Progestogen-only pill (POP, mini pill)

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production.

The progestogen-only pill (POP) is a method of contraception. It contains the hormone progestogen but doesn't contain oestrogen. You need to take the progestogen-only pill at or around the same time every day.

The progestogen-only pill thickens the mucus in the cervix, which stops sperm reaching an egg. It can also stop ovulation, depending on the type of progestogen-only pill you take. Newer progestogen-only pills contain desogestrel.

At a glance: facts about the progestogen-only pill

If taken correctly, it can be more than 99% effective. This means that fewer than 1 woman in 100 who use the progestogen-only pill as contraception will get pregnant in one year.

In real life use about 8 women in 100 will get pregnant in year because they forget to take it (92% effective).

You take a pill every day, with no break between packs of pills.

The progestogen-only pill can be used by women who can't use contraception that contains oestrogen. For example, because they have high blood pressure, have had previous blood clots, are overweight or smoke after the age of 35.

You must take the progestogen-only pill at the same time each day. If you take it more than 3 hours late (or 12 hours late if you take a desogestrel pill, such as Cerazette) it may not be effective.

If you’re sick (vomit) or have severe diarrhoea, the progestogen-only pill may not work.

Some medicines may affect the progestogen-only pill's effectiveness. Ask your doctor for details.

Your periods may stop or become lighter, irregular or more frequent.

Side effects may include spotty skin and breast tenderness. These should clear up within a few months.

The progestogen-only pill doesn’t protect against sexually transmitted infections (STIs). Use condoms as well as the progestogen-only pill to protect yourself against STIs.

How the progestogen-only pill works

The progestogen-only pill works by thickening the mucus in the neck of the womb, so it's harder for sperm to penetrate into the womb and reach an egg.

The progestogen-only pill can prevent ovulation (the release of an egg from your ovaries each month). Non-desogestrel pills stop ovulation about 60% of the time. Desogestrel pills stops ovulation in 97% of menstrual cycles. This means that if you're using a 12-hour progestogen-only pill, you won't release an egg in 97 cycles out of 100.

Using the progestogen-only pill

There are 2 different types of progestogen-only pill:

• 3-hour progestogen-only pill must be taken within 3 hours of the same time each day – for example Norgeston and Noriday
• 12-hour progestogen-only pill (desogestrel pill, such as Cerazette) must be taken within 12 hours of the same time each day

It's important to follow the instructions that come with your pill packet. Missing pills or taking the pill alongside other medicines can reduce its effectiveness.

There are 28 or 35 pills in a pack of progestogen-only pills. You need to take 1 pill every day, within either 3 or 12 hours of the same time each day, depending on which type you are taking. There’s no break between packs of pills. When you finish one pack, you start the next one the next day.

Starting the first pack of pills

1. Choose a convenient time in the day to take your first pill.
2. Continue to take a pill at the same time each day until the pack is finished.
3. Start your next pack of pills the following day. There is no break between packs of pills.

You can start the progestogen-only pill at any time in your menstrual cycle.

If you start the progestogen-only pill on day 1 of your menstrual cycle (the first day of your period) it will work straight away and you'll be protected against pregnancy. You won’t need extra contraception.

If you start the progestogen-only pill on day 5 of your menstrual cycle or earlier (the fifth day after the start of your period or before) you'll be protected from pregnancy straight away unless you have a short menstrual cycle (your period is every 23 days or less). If you have a short menstrual cycle, you'll need extra contraception, such as condoms, until you have taken the pill for 2 days.

If you start the progestogen-only pill on any other day of your cycle, you will not be protected from pregnancy straight away. You'll need extra contraception until you have taken the pill for 2 days.

After having a baby

If you have just had a baby, you can start the progestogen-only pill on day 21 after you give birth. You'll be protected against pregnancy straight away.

If you start the progestogen-only pill more than 21 days after giving birth, you'll need extra contraception (such as condoms) until you have taken the pill for 2 days.

After a miscarriage or abortion

If you have had a miscarriage or abortion, you can start the progestogen-only pill up to 5 days afterwards and you'll be protected from pregnancy straight away.

If you start the pill more than 5 days after a miscarriage or abortion, use extra contraception until you have taken the pill for 2 days.

What to do if you miss a pill

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

• the type of pill you are taking
• how long ago you missed the pill
• how many pills you have forgotten to take
• whether you have had sex without using another form of contraception during the previous 7 days

3-hour progestogen-only pill

If you're taking the 3-hour progestogen-only pill and have taken it:

• less than 3 hours late – take the late pill as soon as you remember and take the remaining pills as normal, even if that means taking 2 pills on the same day
• more than 12 hours late – take the late pill as soon as you remember (if you have missed more than 1, take only 1) and take the remaining pills as normal, even if that means taking 2 pills on the same day

In either case, use extra contraception such as condoms for 2 days. If you had sex around the time you missed your pill, you may need emergency contraception. Get advice from your pharmacy or local sexual health clinic.

12-hour progestogen-only pill

If you're taking the 12-hour progestogen-only pill and have taken it:

• 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 2 pills on the same day
• more than 12 hours late – take the late pill as soon as you remember (if you have missed more than 1, take only 1) and take the remaining pills as normal, even if that means taking 2 pills on the same day

In either case, use extra contraception such as condoms for 2 days. If you had sex around the time you missed your pill, you may need emergency contraception. Get advice from your pharmacy or local sexual health clinic.

