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The progestogen-only pill (POP)

This pill contains a progestogen hormone which is similar to the natural progesterone women produce in their ovaries.  Progestogen-only pills are different to combined pills because they do not contain any oestrogen. There are different types of POP available, some containing different progestogens.

How effective is the POP?

How effective any contraceptive is depends on how old you are, how often you have sex and whether you follow the instructions.

If 100 sexually active women don't use any contraception, 80 to 90 will become pregnant in a year.

If taken according to instructions the POP is 99% effective.  This means that 1 woman in 100 will get pregnant in a year. If the POP is not taken according to instructions, more women will become pregnant.

There is a possibility with some POPs that they are less effective in women who weigh over 70kg (11 stones).

How does the POP work?

The pill works in a number of ways.

  • Mainly by thickening the mucus from your cervix. This makes it difficult for sperm to move through it and reach an egg.

  • It makes the lining of your womb thinner so it is less likely to accept a fertilised eg

  • It sometimes stops your ovaries releasing an egg (ovulation).  This is the main action of one POP, Cerazette. This may mean that Cerazette is more effective than other POPs, but research has not yet confirmed this.

Where can I get the POP?

Family planning doctors, nurses and most GPs provide contraception. You can go to another general practice if you prefer not to see your own doctor.

Can anyone use the POP?

Not all women can take the POP and a doctor or nurse will ask you about your own and your family's medical history.  Do mention any illness or operations you have had.  Some of the conditions which may mean you cannot use the POP are:

  • You think you might already be pregnant

  • You could not cope with any changes to your periods

You have now or had in the past:

  • A heart attack or stroke (severe arterial disease)

  • An active disease of the liver or gall bladder

  • Breast cancer

  • Unexplained bleeding from your vagina (for example, between periods or after sex)

  • A history of ovarian cysts

  • An ectopic pregnancy.

What are the advantages of the POP?

 There are few serious side-effects with the POP.

  • It doesn't interrupt sex

  • You can use it if you are breastfeeding

  • It is useful if you cannot take oestrogens, like those found in the combined pill.

  • You can use it at any age and it can be used by older women who smoke

 It may help with pre-menstrual tension and painful periods.

What are the disadvantages of the POP?

  • You may not have regular periods while you are taking the POP.  Your periods may stop altogether or be irregular, light, or more frequent.  This may settle down and is not harmful but you may find it annoying.  You may also worry that you are pregnant.  If you are in any doubt, see your doctor or nurse.  Changing to a different POP may help.

  • The POP does not protect you against sexually transmitted infections, so you may need to use condoms as well.

  • You have to remember to take the pill at the same time every day.

You may get some temporary side-effects when you first starting taking the POP, these should stop within a few months. They include:

  • Spotty skin

  • Breast tenderness

  • Weight gain

  • Headaches. 

Are there any risks?

The POP is a very safe pill to take but there are some risks:

  • Some women may develop small fluid-filled cysts on their ovaries.  These are not dangerous and do not usually need to be removed. Often there are no symptoms, but some women may have pelvic pain. These cysts usually disappear without treatment.

  • If you do become pregnant while you are taking the POP there is a small increased risk of you having an ectopic pregnancy.  An ectopic pregnancy develops outside your womb, usually in a fallopian tube. Although this is not common, it is dangerous. This risk of ectopic pregnancy is less in women using the POP than in women using no contraception at all.

  • Research about the risk of breast cancer, cervical cancer and hormonal contraception is complex and contradictory. Current research suggests that all users of hormonal contraception appear to have a small increase in risk of being diagnosed with breast cancer compared to non-users of hormonal contraception. Further research is ongoing. All risks and benefits should be discussed with your doctor or nurse.

How do I start the POP?

You can start the POP anytime in your menstrual cycle if you are sure you are not pregnant. If you start the POP on the first day of your menstrual cycle (1st day of your period) you will be protected against pregnancy immediately.

New advice says that you can also start the POP up to and including the fifth day of your menstrual cycle and you will be protected from pregnancy straight away. However, if you have a short menstrual cycle with your period coming every 23 days or less, starting the POP as late as the fifth day of your cycle may not provide you with immediate contraceptive protection. This is because you may release an egg (ovulate) early in your menstrual cycle. You may wish to talk to your doctor or nurse about this and whether you need to use an additional contraceptive method for the first two days.

