Progestogen-only Pill: How It Works, Side Effects & Benefits

What is progestogen-only pill (POP)?

Progestogen-only pill (POP), known as mini pill, is a method of contraception that contains synthetic progestogens (progestins) and does not contain estrogen. 

How does POP work?

The POP works by several mechanisms to prevent pregnancy. 

1. Primarily, it prevents ovulation — the phase in the reproductive cycle where an egg is released from the ovary. 

2. Additionally, POP thickens the cervical mucus, creating a barrier that impedes sperm from reaching the egg. 

3. It also thins the lining of the uterus, reducing the likelihood of a fertilised egg implanting.

Together, these actions provide effective contraception.

How effective is the POP?

When taken consistently at the same time each day, POP reaches an effectiveness of 99% in preventing pregnancy. However, its effectiveness can decrease to approximately 91% if pills are missed or not taken exactly as directed.

How to take POP?

Taking the progestogen-only pill (POP) is straightforward. Here’s how to do it:

1. Daily Routine: 

   • POP comes in a pack of 28 pills. Take one pill orally each day. Choose a time that fits your schedule and stick to it, taking the pill at the same time every day for maximum effectiveness.

2. Consistency is key:

   • To ensure continuous protection, it’s important to take your pill every day without missing a dose.

3. Starting a new pack: 

   • Once you finish a pack, start a new one the very next day without any break in between. This ensures you have continuous contraceptive protection.

How long does it take for POP to start working?

The progestogen-only pill (POP) provides contraceptive protection within different timeframes depending on when you start taking it. 

Starting within the first 5 days of your menstrual period:

• The POP becomes effective immediately at preventing pregnancy.

• No additional contraceptive method is needed.

Starting at any other time during your cycle:

• You must use an additional barrier contraceptive method (e.g. condoms) or abstain from sex for the first 48 hours after starting the POP.

• After 48 hours of consistent POP use, it becomes effective at preventing pregnancy.

• The 48-hour delay is necessary because it takes approximately two days for the POP to thicken cervical mucus and impair sperm viability, ensuring effective contraception.

This guideline also applies if you have a shorter menstrual cycle; additional contraception is advised for the first 2 days of starting POP.

Where to buy POP?

POP contains prescriptive medication which is only available in family planning clinics, women’s clinics, and some GP clinics.

How much is POP in Singapore?

In Singapore, the POP typically costs between $25 to $40 for a monthly pack.

What are the pros and cons of using POP?

Pros

• Unlike barrier methods such as condoms, it does not interfere with sexual activity

• It is safe for use during breastfeeding

• You will be able to get pregnant immediately after stopping the pill

• You may experience lighter, shorter, and less painful menstrual periods

• It is suitable for individuals who cannot use or tolerate estrogen-based contraceptives

Cons

• You will need to take the pills at or around the same time each day for maximum effectiveness

• It does not protect against sexually transmitted diseases (STDs)

What are the side effects of POP?

The POP can have side effects, which vary from person to person. Here are some possible side effects:

1. Menstrual changes:

   • You might experience irregularities in your menstrual cycles, including lighter or more frequent periods, or spotting between periods.

2. Hormonal side effects:

   • Some women may experience temporary hormonal side effects such as breast tenderness, headaches, mood swings, acne, nausea, and vomiting.

3. Ovarian cysts:

   • POP may cause the development of small ovarian cysts, which are usually harmless and often resolve on their own.

Remember, not everyone will experience these side effects, and many women use POP without any issues. If you have any concerns or experience any side effects, seek guidance from your doctor.

FAQ

What if I miss my POP?

It's important to take the progestogen-only pill (POP) at the same time every day because it's absorbed quickly by the body. If you miss your scheduled dose by more than 3 hours, here's what to do:

1. Take the missed pill: As soon as you remember, take the missed pill immediately.

2. Use backup contraception: To ensure you remain protected, use a backup method of contraception, such as condoms, for the next 2 days.

When can I start taking POP after giving birth?

You can start taking the POP immediately after childbirth. Here’s what you need to know:

• Starting POP within 21 days after birth: If you begin taking POP on or before the 21st day after giving birth, you’ll have immediate protection against pregnancy.

• Starting POP after 21 days: If you start taking POP after the 21st day post-delivery, you’ll need to use an additional form of contraception, such as condoms, for the first 2 days to ensure effective pregnancy prevention.

Consult your doctor for personalised advice and support to ensure you start POP at the right time for your situation.

When can I start using POP after miscarriage or abortion?

You can start taking POP immediately following a miscarriage or abortion, and you will receive instant protection against pregnancy. If you start POP more than 5 days after the event, use an additional method of contraception, such as condoms, for the first 2 days to ensure effective pregnancy prevention.

Your doctor can provide further guidance and support to help you manage your contraception effectively during this time.

Who is not suitable for POP?

POP may not be suitable for everyone. Certain individuals should either avoid it or use it with caution under medical guidance. These include people who have:

• Unexplained vaginal bleeding 

• Liver disease 

• Breast cancer 

• Autoimmune diseases such as lupus 

• Circulatory problems such as heart attack or stroke

Does POP protect against STDs?

POP does not protect you against sexually transmitted diseases (STDs). To help protect yourself from STDs, use a male and/or female condom each time you and your partner have sex. 

Should I bleed when I’m on POP?

You may experience a change in your menstrual bleeding pattern (your period may become less or even stop). However, some individuals may still have normal menses while on POP. 

What is the difference between the POP and the normal pill?

There are two different types of contraceptive pills that are commonly used. POP only contains synthetic progesterone while normal pill contains synthetic estrogen and progesterone.