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About desogestrel POP

All modern POPs contain the same active hormone desogestrel 75 micrograms and are available from Dr Fox as Cerazette, Cerelle, Hana, and Lovima brands.

The original POP (Noriday, Norgeston) was often called the 'mini pill' and contained older less effective hormones.

Dr Fox is able to supply women 18-55 years of age wishing to start or continue contraception.

Key facts - desogestrel POP

• Desogestrel POPs can be more than 99% effective, if taken correctly, meaning that fewer than 1 woman in 100 per year becomes pregnant whilst using the POP.
• Desogestrel POPs are taken once daily at the same time, without breaks. Continue monthly packs without a break.
• Some women who can't take pills containing oestrogen, perhaps because of high blood pressure, migraine, or other medical problems, may be able to take a POP instead.
• Women over 35 who smoke can take progestogen-only pills.
• Desogestrel POPs can still be effective even if taken up to 12 hours late.
• Vomiting and severe diarrhoea may prevent pills from working.
• Contraceptive pills do not protect against sexually transmitted diseases and women at risk of these should use condoms as well.
• Women sometimes get light irregular bleeding (spotting) in the first few months after starting a desogestrel POP. This usually settles, often into a pattern of very infrequent or no bleeds.

How the desogestrel POP stops pregnancy

The main action is to stop ovulation (an egg being released from the ovaries). The desogestrel also affects mucus at the neck of the womb (cervix), making it thicker and more difficult for sperm to pass through. There are also changes to the lining of the womb making it thinner and so less easy for a fertilised egg to be implanted.

Obtaining desogestrel POP online

Dr Fox supplies 1-12 months of desogestrel POP only to eligible women over 18 wishing to start the desogestrel POP for contraception.

If already established in using POP, Dr Fox supplies 1-12 months of POP (all types, including older type POPs such as Noriday and Norgeston).

There is a short online questionnaire to assess suitability and eligibility for POP.

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

Most contraception, including desogestrel POP, can be obtained free through the NHS from GPs and sexual health clinics. Under 16s can obtain contraception, without parents or guardians being informed, providing the young person is competent, informed, and assessed not to be vulnerable to exploitation or abuse.

Taking desogestrel progestogen-only pills

Take your tablet at the same time every day. Swallow the tablet whole, with water. Unlike combined contraceptive pills, there is no 7 day pill-free break with POP. When one 28 day calendar pack of the desogestrel POP is finished, another is started straight away, with no break in between and no hormone withdrawal bleed.

Starting desogestrel POP

The desogestrel POP can be started on any day of the menstrual cycle, but if not started in the first five days of the cycle, counting from when the period usually begins, additional temporary contraception (condoms) will be needed, for the first 48 hours. The rules are a little complicated and are regularly reviewed by the FSRH (Faculty of Sexual and Reproductive Health) so may differ from those in the patient information leaflet. See NHS - contraception guide - progestogen-only pill for further details.

Starting desogestrel POP after pregnancy

Desogestrel POP can be started immediately after having a baby or an abortion or miscarriage. If started later, 21 days after childbirth or 5 days after abortion or miscarriage, additional contraception (condoms) is required for the first 48 hours.

Missed pill rules for desogestrel POP

Forgotten pills:

• If you are less than 12 hours late: 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:
  • 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 taking your tablet and have had sex it is best to use emergency contraception - consult your pharmacist, GP or sexual health clinic.
  • If you missed one or more tablets in the very first 2 days of taking your tablets and had unprotected intercourse in the week before missing the tablets, you may become pregnant. Speak to your GP or a sexual health clinic.

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 also vomited additional precautions (condoms) are needed until you have been taking the POP consistently for 48 hours.

Standby emergency contraception is available online from Dr Fox, but should not be ordered for immediate use as the postal service cannot be relied on to deliver in time.

Pharmacies, GP surgeries, GUM, and sexual health clinics can all provide rapid access to emergency contraception when it is needed.

NHS - Where can I get emergency contraception?

Suitability of desogestrel POP

There is a short online medical questionnaire to ensure treatment is suitable.

Dr Fox cannot supply desogestrel POP if any of the following apply:

• Allergy to desogestrel.
• Allergy to peanuts or soya.
• Lactose intolerance.
• History of breast, ovarian, or uterine (womb) cancer.
• Liver cancer or severe liver disease.
• Previous thrombosis (blood clot).
• Diabetes.
• Epilepsy.
• Tuberculosis.
• Unexplained vaginal bleeding.

Some women who cannot take combined contraceptive pills (combining oestrogen and progestogen) can take POP. If in doubt, discuss with your GP or a specialist sexual health advisor.

The desogestrel POP can usually be taken right up to the menopause or the age of 55 years.

Breastfeeding and pregnancy

Breastfeeding women can safely take the desogestrel POP. Women who are exclusively breastfeeding an infant under 6 months of age, and whose periods have not resumed, do not need to take contraception, as this lactational amenorrhoea (LAM) is over 98% effective at preventing pregnancy. If POPs are taken inadvertently during pregnancy, this will not usually adversely affect the pregnancy. A doctor or specialist sexual health advisor should be consulted.

Pros and cons

Pros

• Sex life can continue as normal, pills are taken daily and sex can be spontaneous.
• Can be taken whilst breastfeeding.
• Does not contain oestrogen, which some women cannot take.
• Can be taken by smokers over 35.
• Can reduce the occurrence and intensity of premenstrual syndrome and lighten periods.

Cons

• Must be taken regularly at the same time each day.
• No protection from sexually transmitted infections.
• Possible irregular bleeding pattern.

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.

Most women can take desogestrel POP without significant side effects. Possible side effects include acne, breast tenderness, increased or decreased sex drive, mood changes, headache and migraines, though migraines often improve on POP. Whilst POPs reduce the risk of pregnancy, around 1 in 10 pregnancies that do occur may be ectopic.

Other medicines and desogestrel POP

Some medicines may stop the desogestrel 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 desogestrel POP may be unsuitable for you or you may need extra monitoring.

For a fuller list of side effects and details of interacting medicines see the patient information leaflets supplied with pills.

Risks

There is a small increased risk of ovarian cysts, but these are not usually dangerous and will usually disappear without treatment.

It is possible that there may be a small increased risk of breast cancer, but at present there is no research evidence of this and the risk would decrease with time after stopping the POP.

Further information

• NHS - Your contraception guide
• NIHR/UCL - Contraception Choices
• Frequently Asked Questions: Progestogen-only pill