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'.

Dr Fox can supply POPs as a new contraceptive pill or for continued use for women aged 18-55 (18-49 for Slynd).

Women ordering a POP from Dr Fox are recommended to provide GP details and consent to a notification being sent to inform their GP.

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

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.

Slynd, which became available in the UK in 2024, contains drospirenone.

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.

Most POPs 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 do POPs work?

All POP 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 or drospirenone 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 (Noriday and Norgeston). Slynd has the added benefit of having a 24 hour window.

How to take POPs

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

Slynd also has 28 tablets, but 4 are green inactive (placebo) tablets. Slynd is still taken continuously, but due to the inactive tablets it is important to take them in the correct order.

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 (or for 7 days if taking Slynd).
• 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 medicine's Patient Information Leaflets and are prescribed 'off-label' meaning that doctors take all the responsibility for the prescribing.

Changing to a POP from other hormonal contraceptives

Contraception will remain active if the POP is started:

• The day after the last 'active' tablet of a combined oral contraceptive pill (COC) or a different POP.
• The same day a progesterone implant, patch, vaginal ring, intrauterine system (hormonal coil), or copper coil (IUD) is removed.
• The day the depot injection is due.

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

Missed pill - what to do if you forget to take a POP

• If you are less than 12 hours late (3 hours if Norgeston or Noriday or 24 hours for Slynd):
  • 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 or 24 hours for Slynd):
  • Contraceptive protection may be reduced.
  • 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 (or 7 days for Slynd).
  • If you are more than 12 hours late taking your tablet (3 hours if Norgeston or Noriday or 24 hours for Slynd) 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 to do if you miss a progestogen-only pill or take an extra one

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 vomiting/diarrhoea continues you must follow the 'missed pill' advice above.

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 oral contraceptive (COC) pill or other method of contraception.

How effective are POPs?

Newer desogestrel (Cerezette, Cerelle, Lovima, and Hana) and drospirenone (Slynd) POPs - less than 1 in 100 women will become pregnant each year with perfect use.

Traditional POPs (Noriday and Norgeston) - between 3 and 7 in 100 women will become pregnant in a year. These pills are less effective than the newer POPs, so not used as often.

No contraception - more than 80 in 100 women of childbearing age will become pregnant in a year if sexually active and no contraception is used.

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 methods of contraception guide outlining the various options available.

Do not take POP if you have

• Lactose intolerance/allergy.
• A history of breast, ovarian, or uterine (womb) cancer.
• Liver cancer or severe liver disease.
• A thrombosis (clot).
• Epilepsy.
• Tuberculosis.
• 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 is recommended 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 sunbeds.

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

Other medicines and POP

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

• Epilepsy (eg primidone, phenytoin, carbamazepine, oxcarbazepine, felbamate, and phenobarbital).
• Tuberculosis (eg rifampicin).
• HIV infections (eg ritonavir), or other infectious diseases (eg griseofulvin).
• Stomach upset (medical charcoal).
• Depressive moods (the herbal remedy St. John's Wort).
• Diabetes (eg insulin and glucose lowering medications).
• Weight loss injections eg Mounjaro (tirzepatide).

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.

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 and increases if you have had a previous history of a blood clot. 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))

Honest & accurate responses are necessary for safe medical assessment