Can I drink alcohol on the pill?

How a night out can cause a pill to fail

Alcohol does not break down the hormones in pills such as Trust (levonorgestrel + ethinylestradiol) or Yaz (drospirenone + ethinylestradiol), and a few drinks do not change how the pill stops ovulation. [TODO: source: NHS or FSRH statement that alcohol does not reduce pill effectiveness] When the pill fails after a party, it is almost always one of these:

• Vomiting soon after the pill. The tablet may come up before it is absorbed.
• A forgotten or very late pill the next morning, or a whole weekend of them.
• Sex without condoms while drunk, at a time you were already late with pills.

In typical use, about 7 in 100 pill users get pregnant in a year, mostly because of missed pills.^[src] Nights out are one of the times pills get missed.

If you vomit

The WHO handbook gives a clear rule for combined pills:^[src]

• Vomited within 2 hours of taking a hormone pill: take another hormone pill from your pack as soon as you can, then carry on as usual.
• Vomited more than 2 hours after the pill: you do not need to do anything. It was absorbed.
• Vomiting or severe diarrhea for more than 2 days: follow the missed pill rules, as if those pills were missed.

Taking the extra pill from your current pack means you will finish the hormone pills a day early. Ask your pharmacist about using the last pill from a spare pack, or start the next pack a day early. The Missed Pill Helper covers your brand. More detail in what if I vomit after taking my pill.

A simple plan for inuman nights

1. Move your pill time earlier on days you will drink, for example take it at 6 pm instead of 10 pm, so it is absorbed well before you might feel sick. Keep it within your brand's window. Progestin-only pills like Daphne (lynestrenol) have a 3-hour window, so plan carefully.
2. Set two alarms for the next day, or use the pill tracker.
3. Carry condoms. They also protect against STIs, which no pill does.
4. Keep one spare strip if you can, so you can replace a vomited pill without shortening your pack.

Other things to know

Heavy, regular drinking is a health issue in its own right and can affect the liver, which processes the pill's hormones. If you drink a lot most days, mention it to the doctor who prescribes your pill. Hangover medicines such as paracetamol do not affect the pill. [TODO: source: list of medicines that do not interact with combined pills (FSRH)]