What is a contraceptive pill?

A contraceptive pill is a tablet containing hormones, taken by women, to prevent pregnancy. There are two types. The combined pill (COC), contains both oestrogen and progestogen, and is often simply known as 'The Pill'. The other, often used when the combined pill is not suitable, only contains a progestogen and is called the progestogen-only pill (POP) or mini-pill.

What is a POP?

POP is the Progestogen-Only Pill, also often referred to as the 'Mini Pill'. The original POPs contained older progestogens. The only original type POPs still available contain either levonorgestrel (Norgeston) or norethisterone (Noriday). They are now rarely prescribed and most POP now contains desogestrel. There are various different brands but they all contain 75 mcg of desogestrel.

What is the difference between all the different desogestrel 75 microgram POPs?

In short, nothing! The original branded desogestrel 75 mcg POP was Cerazette manufactured by Organon. The same product is also produced by many different manufacturers as generic equivalents. Some manufacturers have given their equivalent a brand name such as Cerelle, Desorex, Desomono, Feanolla, Hana, Lovima, Moonia, or Zelleta, but desogestrel 75mcg tablets are also produced unbranded just as desogestrel 75mcg.

How does the POP work?

The modern desogestrel POPs stop ovulation (egg release) as well as altering the mucus at the neck of the womb (cervix), and causing changes to the lining of the womb, making it thinner and so less easy for a fertilised egg to be implanted. The original POPs worked mainly by thickening cervical mucus making it difficult for sperm to get into the womb and to reach an egg and fertilise it.

Why choose the POP?

Contraceptive pills are useful for women who do not wish to become pregnant and want a method that does not interrupt sex, and does not reduce subsequent fertility. The POP can be used by most women of all ages up to 55. The POP is taken every day at the same time making it easy to remember. It is 99% effective, if taken reliably and consistently. It can be taken by women who can't use combined hormonal contraception because of blood pressure, migraine, or other medical conditions. It can be used by women who smoke after age 35.

What other contraception options are there?

There are other forms of hormonal contraceptives: implants, injections, progestogen releasing intrauterine systems, patches, vaginal rings, and combined pills.

A non hormonal option is the copper intrauterine device sometimes called a 'coil' or 'copper coil'.

There are also barrier contraceptives: condoms (male and female) and contraceptive caps and diaphragms.

Further details NHS contraception guide - What is contraception?

Please consult your GP or a sexual health clinic to discuss options and to see which is the best for you.

What is LARC?

LARC refers to Long Acting Reversible Contraception. LARC methods are the most reliable forms of contraception. They include injections, implants, coils, and intrauterine systems. These can be obtained from sexual health services and many GPs.

How long does it take for erratic bleeding to settle on POP?

Slightly erratic bleeding is one of the main initial problems with the POP. It usually settles after about 3 months and is often not as heavy as a normal period. The bleeding tends to be light unpredictable 'spotting'.

After starting the POP should I use condoms for 2 days or 7 days?

The manufacturer's patient information leaflet included with the medicine advises 7 days of regular desogestrel POP use before relying on the desogestrel POP for contraception. This relates to the original product licence which relied on the desogestrel POP preventing egg release. More recent research has shown that there is a very good contraceptive effect produced by the POP effect of thickening cervical mucus which happens much earlier. The FSRH (Faculty of Reproductive and Sexual Health) therefore advise that after 2 days use the desogestrel POP will prevent pregnancy.

Does POP contain lactose?

Yes. The POP and all contraceptive pills contain lactose.

Is there a risk of blood clots when taking POP?

Probably not. Developing a blood clot (thrombosis) 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 hormonal contraception, but the risk of clots is higher in combined (COC) pill users than in non-COC users. The risk with the POP has not been fully researched but at present there is no evidence of an increased risk. In fact, it would not be expected to be greater than for a non-pill user as any increased risk from contraception is related to oestrogen, not progestogen.

In theory, the older norethisterone POP (Noriday) may have been linked to an increased risk due to its conversion to oestrogen in the body. However in practice the oestrogen amounts involved were too small to make significant difference, and no risk has been demonstrated.

Is there a risk of cancer when using POP?

Up until recently there was no clear evidence of increased cancer risk from taking POP. However, a new study published in March 2023 shows a very similar slight increase in breast cancer risk from POP to that with combined hormonal contraceptives. This is balanced by a possible decrease in the risk of cancer of the ovaries and womb.

Is it true that you can't get pregnant the first time you have sex?

Unfortunately and importantly, no! This myth causes unwanted pregnancies. If you think you may be going to have sex and need contraception, Dr Fox can supply desogestrel POP to women 18 years and over, or contact your GP, a sexual health clinic, or Brook Centre (if you are under 25).

Is it true that you can't get pregnant if you have sex standing up?

No. Gravity will not prevent sperm from reaching their destination. You can get pregnant in any position.

Is it true that I won't get pregnant if my partner pulls out at the last minute?

Not really. Using the withdrawal method is not very reliable. Sperm leak out before ejaculation and sometimes men do not withdraw in time.

My friends say that condoms are no use, because they split - are they right?

Condoms can break, but if handled carefully and correctly this is rare. When people say that a condom split, it more commonly means that in the heat of the moment the condom didn't actually make it out of the packet! Using a condom is very much safer than not using one at all, but contraceptive pills are much more effective than condoms. Using condoms as well as pills gives protection against STIs too. If no contraception is used, morning after pills are an option. These are most effective when taken as soon as possible after intercourse. Emergency contraception can also be provided by having a coil fitted within a few days of unprotected sex.

Can under 16s get contraceptives?

Yes they can. Under 16s needing contraception can see a GP or nurse, or visit a sexual health clinic. Parents don't have to be informed, as long as there is good understanding and the young person is not vulnerable and in need of protection.

