What Are Progestin-Only Pills?
- Pills that contain very low doses of a progestin like the natural hormone progesterone in a woman’s body.
- Do not contain estrogen, and so can be used throughout breastfeeding and by women who cannot use methods with estrogen.
- Progestin-only pills (POPs) are also called “minipills” and progestin-only oral contraceptives.
- Work primarily by:
– Thickening cervical mucus (this blocks sperm from meeting an egg)
– Disrupting the menstrual cycle, including preventing the release of eggs from the ovaries (ovulation).
Effectiveness depends on the user: For women who have monthly bleeding, risk of pregnancy is greatest if pills are taken late or missed completely
- As commonly used, about 1 pregnancy per 100 women using POPs over the first year. This means that 99 of every 100 women will not become pregnant.
- When pills are taken every day, less than 1 pregnancy per 100 women using POPs over the first year (3 per 1,000 women).
Less effective for women not breastfeeding:
- As commonly used, about 3 to 10 pregnancies per 100 women using POPs over the first year. This means that 90 to 97 of every 100 women will not become pregnant.
- When pills are taken every day at the same time, less than 1 pregnancy per 100 women using POPs over the first year (9 per 1,000 women).
Return of fertility after POPs are stopped: No delay
Protection against sexually transmitted infections (STIs): None
Side Effects, Health Benefits, and Health Risks
Some users report the following:
- Changes in bleeding patterns including:
– For breastfeeding women, longer delay in return of monthly bleeding after childbirth (lengthened postpartum amenorrhea)
– Frequent bleeding
– Irregular bleeding
– Infrequent bleeding
– Prolonged bleeding
– No monthly bleeding
Breastfeeding also affects a woman’s bleeding patterns.
- Mood changes
- Breast tenderness
- Abdominal pain
Other possible physical changes:
- For women not breastfeeding, enlarged ovarian follicles.
Known Health Benefits: Help protect against – Risks of pregnancy
Known Health Risks: None.
Who Can and Cannot Use Progestin-Only Pills
Safe and Suitable for Nearly All Women
Nearly all women can use POPs safely and effectively, including women who:
- Are breastfeeding (starting as soon as 6 weeks after childbirth)
- Have or have not had children
- Are not married
- Are of any age, including adolescents and women over 40 years old
- Have just had an abortion, miscarriage, or ectopic pregnancy
- Smoke cigarettes, regardless of woman’s age or number of cigarettes smoked
- Have anemia now or had in the past
- Have varicose veins
- Are infected with HIV, whether or not on antiretroviral therapy, unless that therapy includes ritonavir
Women can begin using POPs:
- Without a pelvic examination
- Without any blood tests or other routine laboratory tests
- Without cervical cancer screening
- Without a breast examination
- Even when a woman is not having monthly bleeding at the time, if it is reasonably certain she is not pregnant
- Do not cause a breastfeeding woman’s milk to dry up.
- Must be taken every day, whether or not a woman has sex that day.
- Do not make women infertile.
- Do not cause diarrhea in breastfeeding babies.
- Reduce the risk of ectopic pregnancy.
Managing Any Problems
- No monthly bleeding.
- Irregular bleeding (bleeding at unexpected times that bothers the client).
- Heavy or prolonged bleeding (twice as much as usual or longer than 8 days).
- Missed pills.
- Ordinary headaches (nonmigrainous).
- Mood changes or changes in sex drive.
- Breast tenderness.
- Severe pain in lower abdomen.
- Nausea or dizziness.
New Problems That May Require Switching Methods
- Unexplained vaginal bleeding (that suggests a medical condition not related to the method)
- Starting treatment with anticonvulsants, rifampicin, rifabutin, or ritonavir
- Migraine headaches
- Certain serious health conditions (suspected blood clots in deep veins of legs or lungs, liver disease, or breast cancer).
- Heart disease due to blocked or narrowed arteries (ischemic heart disease) or stroke
- Suspected pregnancy
Contact your doctor if you have any of the problems listed above.
Questions and Answers About Progestin-Only Pills
1. Can a woman who is breastfeeding safely use POPs?
Yes. This is a good choice for a breastfeeding mother who wants to use pills. POPs are safe for both the mother and the baby, starting as early as 6 weeks after giving birth. They do not affect milk production.
2. What should a woman do when she stops breastfeeding her baby? Can she continue taking POPs?
A woman who is satisfied with using POPs can continue using them when she has stopped breastfeeding. She is less protected from pregnancy than when breastfeeding, however. She can switch to another method if she wishes.
