Progesterone Only Pill

The Progestogen-only pill (POP) is commonly referred to as the 'mini-pill', which tends to give persons the impression that it is of low contraceptive efficacy. The POP have many advantages over other methods that are often underestimated.

How does the POP work?
It contains only the hormone progesterone and prevents pregnancy in several ways, by:

• Thickening the cervical mucus, hindering sperm penetrability.
• Suppressing ovulation in some cycles.
• Rendering the endometrium unreceptive for implantation.
• Reducing fallopian tube function.

How effective is the POP?
The effectiveness of the POP is between 96% and 99% in preventing pregnancy. This means fewer than 1 female in 100 who uses the progesterone-only pill as contraception will get pregnant in 1 year. If used consistently and correctly the efficacy will be higher, but in typical use the efficacy will be lower; this may be due to people not taking their pills on time. Research has also shown that if a person is heavier than 70kg there is a trend that indicates that failure rate is higher.

When can I start the pill?

• You can start today if you have been fully breastfeeding at least 6 weeks.
• If not breastfeeding, you can start any day of the menstrual cycle if the health care professional can be sure you are not pregnant.

How do I take the pill?
The POP contains the same amount of progestogen throughout the packet and is taken every day. It should be commenced on the first day of a person’s menstrual period with no extra precautions required. The POP is taken every day with no break. Once you have finished all the pills in the pack, start a new pack the following day.

Missed Pill Advise
If the POP is taken 3 or more hours later then the user should have taken her pill, you should use additional contraception such as condoms for the next 7 days of and still continue taking the pill.

If I take other medicines will it affect the POP?
When you are taking more than 2 medicines at the same time, sometimes interaction with each other can happen. They might affect the POP and stop it from working properly. It is important to consult with your healthcare professional for guidance. You may be advised to use an alternative or additional form of contraception while taking any other medicines.

What to do when a pill is missed, there is vomiting, or have severe diarrhoea?
If a person has severe diarrhoea or vomits within 3 hours of taking her pill and fails to take another she will need to use extra precautions (such as condoms) 7 days afterwards. However, if there is any likelihood of pregnancy this should be excluded first.

What are the advantages of the pill?

• Does not inhibit lactation so suitable for breast feeding mothers.
• No evidence of increased risk of cardiovascular disease.
• No evidence of increased risk of venous thromboembolism.
• No evidence of increased risk of hypertension.
• Does not need to be stopped prior to surgery.
• Is not affected by broad spectrum antibiotics taken at the same time.
• Suitable for persons with diabetes or focal migraines.
• Reduction in excessive menstrual pain.
• May relieve pre-menstrual symptoms.
• Suitable for persons unable to take oestrogen.

What are the disadvantages of the pill?

• To be effective needs to be taken carefully, same time each day.
• Irregular menstrual cycle.
• A small number of persons develop functional ovarian cysts.
• If POP fails may have possible increased ectopic pregnancy rate.
• Effect of POP on breast cancer.

Can anyone use the pill?
The pill may not be right for you if you:

• Are Pregnant.
• Have undiagnosed genital tract bleeding.
• Have / had past or present severe arterial disease.
• Have severe lipid abnormalities.
• Had recent trophoblastic disease.
• Had serious side effects occurring on the COC which are not due to oestrogen.
• Had previous ectopic pregnancy.
• Have present liver disease, liver adenoma or cancer.

Are there any side-effects?
You may experience the following side-effects:

• Functional ovarian cysts.
• Breast tenderness.
• Acne.
• Depression.
• Increased hair growth.
• Fluctuations in weight.
• Nausea.
• Irregular bleeding.
• Absence of periods.

What are the risks?
Overall, the progesterone-only pill is safe to take.

• Ovarian cysts - some persons can develop fluid-filled cysts on their ovaries.
• Cancer risks - research is continuing as to whether there is a link between cancer and POP.

Where you can get the progesterone-only pill?

• You can speak to your family doctor who will guide you accordingly.
• Gynaecologist consultation or any other sexual health clinic that offers contraceptive advice.

Can I use the pill after a miscarriage?
You can start taking the combined pill 5 days after a miscarriage. If you start the pill after 5 days from the miscarriage, use extra contraception until you have taken the pill for 2 days. It is important to consult with a medical doctor for advice and guidance.

I have just had a baby. Can I start using the pill?
If you have just had a baby it is recommended that you wait until day 21 after birth. Always check with your medical doctor for guidance. If you start the pill later than 21 days, you will need addition contraception such as condoms for the first 7 days. If you are breastfeeding, the progesterone-only pill is safe to use. Small amounts of progesterone may pass into your breast milk, but it is not harmful to your baby.

Can I change to a different pill?
Yes, you can change to a different pill, however, it is important to ask for advice from your healthcare professional and guide you when to stop and start the new pill.

Can I get pregnant when I stop POP?
When you stop taking the pill the fertility will return to what is normal for you. Your periods may not start immediately. Pregnancy can happen as soon as you stop taking the pill.

If you do not want to get pregnant and recently had sex, seek advice as you are at risk of becoming pregnant.

How often should I go for a check-up?

• When a person commences the POP, she should return for a follow-up visit in 3 months if there are no problems, then she should be seen for a thorough examination every 6 months.
• Ask for advice from your healthcare provider when are you due for a next appointment.
• If you are experiencing any problems since you started having the pill or have any concerns speak to your healthcare professional.
• When commencing oral contraception, the risks along with the benefits should be discussed fully with a medical doctor, so that one is able to fully understand and weigh up the risks and benefits of the contraceptive pill.

If I am on POP, am I protected from Sexually Transmitted Infections?
No, only male and female condoms (when used correctly and consistently) protects you from STIs.