Vomiting and diarrhoea

If you vomit within 2 hours of taking a progestogen-only pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

If you don’t take the replacement within 3 hours (or 12 hours for the 12-hour pill) of your normal time, use extra contraception, such as condoms, for 2 days.

If you continue to be sick, keep using another form of contraception while you’re ill and for 2 days after recovering.

Very severe diarrhoea (6 to 8 watery stools in 24 hours) may also mean that the pill doesn’t work properly. Keep taking your pill as normal, but use extra contraception, such as condoms, while you have diarrhoea and for 2 days after recovering (7 days if you are taking a 12-hour pill).

Speak to your GP or contraception nurse or phone 111 or our Sexual Health Line on 0800 22 44 88 if you are unsure whether you are protected against pregnancy, or if your sickness or diarrhoea continues.

Who can use the progestogen-only pill?

The progestogen-only pill is suitable for almost everyone, even if they have health conditions. It's not advised if you have had a hormone-dependent cancer such as breast cancer. You'll be asked about any health conditions to check the progestogen-only pill is suitable for you.

If you are healthy and there are no medical reasons why you should not take the progestogen-only pill, you can take it until your menopause or until you are 55.

Breastfeeding

The progestogen-only pill is safe to use if you are breastfeeding. Small amounts of progestogen may pass into your breast milk, but this is not harmful to your baby. The progestogen-only pill does not affect the way your breast milk is produced.

Pregnancy

Although it is very unlikely, there is a very small chance that you could become pregnant while taking the progestogen-only pill. If this happens, there is no evidence that the pill will harm your unborn baby. If you think you may be pregnant, speak to your GP or visit your local sexual health clinic.

Get medical advice if you have a sudden or unusual pain in your abdomen (tummy), or if your period is much shorter or lighter than usual. It is possible that these are warning signs of an ectopic pregnancy, although this is rare.

Advantages and disadvantages of the mini pill

Some advantages of the progestogen-only pill include:

• it does not interrupt sex
• you can use it when breastfeeding
• it is useful if you cannot take the hormone oestrogen, which is in the combined pill, contraceptive patch and vaginal ring
• you can use it at any age – even if you smoke and are over 35
• it can reduce the symptoms of premenstrual syndrome (PMS) and painful periods

Some disadvantages of the progestogen-only pill include:

• you may not have regular periods while taking it – your bleeding may be lighter, more frequent or may stop altogether, and you may get spotting between periods
• it doesn't protect you against STIs so you may need to use condoms if you are at high risk of getting an STI, for example, if you have more than one sexual partner or you are not certain of your partner's sexual health
• you need to remember to take it at or around the same time every day
• some medications, including certain types of antibiotic, can make it less effective

The progestogen-only pill is generally well tolerated and side effects are rare. Some side effects can include:

• acne
• breast tenderness and breast enlargement
• an increased or decreased sex drive
• mood changes
• headache and migraine
• nausea or vomiting
• cysts (small fluid-filled sacs) on your ovaries (these are usually harmless and disappear without treatment)

These side effects are most likely to occur during the first few months of taking the progestogen-only pill. They generally improve over time and should stop within a few months.

If you have any concerns about your contraceptive pill, see your GP, practice nurse, pharmacist or sexual health clinic. They may advise you to change to another pill or a different form of contraception.

The progestogen-only pill with other medicines

Some medicines can reduce the progestogen-only pill's effectiveness. These include:

• some medication for HIV
• some medication for epilepsy
• complementary remedies, such as St John's Wort
• rifabutin (which can be used to treat tuberculosis)
• rifampicin (which can be used to treat several conditions, including tuberculosis and meningitis)

These are called enzyme-inducing drugs. If you are using these medicines for a short while (for example, rifampicin to protect against meningitis), it's recommended that you use extra contraception during the course of treatment and for 28 days afterwards.

Women taking enzyme-inducing drugs in the long term may wish to consider using a method of contraception that isn't affected by their medication. Always tell your doctor that you are using the progestogen-only pill if you are prescribed any medicines.

Ask your doctor or nurse for more details about the progestogen-only pill and other medication.

Risks of taking the progestogen-only pill

The progestogen-only pill is very safe to take. However, as with the combined contraceptive pill, there are certain risks. These risks are small. For most women, benefits of the progestogen-only pill outweigh the risks.

Ovarian cysts

Some women can develop fluid-filled cysts on their ovaries. These are not dangerous and do not usually need to be removed. These cysts usually disappear without treatment. In many cases, the cysts do not cause symptoms, although some women experience pelvic pain.

Breast cancer

Research is continuing into the link between breast cancer and the progestogen-only pill. Women who use any type of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with people who don’t use hormonal contraception. However, 10 years after you stop taking the pill, your risk of breast cancer goes back to normal.

Where can you get the progestogen-only pill?

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

• most GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraceptive and STI testing services
• pharmacies – they can give an initial 3-month supply
• some young people’s services

Some brands of the desogestrel progestogen-only pill are available to buy in a pharmacy without a prescription. They can also be bought from online pharmacies. Look for the NHS internet pharmacy logo before buying.

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors, nurses and pharmacists have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.