Mini Pill (Progesterone Only Pill, POP) Patient Information Leaflet
Key points every woman who takes the progesterone only pill should know:
- No contraceptive option is 100% effective, though taken correctly the POP is extremely reliable
- Vomiting or diarrhoea when taking the pill, or a missed pill, can lead to pregnancy
- The POP does NOT protect against sexually transmitted infections
- The POP must be taken within the same 3 hour period of time every day. If you take your POP more than 3 hours later than yesterday’s POP, you may become pregnant
- There are no inactive “sugar” pills in a POP pack- you take an active pill EVERY day, with no breaks
- Irregular vaginal bleeding is a common side effect of the POP, but you should have it checked out by your doctor to rule out other causes
- All sexually active women are advised to have regular pap smears
What is the POP and what is it used for?
- The POP is used as a contraceptive, and is often prescribed when the combined oral contraceptive pill (COCP) is not suitable for some reason.
- Unlike the COCP, the Mini Pill does not contain oestrogen.
How does the POP work?
When taken correctly the POP:
- thickens the mucus in the cervix making it more difficult for sperm to enter
- affects the wall of the womb, making it less likely to allow a fertilised egg to attach
- causes women to ovulate less often
How effective is the POP?
- If used correctly the POP is more than 99% effective
- However, if the POP is not always used according to instructions, about 9% of users will become pregnant within a year
Who shouldn’t take the POP?
The POP is very safe for most women but should not be taken if any of the following apply :
- Allergy to any of the ingredients contained in the POP
- Unexplained/irregular vaginal bleeding
- Pregnancy, or if you suspect you may be pregnant
- Breast cancer- now OR in the past
- An undiagnosed breast lump
- Liver tumours or any severe liver disease
- Heart disease, stroke, TIA
- Migraine with aura that first occurred whilst taking the POP, < “what is migraine”> link
- History of molar pregnancy
Some other conditions MAY mean the POP is not suitable for you-if you have any of the following, you should consult a doctor prior to considering the POP:
- Risk factors for cardiovascular disease (such as older age, obesity, high cholesterol, smoking, diabetes and high blood pressure)
- Vascular (blood vessel) disease, heart disease, atrial fibrillation (AF), stroke or mini-stroke (TIA)
- Blood clots in the blood vessels, legs or lungs- now, or in the past
- Any condition (or a family history of a condition), which increases your risk of blood clots
- Lupus (SLE) or rheumatoid arthritis
- History of organ transplant
- Recent major surgery with prolonged immobility (bed-bound, wheelchair bound)
- Migraine
- Carrier of a breast cancer gene such as the BRCA1 or BRCA2 mutation
- Gallbladder disease
- Cholestasis/jaundice caused by the combined oral contraceptive pill
- HIV drug treatment
- History of ectopic pregnancy or abnormal fallopian tubes
- conditions causing malabsorption (i.e. the gut does not absorb food & medicines properly), such as coeliac disease or ulcerative colitis.
- conditions causing malabsorption (i.e. the gut does not absorb food & medicines properly), such as coeliac disease or ulcerative colitis.
What are the possible risks and side effects of taking the POP?
The POP can cause side-effects, but serious side effects are very uncommon. For most women the benefits of taking the POP outweigh the risks. Possible side effects are listed below and further details are available on the leaflet contained in your POP pack. If you have any questions about the risks of taking the POP you should ask your doctor or pharmacist.
- Breast tenderness/ enlargement
- Irregular vaginal bleeding
- Changes in vaginal discharge
- Increased or decreased sex drive
- Acne, other skin rashes, chloasma ( pigmentation of the face)
- Unwanted hair growth
- Mood changes /depression
- Nausea or vomiting
- Ovarian cysts
- Weight gain (uncommon)
- Headaches/ migraine/dizziness
- Possible small increased risk of breast, liver or cervical cancers
- Fluid retention
- High blood pressure
- Gallbladder disease
- Changes in cholesterol/lipids
- If pregnancy occurs while taking the POP it is more likely to be an ectopic pregnancy ( a potentially serious condition in which the pregnancy is located outside the womb)
If you experience any side effects, including any new symptoms not listed in this leaflet, or worsening of an existing health problem after starting the POP, you should discuss it with your pharmacist or doctor.
How do I take the POP?
- The POP must be taken within the same 3 hour period each day. If you do not do this, you may become pregnant
How do I start the first pack and how do I take the next pack?
- If no contraceptive pills have been taken in the past month: start on day 1 of your period and continue to take each day at the same time. When you come to the end of the first pack, continue to the next pack without interruption.
- If changing from the combined pill (COCP): start the POP on the day after the last active COCP/pill is taken ( i.e skip the sugar pills)
- If changing from another brand of POP: continue the new POP without a break
- If changing from an injectable/implant contraceptive- start the POP on the day the injectable is due or the day an implant is removed, but condoms are required for the first seven days also.
- If starting after recent childbirth- start the POP any time from 4 weeks after delivery, but condoms should be used for the first 7 days. However if you have already been sexually active, then a pregnancy test should be taken first, or wait till the first day of the next period.
- After an abortion/termination of pregnancy- the POP can be started immediately, though we advise discussing contraception with your doctor in this case.
What if I miss my POP?
- If even one tablet is late (more than 3 hours later than the timing of yesterday’s POP), or if a tablet is entirely missed, you may become pregnant.
- The next POP should be taken as soon as remembered (even if that means taking two at once) , then continue to take one each day, but also use condoms for the next 7 days.
- If sexual intercourse has occurred in the 7 days leading up to the missed/late pill, you may become pregnant- the morning after pill/ emergency contraception may be required.
- The more doses missed, the higher the chance of pregnancy.
What should I do if I have vomiting or diarrhoea?
- If you vomit within 4 hours or have severe diarrhoea after taking a tablet, it may not have been completely absorbed. This is like missing a dose- see above.
What happens if I take more pills than I should?
- There have been no serious side effects reported- though nausea, vomiting and unscheduled vaginal bleeding are possible. In the case of overdose, contact your doctor or pharmacist immediately.
If I don’t have a period as expected what should I do?
- Some women do not get periods when they take the POP. If you have missed a period, but you have taken all your tablets correctly, have not had vomiting/diarrhoea, and have not taken any medications that interfere with your POP, then it is very unlikely that you are pregnant- continue to take the POP as usual. If you have further concerns consult your doctor or pharmacist.
- If you miss two periods in a row, you may be pregnant even if you have taken your POP correctly – do a pregnancy test , and/ or seek advice from your doctor.
What does it mean if I have unexplained or irregular bleeding?
- Irregular vaginal bleeding (spotting or breakthrough bleeding) between periods is common in the first few months of taking the POP. Continue to take your tablets as usual. The bleeding often stops once your body has adjusted to the POP.
- If you have unexpected bleeding which is repeated, continuous or heavy you should consult your doctor. If there is abdominal pain or abnormal vaginal discharge with the bleeding, you should also seek prompt medical attention.
Breastfeeding and the POP
- The POP is safe during breastfeeding
Can other medications affect the POP?
- If you take any other medication you need to be certain that it doesn’t interact with the pill. If you are in any doubt you should speak to a pharmacist
- There are a number of medications that interact with the pill. You can find a more complete list in the Consumer Medicines Information Leaflet. Below is a list of the most common ones:
- Epilepsy medications
- HIV medications
- St John’s Wort
