Related to this topic: Leaflets | Support | Patient+ | UK Guidelines | News | Weblinks | Medicines | Equipment | Books | Your Experience | Other resources | Glossaries
Print options:
Other options:
(what's this?)
PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Progestogen-only Contraceptive Pill
Synonyms: POP, mini-pill
- Ovulation is inhibited in about 60% of cycles2 although it does not occur in 100% of cycles without hormonal contraception. With desogestrel ovulation is inhibited in 97% of cycles.3
- Transport of the ovum is delayed
- The cervical mucus becomes more viscous and impenetrable to sperm
- The endometrium is unsuitable for implantation.
- It is an effective and safe form of contraception, and is often used when combined pill contraindicated - e.g. venous thromboembolism, or past history or tendency to venous thromboembolism.
- It contains an even lower dose of progestogen than low-dose combined contraceptives, and no oestrogen.
- It is a suitable alternative for those over 35 who need to be changed from a COC, heavy smokers, those with hypertension, valvular heart disease, diabetes mellitus, migraine.There is however very little data on cardiovascular risk and the POP.
- It can be used during breast feeding
- It is suitable for women with valvular heart disease, and those about to undergo major surgery or surgery on their legs.
- It is suitable for those who want a minimal dose of hormone as it gives a very low dose
- It can be used by those who must not take oestrogens for various reasons like a history of deep vein thrombosis or migraine with aura.
- The failure rate is slightly higher than with a COC with a method failure rate of 0.5% compared with 0.1% for the COC. This is the per centage of unintended pregnancies in the first year of use. However, user failure rate pushes both up to 5%.
- It has to be taken meticulously at the same time each day. The error for forgotten pills is just 3 hours late for POPs with the exception of Cerazette that has a licence for 12 hours.
- It is just as susceptible to substances that cause enzyme induction like rifampicin, many anticonvulsants and St John's wort. It is not affected by broad spectrum antibiotics.
- It does not give the regulation of menstruation of the COC, including its tendency to alleviate symptoms of PMT, dysmenorrhoea and making menstruation lighter. It may produce irregular menstruation or amenorrhoea. This may be trouble enough for some to lead to cessation of the method. If oestrogen levels fall and cause amenorrhoea there may be concern that there is a risk of osteoporosis. This has been considered in relation to depot and implant contraception. An overview of the relationship between use of progestogen-only contraceptives and bone mineral density found remarkably little evidence about this in users of the POP.4
- There is an increased risk of ovarian cysts, perhaps up to 30%. They are usually reversible and do not require operation.
- The data on the risk of breast cancer is unreliable because of small numbers but it may be that the risk is small but finite as with the COC. After stopping the method the risk disappears after 10 years.5
- It is no less effective in women weighing over 70kg.6
- The POP must not be used in the presence of breast cancer as this is a hormone dependent tumour. It may be considered if there has been no evidence of disease for 5 years if other methods do not seem acceptable.
- The risk of thromboembolism is much less than with the COC but in the presence of deep vein thrombosis or pulmonary embolism it should be avoided.
- There is concern about reduction in the levels of HDL, although this may be less marked with the newer progestogens. Hence they are better avoided in established CHD or stroke.
- As with any other form of hormonal contraception it should be avoided in liver disease.
- It is usually started on the first day of menstruation and then no additional contraceptive is required.
- After childbirth it can be started on day 21. There is no need for contraception before then and the risk of intermenstrual bleeding is increased by starting earlier. WHO recommend waiting until 6 weeks postpartum if breastfeeding and using an alternative method for the extra 3 weeks. This is because of hormones getting into the milk and hence the baby.
- It can be started immediately after termination of pregnancy in any trimester and it is immediately effective.
- If changing from a COC to a POP, start at the end of a COC pack, moving straight on from the last COC pill to the POP the following day. If the COC is an ED (every day) pack then start after the last active pill.
- Pills must be taken about the same time each day. It is regarded as late if it is taken more than 3 hours after the usual time or 12 hours with Cerazette. The missed pill should be taken as soon as possible. The subsequent pills should be taken as usual but additional contraception should be used until pills have been taken correctly for 2 days.
- Vomiting or severe diarrhoea may impair absorption of the hormone. Additional contraception should be used during this phase and for 7 days after
- Irregular menstrual pattern may settle with time or a change to a different formulation.
