Progestogen-Only Pill

What are Progestogen-Only Pills?

The progestogen-only pill (POP) is a form of oral contraception that is used to prevent pregnancy.

POPs contain a hormone called progestogen, which is similar to the hormone progesterone produced by the ovaries. There are three types of POP available in Australia – those that contain either levonorgestrel (LNG) or norethisterone (NET), and a POP containing drospirenone (DRSP).

The LNG and NET POPs come in a packet which has 28 days of hormone pills (active pills) and no inactive pills (non-hormone pills).

The DRSP POP comes in a packet which has 24 days of active pills and 4 days of inactive pills.

How do POPs work?

POPs work by:

• making the mucus (sticky fluid) at the cervix (opening of the uterus) thicker so sperm can’t get through
• the DRSP POP also stops the release of an egg by the ovary (ovulation).

How effective are POPs?

The POP is as effective as the combined oral contraceptive pill i.e. the Pill when taken correctly. This means they are greater than 99% effective with perfect use, but with typical day-to-day use they can be about 93% effective.

How do I get the POP?

The POP is available on prescription, which you can get from your doctor, SHINE SA clinics, community health clinics or youth health clinics.

How do I take the POP?

• All POPs are immediately effective if started during the first 5 days of your menstrual cycle, which starts with the first day of bleeding.
• If the LNG or NET POP is started at any other time in the menstrual cycle it is effective after 48 hours (after 3 active pills have been taken).
• The DRSP pill is effective after 7 days (after 7 active pills have been taken).
• Other contraception such as condoms should be used while you are waiting for the POP to start working.
• If changing from the Pill or another method of contraception discuss the best time for starting the POP with your doctor.
• The POP is taken at the same time every day.
• If you are taking the LNG or NET POP and you are more than 3 hours late (27 hours since your last pill) you will not be protected against pregnancy.
• If you are taking the DRSP POP and you miss a pill completely (more than 48 hours since the last pill was taken) you will not be protected against pregnancy.

Can I skip my period?

It is not possible to reliably skip your period with the POP.
Periods will often change when taking POP.

For those taking the LNG or NET POPs:

• approximately 2 in 10 people have no bleeding
• approximately 4 in 10 people have regular bleeding
• approximately 4 in 10 people have irregular bleeding.

For those taking the DRSP POP:

• a withdrawal bleed is planned to start during the 4 days of inactive pills
• even with the inactive pills, approximately 1 in 10 people will not have bleeding from the start and around half will have stopped bleeding by 12 months of use
• bleeding may be irregular if you skip the 4 inactive pills in the pack.

If you have breakthrough bleeding (vaginal bleeding at times other than your period) while taking a POP, don’t stop, continue the packet as usual. Consult a doctor if this persists beyond the first 3 months of starting or if the bleeding bothers you.

When is the POP not effective?

The POP may not be effective if:

• the pill is missed (the definition of a missed pill depends on the type of POP – see Missed pills)
• vomiting occurs within 3 hours of taking an active pill
• you have very severe diarrhoea.

See Missed pills below for instructions on what to do if you miss either an LNG or NET POP or a DRSP POP.

Always check with your doctor, pharmacist or the Sexual Healthline if you are taking other medications, as some drugs may stop the POP from working (e.g. some anti-epileptic medication). This can also include herbal medicines like St John’s Wort. If you are taking one of these medications, you will need to use condoms or avoid unprotected sex while taking the medication and for one month after stopping.

What are the benefits of POPs?

• It is an effective form of contraception if taken consistently.
• Can be safely used after giving birth and during breastfeeding.
• Can be used by people who can’t take oestrogen, which is a hormone found in the combined Pill.
• Does not have the same risk of blood clots as the combined Pill which contains oestrogen.
• Your period may stop completely.
• Once you stop taking the POP, your fertility returns to your normal level immediately.
• The LNG POP is available to concession card holders at a reduced cost.

What are the possible side effects?

In addition to changes in bleeding/periods the side effects can include headaches, breast tenderness and nausea. These will often decrease or stop after the first few months. In some people the hormone in POP can cause patchy brown discolouration to appear on the face, if this happens speak to your doctor.

What are the disadvantages of POPs?

• Bleeding may be unpredictable.
• The LNG and NET POPs have to be taken within a 3 hour window every day to be effective.
• The LNG and NET POPs may be less effective in people under 30 even when taken correctly.
• The DRSP POP is more expensive than other POPs and is not available at reduced cost for concession card holders.

Who should not take the POP?

The POP may not be suitable for someone who:

• has breast cancer, or has had breast cancer in the past
• has severe liver disease
• is taking other medications such as certain antiepileptic drugs, which reduce the effectiveness of the POP.

Tips for good pill taking

• Take the POP every day at a time that’s easy to remember.
• If you have any side effects, including irregular bleeding, continue to take the POP.
• If the bleeding is bothering you get advice from your doctor or SHINE SA.
• Do not stop taking the POP unless you want to get pregnant or have started another form of contraception.

Missed pills

If you are worried about having missed a pill, contact a pharmacist, doctor or SHINE SA clinic. If you are thinking about using an Emergency Contraceptive Pill, it’s best taken as soon as possible, but can be taken up to 5 days after unprotected sex.

The progestogen-only pill does not protect against sexually transmitted infections (STIs) or blood-borne viruses (BBVs). Practise safer sex. Condoms reduce the risk of STIs and BBVs.