Contraception: Progestogen Only Pill (POP)

The POP works in a number of ways.

• The main action of desogestrel POPs is to stop your ovaries releasing an egg (ovulation). Other types of POP may only sometimes stop you releasing an egg.
• All POPs work by thickening the mucus from your cervix (neck of the womb). This makes it difficult for sperm to move through it and reach an egg.
• All POPs make the lining of your uterus (womb) thinner so it’s less likely for a fertilised egg to be able to implant into the womb and create a pregnancy.
• It’s common for your bleeding pattern to change while you’re taking the POP.
• Bleeding may be irregular, lighter, shorter, more frequent, less frequent, last longer or stop altogether. This may settle down and isn’t harmful. If you have any concerns, see your doctor or nurse. Changing to a different POP may help.

If the POP is always used perfectly, according to instructions, it’s over 99% effective.

This means that less than one in 100 women who use the POP will get pregnant in one year.

If the POP is not always used according to instructions, about nine in 100 pill users will get pregnant in one year.

Most women can use the POP. A doctor or nurse will ask you about your own and your family’s medical history.

Some of the conditions which may mean you shouldn’t use the POP are:

• you think you might already be pregnant
• you take certain medicines.

You have now or had in the past:

• heart disease or a stroke
• disease of the liver
• breast cancer.

If you’re healthy and there are no medical reasons for you not to take the POP, you can take it until your menopause or until you’re 55 years old.

You can probably use it if you can’t take oestrogens, like those found in the Combined oral contraceptive pill, combined contraceptive patch or ring

It can be prescribed independently of Body Mass Index (BMI)

You can use it at any age until the age of 55, but it’s especially useful if you smoke and are 35 years or over

It may help with premenstrual symptoms and painful periods

You can use it if you’re breastfeeding.

Your bleeding pattern may change in a way that’s not acceptable to you; this is particularly true when you first start the POP (or any method of hormonal contraception). Lots of women may stop bleeding completely with the POP and this is nothing to worry about.

The POP doesn’t protect you against sexually transmitted infections, so you may want 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 start taking the POP, such as skin changes, breast tenderness and headaches. These often settle within a few months.

Research about the risk of breast cancer and hormonal contraception is complex and contradictory. Research suggests women who use hormonal contraception may have a small increase in the risk of being diagnosed with breast cancer compared to women who don’t use hormonal contraception.

You can normally start taking the POP at any point in your menstrual cycle.

There is special guidance if you have just had a baby, abortion or miscarriage.

You can start the POP any time in your menstrual cycle if you’re sure you’re not pregnant.

If you start the POP:

• On the first day of your period, you’ll be protected from pregnancy immediately.
• Up to, and including, the fifth day of your period, you’ll be protected from pregnancy immediately.
• At any other time in your menstrual cycle, you’ll need to avoid sex or use additional contraception, such as condoms, for the first two days of pill-taking.

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 period may not give you immediate contraceptive protection. This is because you may ovulate (release an egg) early in your menstrual cycle. You may wish to talk to your doctor or nurse about this and whether you need additional contraception for the first two days.

If you start the progestogen only pill after having had unprotected sex or after taking emergency contraception please do a pregnancy test three weeks after the last time you had unprotected sex.

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

Once you’ve chosen a time, you must take one POP each day at this same time until you finish all the pills in the pack. You continue to take POP daily while you require contraception.

You do not have any breaks (hormone-free intervals) like you do with the combined oral contraceptive pill (COCP).

There are two different types of progestogen-only pill:

• 3-hour progestogen-only pill (traditional progestogen-only pill) – must be taken within three hours of the same time each day
• 12-hour progestogen-only pill (desogestrel progestogen-only pill) – must be taken within 12 hours of the same time each day.

If you forget to take a progestogen-only pill, what you should do depends on:

• the type of pill you're taking
• how long ago you missed the pill
• how many pills you've forgotten to take
• whether you've had sex without using another type of contraception in the previous seven days.

If you're less than three or less than 12 hours late taking the pill

If you're taking a three-hour progestogen-only pill and are less than three hours late taking it, or if you're taking the 12-hour progestogen-only pill (desogestrel POP) and are less than 12 hours late:

• take the late pill as soon as you remember, and
• take the remaining pills as normal, even if that means taking two pills on the same day

The pill will still work, and you'll be protected against pregnancy – you do not need to use additional contraception.

Do not worry if you've had sex without using another form of contraception. You do not need emergency contraception.

If you're more than three or more than 12 hours late taking the pill

If you're taking a three-hour progestogen-only pill and are more than three hours late taking it, or you're taking the 12-hour progestogen-only pill (desogestrel POP) and are more than 12 hours late, you will not be protected against pregnancy.

What you should do:

• take a pill as soon as you remember – only take one, even if you've missed more than one pill
• take the next pill at the usual time – this may mean taking two pills on the same day (one when you remember and one at the usual time); this is not harmful
• carry on taking your remaining pills each day at the usual time
• use extra contraception such as condoms for the next two days (48 hours) after you remember to take your missed pill, or do not have sex
• if you have unprotected sex from the time that you miss your pill until two days after you start taking it reliably again, you may need emergency contraception – get advice from your contraception clinic or GP
• tell them that you've been taking the progestogen-only pill as this can affect which emergency contraception is best for you to take.

It takes two days for the progestogen-only pill to thicken cervical mucus so sperm cannot get through or survive.

The Faculty of Sexual Health and Reproductive Healthcare recommends using extra contraception for two days after you remember to take your pill.

The patient information leaflet that comes with your pill might say to use condoms for the next seven days after you remember to take your pill. This is because it takes seven days for the Desogestrel POP to stop you ovulating.

Please note:

If you are taking a traditional three hour POP a pill is missed if taken more than three hours late.

If you are taking a desogestrel containing POP a pill is missed if taken more than 12 hours late.

If you’re not sure what type of progestogen is in your POP, check the patient information leaflet inside your pack, or ask your doctor or nurse.

Vomiting and diarrhoea

If you vomit within two - four hours of taking a pill, it won’t have been absorbed by your body, so it’s as if you hadn’t taken it. Take another pill straight away and the next pill at your usual time. Keep using another form of contraception until you’ve taken the pill for two days without vomiting.

If you have very severe diarrhoea that continues for more than 24 hours, this may make the pill less effective. Keep taking your pill at the normal time, but treat each day that you have severe diarrhoea as if you’d missed a pill. Keep using another form of contraception until you’ve taken the pill for two days without diarrhoea.

Speak to a doctor or nurse or call NHS 111 for more information if your sickness or diarrhoea continues.

Some medicines may make the POP less effective. These include some of the medicines used to treat HIV, epilepsy and tuberculosis (TB), and the complementary medicine St John’s Wort. These are called enzyme-inducing drugs. If you take these medicines, it’ll be recommended that you change to a different method of contraception or that you use additional contraception, such as condoms.

Always tell your healthcare professional that you’re taking the POP if you’re prescribed any medicines.