If you start the POP at any other time in your menstrual cycle you will need to use another contraceptive method for the first two days of your pill taking. 

How do I take the POP?

When taking your first pill choose a convenient time to take it. This can be anytime of the day.

Once you have chosen a time you must then take one POP each day at this same time until you finish all the pills in the pack. You then start a new pack the next day so there are no breaks between packs. This means that you will be taking pills during your period.

What if I forget to take it on time? 

For your pill to work it is important not to take it more than three hours (12 hours for Cerazette) after your chosen time . If you remember later than this, don't panic, the section "What do I do if I forget a pill"  tells you what to do.

What if I want to change to a different pill?

If you are changing to another POP or from the combined pill you may be advised to start the new pill immediately or start the day after you take your last pill.  Do not have a break between packs.  There is no need to wait for your period. You will then continue to have protection against pregnancy.

Can anything make the POP less effective?

If you are late in taking your pill or you miss one or more pills. (See the section 'What do I do if I forget a pill').

If you vomit within two hours of taking the pill or if you have very severe diarrhoea.  If this happens continue taking the pill as usual and use an extra method of contraception, such as a condom, during the stomach upset and for two days after.

If you are given medicines by a doctor, nurse or hospital always say that you are taking the POP. Commonly used antibiotics do not affect the POP. Medicines such as some of those used to treat epilepsy, HIV and TB and the complementary medicine St John’s Wort may make it less effective. If you take these medicines, talk to your doctor or nurse about how to take the pill or whether you need to use a different method of contraception.
If you are worried about the pill not working and you are not sure what to do, seek advice straight away.  Until you do, use an extra contraceptive method, such as a condom, when you have sex.

What do I do if I forget a pill?

How late are you?

*More than 3 hours late:

  • Take a pill as soon as you remember. If you have missed more than one pill just take one.
  • Take your pill at the usual time. This may mean taking two pills in one day. This is not harmful.
  • You are not protected against pregnancy. Continue to take your pills as usual but you must also use an extra method, such as condom for the next two days.

*Less than 3 hours late:

  • Take it as soon as you remember, and take the next one at the usual time.  You are protected against pregnancy.

*12 hours if you are taking the POP, Cerazette.

What should I do if I think I'm pregnant?

If you took all your pills correctly and you didn't have an upset stomach or take any other medicines which might affect the POP, then it is unlikely you are pregnant. Continue to take your pills as normal.  There is no evidence that if you take the POP when you are pregnant it will harm the baby. If you are worried ask your doctor or nurse for advice or do a pregnancy test.

You should seek medical advice as soon as possible if you have a sudden or unusual pain in your lower abdomen or if your period is shorter or lighter than usual.  These might be the warning signs of an ectopic pregnancy.

How often do I need to see a doctor or nurse?

When you first start the POP you will usually be given three months' supply to see how it suits you.  At the next visit supplies may be given for six months or up to a year. You do not have to have a vaginal examination or cervical smear test when you are first prescribed the POP. 

At what age should I stop taking the POP?

If you have no medical problems you can take the POP until your menopause.

I've just had a baby.  Can I take the POP?

Yes. The POP can be started from anytime after the birth. If you start the POP after day 21 you will need to use additional contraception for two days.  You can breastfeed while you are taking the POP.  A tiny amount of hormone enters your breast milk, but research has shown this will not harm your baby.

Can I start the POP after a miscarriage/abortion?

You can start taking the POP immediately after a miscarriage or abortion.

I want to have a baby.  Can I try to get pregnant as soon as I stop taking the POP?

You can try to get pregnant as soon as you stop taking the POP.  You can stop taking the pill at any time.  Ideally you should wait for one period before trying to get pregnant, so you will need to use another method of contraception, such as condoms. Waiting means the pregnancy can be dated more accurately and you can start pre-pregnancy care such as taking folic acid and stopping smoking. You can ask your doctor or nurse for advice.  Don't worry if you get pregnant sooner, it will not harm the baby.

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