Desogestrel is a newer progestogen that is converted in the body to the active form of etonogestrel. The only contraceptive pill containing desogestrel currently licensed in the UK is Cerazette.7 Desogestrel tends to be metabolically "cleaner" than the older progestogens and appears very promising. Amenorrhoea is more likely to occur, being present in 50% of desogestrel users compared with 10% of those taking levonorgestrel in one study.8 Failure rate was also lower with desogestrel but the numbers were so small that confidence intervals were very wide and there was considerable overlap. The feature of this formulation that is likely to have the greatest impact is the 12 hours window for "forgetfulness" rather than just 3 hours.9
Document references
- British National Formulary British Medical Association and Royal Pharmaceutical Society of Great Britain. London.
- No authors listed; A double-blind study comparing the contraceptive efficacy, acceptability and safety of two progestogen-only pills containing desogestrel 75 micrograms/day or levonorgestrel 30 micrograms/day. Collaborative Study Group on the Desogestrel-containing Progestogen-only Pill.; Eur J Contracept Reprod Health Care. 1998 Dec;3(4):169-78. [abstract]
- Trussell, J. (2004) Contraceptive efficacy. In: Hatcher, R.A., Trussell, J., Stewart, F., et al, (Eds.) Contraceptive technology. 18th edn. New York: Ardent Media
- Banks E, Berrington A, Casabonne D; Overview of the relationship between use of progestogen-only contraceptives and bone mineral density.; BJOG. 2001 Dec;108(12):1214-21. [abstract]
- No authors listed; Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Collaborative Group on Hormonal Factors in Breast Cancer.; Lancet. 1996 Jun 22;347(9017):1713-27. [abstract]
- Contraception, Clinical Knowledge Summaries (2007)
- Cerazette Guidance, FFPRHC
- No authors listed; Oral contraceptives and cardiovascular risk. Drug Ther Bull. 2000 Jan;38(1):1-5. [abstract]
- Summary of Product Characteristics - Cerazette® 75 microgram film-coated tablet (desogestrel); Organon Laboratories Limited, Updated May 2004; electronic Medicines Compendium.
Internet and further reading
- World Health Organisation; Medical eligibility for contraceptive use progestogen only contraceptives
DocID: 471
Document Version: 2
DocRef: bgp146
Last Updated: 28 Aug 2007
Review Date: 27 Aug 2008
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
Related pages in Patient UK
Your Experience (^ top of page)
Please add your experience about this condition / medicineInformation leaflets related to this topic (^ top of page)
Combined Oral Contraceptive Pill
Condom (Sheath)
Contraceptive Choices
Deep Vein Thrombosis - Prevention When Travelling
Emergency Contraception - Progestogen
Female Sterilisation
Implanon - The Contraceptive Implant
Injectable Contraceptive
Intrauterine Device (The Coil)
Intrauterine System
Natural Family Planning
Progestogen Only Pill
Vasectomy
Vasectomy - Picture SummaryPatient Support related to this topic (^ top of page)
Billings Natural Family Planning Centre
Brook Advisory Centres
Caledonia Youth
Fertility Education Trust & Natural Family Planning
FPA (Northern Ireland)
FPA (Scotland)
FPA (sexual health & contraception)
FPA (Wales)
Marie Stopes Intemational (family planning)Medical reference articles in PatientPlus related to this topic (^ top of page)
Combined Oral Contraceptive (First Prescription)
Contraception - General Overview
Contraception and Special Groups
Contraceptive Methods Compared
Deep Vein Thrombosis (DVT)
Emergency Contraception
Ethnocultural Issues in Contraception
Intrauterine Contraceptive Device (IUCD)
IUCD Insertion Technique
IUCDs Lost Threads and Other Problems
Missed Contraceptive Pills
Pill Questions - What to Ask When Starting the OCP.
Postpartum Contraception
Progestogens
Pulmonary Embolism
Sexual Health
The Risks of Combined Hormone Contraception and HRTUK guidelines related to this topic (^ top of page)
Guidelines on ContraceptionRecent news items related to this topic (^ top of page)
'Female snip' to transform women's lives
Gynaecological first for ScotlandLinks to other selected websites related to this topic (^ top of page)
Birth Control
Contraception
Family PlanningMedicines related to this topic (^ top of page)
Emergency Hormonal Contraception
Progestogen-only pillOther - Useful resources (^ top of page)
Pictures, diagrams, photos, images, etc.Evidence based medicine
Online textbooks and journals
A-Z of UK Guidelines
A-Z of Online Videos
Medline
Other good health sites
Medical equipment products related to this topic (^ top of page)
Pill/Tablet Equipment
Books related to this topic (^ top of page)
Contraception
Pill and Other Forms of Hormonal Contraception (The): The Facts
The Pill and Other Forms of Hormonal Contraception: The Facts
Want to search some more? Use the Google Search box below to search our site.

Would you like to try our advanced on-line knowledge support system designed to provide professionals with relevant up to date information about recognition and management of disease or take the Mentor Challenge?
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