3. Do POPs cause birth defects? Will the fetus be harmed if a woman accidentally takes POPs while she is pregnant?
No. Good evidence shows that POPs will not cause birth defects and will not otherwise harm the fetus if a woman becomes pregnant while taking POPs or accidentally takes POPs when she is already pregnant.
4. How long does it take to become pregnant after stopping POPs?
Women who stop using POPs can become pregnant as quickly as women who stop nonhormonal methods. POPs do not delay the return of a woman’s fertility after she stops taking them. The bleeding pattern a woman had before she used POPs generally returns after she stops taking them. Some women may have to wait a few months before their usual bleeding pattern returns.
5. If a woman does not have monthly bleeding while taking POPs, does this mean that she is pregnant?
Probably not, especially if she is breastfeeding. If she has been taking her pills every day, she is probably not pregnant and can keep taking her pills. If she is still worried after being reassured, she can be offered a pregnancy test, if available, or referred for one. If not having monthly bleeding bothers her, switching to another method may help—but not to a progestin-only injectable.
6. Must the POP be taken every day?
Yes. All of the pills in the POP package contain the hormone that prevents pregnancy. If a woman does not take a pill every day— especially a woman who is not breastfeeding—she could become pregnant. (In contrast, the last 7 pills in a 28-pill pack of combined oral contraceptives are not active. They contain no hormones.)
7. Is it important for a woman to take her POPs at the same time each day?
Yes, for 2 reasons. POPs contain very little hormone, and taking a pill more than 3 hours late (more than 12 hours late with POPs containing desogestrel 75 mg) could reduce their effectiveness for women who are not breastfeeding. (Breastfeeding women have the additional protection from pregnancy that breastfeeding provides, so taking pills late is not as risky.) Also, taking a pill at the same time each day can help women remember to take their pills more consistently. Linking pill taking with a daily activity also helps women remember to take their pills.
8. Do POPs cause cancer?
No. Few large studies exist on POPs and cancer, but smaller studies of POPs are reassuring. Larger studies of implants have not shown any increased risk of cancer. Implants contain hormones similar to those used in POPs, and, during the first few years of implant use, at about twice the dosage.
9. Can POPs be used as emergency contraceptive pills (ECPs) after unprotected sex?
Yes. As soon as possible, but no more than 5 days after unprotected sex, a woman can take POPs as ECPs. Depending on the type of POP, she will have to take 40 to 50 pills. This is many pills, but it is safe because there is very little hormone in each pill.
10. Do POPs change women’s mood or sex drive?
Generally, no. Some women using POPs report these complaints. The great majority of POP users do not report any such changes, however, and some report that both mood and sex drive improve. It is difficult to tell whether such changes are due to the POPs or to other reasons. Providers can help a client with these problems. There is no evidence that POPs affect women’s sexual behavior.
11. What should be done if a POP user has an ovarian cyst?
The great majority of cysts are not true cysts but actually fluid-filled structures in the ovary (follicles) that continue to grow beyond the usual size in a normal menstrual cycle. They may cause some mild abdominal pain, but they only require treatment if they grow abnormally large, twist, or burst. These follicles usually go away without treatment .
12. Do POPs increase the risk of ectopic pregnancy?
No. On the contrary, POPs reduce the risk of ectopic pregnancy. Ectopic pregnancies are rare among POP users. The rate of ectopic pregnancy among women using POPs is 48 per 10,000 women per year. The rate of ectopic pregnancy among women in the United States using no contraceptive method is 65 per 10,000 women per year. On the uncommon occasions that POPs fail and pregnancy occurs, 5 to 10 of every 100 of these pregnancies are ectopic. Thus, the great majority of pregnancies after POPs fail are not ectopic. Still, ectopic pregnancy can be life-threatening, so a provider should be aware that ectopic pregnancy is possible if POPs fail.
Where to address?
For a family planning consultation:
- Ask your family doctor at your health care facility in your area of residence (see here). WARNING: if you belong to one of the socially vulnerable groups (see here) you can benefit from free contraceptives!
- Ask Youth Friendly Health Centers
- Call the RHTC Hotline (free and confidential call) – 0800-088-08
- Call RHTC – 022355072 / 060903782 / 078306973
- Write to RHTC e-mail – firstname.lastname@example.org