Progestogen only pill (POP): A Guide for Women

What’s the Deal with the POP?

Ever heard of the progestogen-only pill, or POP for short? It’s a contraceptive pill that contains progestogen without the oestrogen found in the combined pill. It is sometimes called the “mini pill”.

But how does it work? The POP thickens your cervical mucus, making it difficult for sperm to reach an egg. Some types, including desogestrel and drospirenone pills, also work mainly by preventing ovulation.

Taking the POP: It’s All About Timing

Now, let’s talk about taking these pills. Unlike combined contraceptive pills that may have a pill-free interval, most POPs are taken every single day, without a break. Some drospirenone packs contain inactive tablets, so follow the instructions for your particular brand.

Here’s where timing matters: traditional POPs have a 3-hour window, desogestrel POPs have a 12-hour window, and drospirenone POPs have a 24-hour window. Taking your pill at approximately the same time every day helps you stay protected.

Starting out? You can usually begin taking the POP at any point in your menstrual cycle if you are reasonably certain you are not pregnant. With traditional and desogestrel POPs, starting during the first five days of your period generally provides immediate protection. Starting later usually means using condoms or avoiding sex for the next two days. Drospirenone POPs have different starting rules and may require seven days of additional contraception. Always check the instructions for your pill or ask your pharmacist or sexual health clinic.

Is the POP Your Perfect Match?

Here’s the important point: some women cannot use the combined pill because it contains oestrogen. The POP can be a suitable alternative for many of them. It can also be used while breastfeeding.

And if you are in good health, the POP may remain an option until the age of 55, although your individual circumstances and medical history should be reviewed with a healthcare professional.

The POP is not suitable for everyone. Certain medical conditions, including current or previous breast cancer, severe liver disease and some unexplained vaginal bleeding, may affect whether it is appropriate. Tell your prescriber about your medical history and any medicines or herbal products you take.

The Perks of Popping POPs

Let’s look at the advantages of the POP:

1. Lighter periods? They may become lighter, less frequent or stop altogether, although irregular bleeding is also common.
2. Spontaneous sex? Once the pill is working and you take it correctly, you do not need to interrupt sex to use contraception.
3. Breastfeeding-friendly? The POP can be used while breastfeeding, so you do not have to choose between feeding your baby and preventing pregnancy.

Because the POP does not contain oestrogen, it avoids some of the oestrogen-related risks associated with the combined pill, including an increased risk of blood clots. However, it is still important to discuss your personal health risks with a clinician.

When taken correctly, the POP is more than 99% effective at preventing pregnancy. With typical use, which includes missed or late pills, effectiveness is around 91%. It does not protect against sexually transmitted infections (STIs), so condoms may still be needed.

The Not-So-Rosy Side of the POP

Now, let’s consider the disadvantages. Your periods may become irregular, lighter, more frequent or stop altogether. You might also experience spotting between periods. And timing matters with this pill, particularly with traditional POPs that have a shorter missed-pill window.

In the first few months, some people report:

• Acne or changes in their skin
• Breast tenderness
• Changes in sex drive
• Mood changes
• Nausea
• Headaches

These symptoms may improve after a few months, although it is not always clear whether the pill is responsible for them. If side effects persist or bother you, speak to your pharmacist, GP or sexual health clinic.

Oh, and a word of caution: vomiting or severe diarrhoea can reduce the pill’s effectiveness. Some medicines, including certain treatments for epilepsy, tuberculosis and HIV, and the herbal remedy St John’s wort, can also interfere with contraception. Most commonly prescribed antibiotics do not reduce POP effectiveness, but rifampicin and rifabutin are important exceptions. Always check with a pharmacist or prescriber before starting a new medicine.

Oops, I Did It Again: Missed Pills and Sickness

We’re all human, and sometimes life gets in the way of our pill-taking routine. If you take your pill later than the permitted window, your protection against pregnancy may be reduced. The missed-pill window is more than 3 hours for traditional POPs, more than 12 hours for desogestrel POPs and more than 24 hours for drospirenone POPs.

For traditional and desogestrel POPs, take the missed pill as soon as you remember and take your next pill at the usual time, even if this means taking two pills in one day. Use condoms or avoid sex for the next two days. The instructions for drospirenone POPs are different and depend on which tablets were missed, so follow your pack leaflet or seek advice from a pharmacist or sexual health clinic.

If you have had unprotected sex around the time of a missed pill, ask a pharmacist or sexual health clinic promptly whether you need emergency contraception. The appropriate advice depends on the type of POP, when pills were missed and when sex occurred.

Feeling under the weather? Vomiting soon after taking your pill may mean it has not been absorbed. The relevant period varies by pill type, so check your patient information leaflet. Severe diarrhoea can also affect protection. You may need to take another pill and use additional contraception until protection is restored. If symptoms continue, seek advice rather than assuming the same rules apply to every POP.

Remember, the POP can be a reliable contraceptive choice, but it needs to be taken according to the instructions for your particular pill. If you are unsure about a missed dose, sickness or a possible pregnancy risk, your pharmacist or sexual health clinic can help.

Further Information

For current NHS advice, including how to start the POP, missed pills and side effects, see the NHS guide to the progestogen-only pill.

For specialist UK contraceptive guidance, visit the Faculty of Sexual and Reproductive Healthcare (FSRH).

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