Progestogen-only pill (mini pill)

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

The progestogen-only pill (POP) is a daily contraceptive pill for the prevention of pregnancy, containing only one hormone type: Progestogen. It is also known as the 'mini pill'.

• Daily pill containing progestogen for contraception.
• Starting contraception for the first time or after a break: 1-12 months of desogestrel POP only can be supplied.
• Already using for 12 months: 1-12 months of all types of POP can be supplied.

Women ordering desogestrel POP from Dr Fox are recommended to provide GP details and consent to a notification being sent to inform their GP. This is required for Noriday and Norgeston orders.

The service is available only to women 18-55 years of age. Younger women, including under 16 years, can obtain contraception from their GP or a local sexual health clinic.

Sexual health clinics

• England
• Wales
• Scotland
• Northern Ireland

POP patient information

The progestogen-only contraceptive pill (POP or mini pill) is a pill taken at the same time everyday for contraception (to prevent pregnancy).

There are different types of POP and the newer types contain desogestrel. There are several brand names of the newer desogestrel POP, including Cerazette, Cerelle, and in 2021 Hana and Lovima were introduced, available to buy directly from a pharmacist. They are all medically the same, containing desogestrel 75 micrograms.

The older types of POP contain different types of progestogen and these are probably slightly less effective. Only two older POP brands are still available in the UK - these are Norgeston containing levonorgestrel, and Noriday containing norethisterone.

The POP can be used by women until 55 years of age at which point contraception is usually no longer needed as there is a natural loss of fertility.

How does it work?

All POPs affect mucus at the neck of the womb (cervix), making it thicker and more difficult for sperm to pass through and they also cause changes to the lining of the womb making it thinner and less easy for an egg to be implanted. The main action of desogestrel containing POPs is to stop ovulation (an egg being released from the ovaries).

Desogestrel POPs are slightly easier to take than the traditional POPs. Because they stop ovulation, and do not only rely on mucus and womb changes, you have 12 hours in which to remember to take your pill. This is in contrast to a 3 hour window with the traditional pills.

How to take POP

Take your tablet at the same time every day. Swallow the tablet whole, with water. You have no pill free days with the POP and you start the next packet the day after finishing a packet.

Starting the POP

If you are not using hormonal contraception at present (or in the past month)

• Traditionally the advice is to wait for your period to begin (day 1). Use alternative methods of contraception until then.
• On the first day of your period take the first POP tablet. Contraceptive cover starts immediately.
• It is also possible to start POP at any time in the cycle if you can reasonably assume that you are not pregnant. If you start later than day 5 in the cycle, use condoms as well for the first 48 hours.
• If you have had sex without using contraception, within the last 21 days and are not sure if you may be pregnant, you can still start the POP, but you should take a pregnancy test 21 days after you last had unprotected sex. Taking POP whilst in early pregnancy has not been shown to cause any harm.
• These non-traditional starting regimes are supported by the Faculty of Sexual and Reproductive Health but are not described in the Patient Information Leaflet supplied with the medicine and are prescribed 'off-label' meaning that doctors take all the responsibility for the prescribing.

When you change from a combined pill (COC), vaginal ring, or transdermal patch

• Start taking the POP on the day after you take the last tablet from the present pill pack, or on the day of removal of your vaginal ring or patch.
• If your present pill pack also contains inactive (placebo) tablets you start the POP on the day after taking the last active tablet (if you are not sure which this is, see the Patient Information Leaflet included with medicine or contact us).
• Contraceptive cover starts immediately.

When changing from an injection or implant or a hormonal IUS

• Start using POP when your next injection is due or on the day that your implant or your IUS is removed.
• Contraceptive cover starts immediately.

More information for starting after having a baby, a miscarriage or using emergency contraception on POP FAQs page.

What to do if you forget to take a POP

• If you are less than 12 hours late (3 hours if Norgeston or Noriday):
  • Take the missed tablet as soon as you remember and take the next one at the usual time. It will still protect you from pregnancy.
• If you are more than 12 hours late (3 hours if Norgeston or Noriday):
  • You may not be completely protected against pregnancy.
  • Take a tablet as soon as you remember and take the next one at the usual time. This may mean taking two in one day. This is not harmful. (If you have forgotten more than one tablet you don't need to take the earlier missed ones.) Continue to take your tablets as usual but you must also use an extra method, such as a condom, for the next 48 hours.
  • If you are more than 12 hours late (3 hours if Norgeston or Noriday) taking your tablet and have had sex since taking the last tablet, it is best to use emergency contraception - consult a pharmacist, GP, or sexual health clinic.

Further information from NHS - What should I do if I miss a pill (progestogen-only pill)?

