills are considered to be the safest. Third and fourth generation pills have been developed to address side effects some people get when they use second generation pills; and therefore tend to be better tolerated.

However, the risk of oestrogen-sensitive cancer (such as breast cancer) and blood clots is slightly higher for women using third and fourth generation pills.

This difference in risk is still very small:

  • In women who don’t take the pill, the risk of a blood clot is about 2 in 10,000.
  • It increases to 5 to 7 in 10,000 for women taking the second generation pill.
  • For women taking the third generation pill, it’s about 9 to 12 in 10,000.

First Generation Pill

The first contraceptive pills to be developed in the 1960s had a higher concentration of both oestrogen and progestin. The artificial versions of the hormone progesterone found in the 'first' first generation pills included norethynodrel, lynestrenol and ethynodiol diacetate.

The very first contraceptive pills caused side effects in many women who used them, which eventually led to a change in the amount of hormones used. You can still get some versions of the first generation pill today, but these use a lower amount of both hormones.

Second Generation Pill

Microgynon30 TabletsThe next generation of pills came into use in the 1970s, and had a much lower amount of hormones. They contain progestins such as levonorgestrel and norethisterone. Lots of pills still prescribed today contain these ingredients.

Second generation pills your doctor may prescribe include Microgynon, Logynon and Loestrin.

Third Generation Pill

Marvelon TabletsAround a decade after the release of second generation pills came third generation pills. This group of pills uses progestins such as norgestimate, desogestrel, gestodene and cyproterone acetate.

Third generation pills available on prescription in the UK include Cilest and Marvelon.

Doctors can also prescribe third generation contraceptives, such as Evra Patch and NuvaRing, as alternatives to the pill.

Fourth Generation Pill

Yasmin TabletsThe most recent type of combined oral contraceptives contain progestins such as drospirenone, nomegestrol acetate or dienogest.

Pills in this group include Yasmin (ethinylestradiol and drospirenone), Zoely (estradiol hemihydrate and  nomegestrol acetate) and Qlaira (estradiol valerate and dienogest).

Which should I use?

There a lots of different brands of pill available to use, however they contain varying amounts of hormones and can therefore cause different side effects for different women.

For this reason if you are initially prescribed one type of oral contraceptive pill, which you find causes unwanted side effects; then it is highly likely that your doctor will suggest an alternative type of pill before they completely discount it as an option for you.

This is because making a slight change to the combination of the hormones may decrease any adverse effects whilst still offering the same high level of contraceptive protection.

Throughout the generations, the contraceptive pill has been linked to an increased chance of developing blood clots; but in recent years there have been various media stories suggesting that newer forms of contraceptive pill are more dangerous than their second generation counterparts.

Using a combined oral contraceptive has been found to increase the chances of a blood clot developing. Whilst the overall chances are still small, your risk can depend on the type of hormones and how much of them is being used. 

Family history and past medical history might put someone at higher risk of developing a blood clot, and both factors are taken into consideration by the prescribing clinician before a decision is made on the suitability of the medication.

The contraceptive pills currently available have been deemed very safe for use and women should feel confident in their decision to take them.

If this article has raised any questions about your pill and its side effects then you should arrange to speak to your doctor.

Page last reviewed:  10/03/2022