If you vomit or have severe diarrhoea

• If you vomit, or have severe diarrhoea within 3-4 hours after taking your tablet, the active ingredient may not have been completely absorbed.
• Take another pill as soon as possible. If this pill is vomited additional precautions, such as a condom, are needed until you have been taking the POP consistently for 48 hours.

Pregnancy

Do not use POP if you are pregnant, or think you may be pregnant.

Breastfeeding

The POP may be used while you are breastfeeding and is often a very good choice before restarting a combined pill or other method of contraception.

How effective is POP?

Desogestrel POP prevents egg release (ovulation) in up to 97% of cycles, it is therefore believed to be more effective than a traditional POP (Norgeston, Noriday) where only 50-60% of egg releases are prevented. In trials, with 'perfect use', the progestogen-only pill POP is 99% effective at preventing a pregnancy. With 'typical use' it is around 92% effective. The pill only works as well as you take it.

Alternative treatments

Please speak to your doctor or a sexual health clinic if you would like to discuss alternative methods of contraception such as the combined contraceptive pill (COC), implant, depot injection, IUS or IUD. Long-acting reversible methods of contraception LARC) are more effective. The NHS provides a contraception guide outlining the various options available.

Do not take POP if you have

• A history of breast, ovarian, or uterine (womb) cancer.
• Liver cancer or severe liver disease.
• A thrombosis (clot).
• Diabetes.
• Suffer from epilepsy (see other medicines and POP).
• Tuberculosis (see other medicines and POP).
• Unexplained vaginal bleeding.

If any of these conditions appear for the first time while using POP consult your GP immediately, or if you develop an allergic reaction whilst taking it, such as facial, tongue or throat swelling, or difficulty breathing and swallowing seek immediate medical help - telephone 999 in the UK.

If you experience mood changes or depressive symptoms, including shortly after starting treatment, you should contact your GP for medical advice as soon as possible.

Caution in taking if you have or have had chloasma (yellowish-brown pigmentation patches on the skin, particularly of the face) as this can be made worse or flare-up when taking the POP. If so, avoid too much exposure to the sun or ultraviolet radiation.

If you have high blood pressure which does not improve then please speak to your GP.

Allergy

• Do not take any desogestrel POP if you have previously been allergic to desogestrel.
• Do not take Norimin if previously allergic to norethisterone.
• Do not take Noriday if previously allergic to levonorgestrel.
• All brands of POP also contain lactose.
• Some brands of POP also contain peanut or soya oil and should not be taken by anyone with peanut allergy. Cerazette and Cerelle do not contain any soya or peanut oil.
• If you have any known allergies, it is important to check the manufacturer's patient information leaflet for extra ingredients.

Other medicines and POP

Some medicines may stop the POP from working properly. These include medicines used for the treatment of:

• Epilepsy (e.g. primidone, phenytoin, carbamazepine, oxcarbazepine, felbamate, and phenobarbital).
• Tuberculosis (e.g. rifampicin).
• HIV infections (e.g. ritonavir), or other infectious diseases (e.g. griseofulvin).
• Stomach upset (medical charcoal).
• Depressive moods (the herbal remedy St. John's Wort).

Please speak with your GP about contraception if you are on any of the above medications as it may mean the POP is unsuitable or you may need extra monitoring.

Some medications can also affect the absorption of the hormones in the pill so if you are starting on new medication, please ensure you read the patient information leaflet supplied with it to check.

Possible side effects

Vaginal bleeding may occur at irregular intervals while using the POP which could be light spotting or heavier like a period. You may not have any bleeding at all but breakthrough bleeding or spotting is very common. If bleeding is very heavy or prolonged you should consult your GP. The bleeding usually improves after taking the POP for 3 months and continues to improve the longer you take it.

Common side effects, occurring in less than 1 in 10 women are: mood changes, depressed mood, decreased sexual drive (libido), headache, nausea, acne, breast pain, irregular or no periods, weight increase.

Please see the patient information leaflet for more information on less common side effects.

Risk of blood clots/Venous Thromboembolism (VTE)

Developing a blood clot in the veins of the legs, lungs or other parts of the body is a rare occurrence. It can develop whether or not you are taking the pill but the risk is higher in pill-users than in non-users. The risk with the POP is lower than in users of pills that also contain oestrogens (combined oral contraceptives).

The patient information leaflet has more information about this. Contact your GP or NHS 111 immediately if you notice possible signs of a blood clot.

Buy treatment

Dr Fox supplies contraceptive pills on prescription to prevent pregnancy - you are required to answer a medical questionnaire before your order can be completed. Contraception can be obtained free of charge from an NHS provider such as your GP or a sexual health clinic following a consultation with them.

1. Medical questions
2. Choose treatment
3. Complete order

Answer medical questions to order(progestogen-only pill (mini pill))

Women only

Honest & accurate responses are necessary for safe medical assessment