Find a local sexual health clinic

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Note: Dr Fox supplies medication online only to adults (18 years or older).

Will the POP protect me from sexually transmitted disease?

No. If you are in a new relationship or otherwise at risk, you need to use condoms as well to protect from sexually transmitted disease.

Where can I get the POP?

You can obtain POP from your GP surgery, a sexual health clinic, a Brook Advisory Centre (if you are under 25) or online. Dr Fox can provide first packs to start using the desogestrel POP and can also supply follow up prescriptions, for all POP.

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Will I have to pay for the POP?

Contraception, including the POP is available free on the NHS from GP surgeries, sexual health clinics and Brook Centres (if you are under 25). If you prefer to access your contraceptive privately including online, charges apply - see POP prices from Dr Fox.

I've missed taking my POP and had sex - do I need emergency contraception?

It depends when you missed a pill and whether you are taking a modern desogestrel pill. Modern desogestrel POPs can still be effective even if taken up to 12 hours late. In the older POPs (Norgeston or Noriday) this is only 3 hours.

Missed pill rules

• If you are less than 12 hours late (3 hours if Norgeston or Noriday):
  • 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):
  • 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 (3 hours if Norgeston or Noriday) 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.

See also NHS contraception guide - What should I do if I miss a pill (progestogen-only pill)?

Will antibiotics stop my POP working?

It depends on which antibiotics you are taking. There used to be concerns about common antibiotics affecting contraceptive pills. However, current understanding (2022) is that the only types of antibiotic that interact with hormonal contraception, including the POP, and make it less effective are the rarely used rifampicin and rifabutin (for tuberculosis and meningitis) and the antifungal griseofulvin (for fungal infections).

Do other drugs interact with POP?

As well as the antibiotics rifampicin and rifabutin decreasing the strength of hormonal contraceptives, including POP, some other medications have a similar effect. These include treatment for epilepsy and antiretroviral medicines (HIV treatment). Full lists of interactions can be found in the manufacturer's patient information leaflet supplied with the pills.

• Cerazette Patient Leaflet
• Noriday Patient Leaflet
• Norgeston Patient Leaflet

What over the counter products interfere with the POP?

St. John's Wort, the herbal remedy for low mood reduces the effectiveness of POP.

Can I trust my contraceptive?

The effectiveness of any contraception is affected by user reliability, the life span of sperm, stage in the menstrual cycle, age, weight, and other medications - all these issues are factors.

Our doctors have written an in-depth article which explores all aspects of the reliability of different forms of contraception, and what to do if it fails.

Do I really need to take my POP at the same time each day?

The modern desogestrel POP can be taken up to 12 hours late, with no loss of effectiveness. Older POPs had to be taken within 3 hours of the usual time.

Despite the leeway, it is usually easier to remember your POP, if you do try to take it at the same time each day. Sometimes using a mobile phone alarm or app can help you remember. If you have trouble remembering your pills, then a LARC method of contraception may suit you better.

See also I've missed taking my POP and had sex - do I need emergency contraception?

I've heard I can delay periods using the pill - can I do this with the POP?

Unfortunately no. The POP cannot be used to delay periods. However, many women taking the POP have a change in their period pattern to either very infrequent or no periods at all. The bleeding may be predictably regular but is often unpredictable. If it is very important to delay any bleeding, discuss other options with your GP or sexual health provider.

I'm pregnant - can I use the POP after having my baby?

The POP is often recommended after childbirth, especially if you are breastfeeding, as unlike the combined contraceptive pill, it does not reduce your flow of breast milk.

Breastfeeding itself is 98% effective as contraception, but ONLY if all three of the following apply:

1. The baby must be under six months of age AND
2. The woman must not have had a period AND
3. The baby must be exclusively breastfed (no formula or pablum/baby rice with breastfeeds at least every 4 hours during the day and at least every 6 hours at night).

If these conditions do not apply, or you prefer greater security, a POP is usually taken, whilst breastfeeding. The POP can be started immediately after the birth. If you start more than 3 weeks later, then you would not be protected for the first 2 days of pills, whilst the hormones build up, so condoms would be required as well during that time. Once breastfeeding stops, the POP could be continued or you could swap to another hormonal contraceptive, or another form of contraception.

When can I start the POP after a miscarriage or an abortion?

You can start POP anytime within the first 5 days after a miscarriage or abortion, no extra condom use is needed. If you start later than 5 days after the miscarriage or abortion then 2 days of condom use is recommended whilst the POP hormone levels stabilise.

When can I start POP after using emergency contraception?

This depends on which form of emergency contraception (EC) you used.

• After either levonorgestrel or ellaOne, you can choose to wait to start the POP until the first day of your period and use condoms for contraception until this time.
• If you are unable to wait then you can start on the same day as the EC, if you have used emergency contraception containing levonorgestrel (Levonelle). Use condoms as well for the first 2 days.
• EllaOne interacts with progestogen, so POP should not be started until 5 days after taking it. You need to use condoms for those 5 days and also for 2 more days until it works, so a total of 7 days.
• If you start POP before your next period then you also need to take a pregnancy test, 3 weeks after the sex leading to the use of the emergency contraceptive pill.

How long can I stay on the POP for?

It is safe to take the POP long term and it can be taken till the menopause, by most women. It is usually better for women to take the POP, instead of CHC as they get older, especially over 40 (over 35 if a smoker). There are fewer health risks from POP particularly relating to blood clots. You should use contraception until 1 year after your periods stop or until age 55.

Does being on the POP decrease fertility?

No. Fertility returns as soon as you stop taking the POP.

Can I request a different contraceptive pill from Dr Fox to the one I usually use?

You can start the desogestrel POP from Dr Fox either as a swap from another hormonal contraceptive or as your first contraceptive pill.

However, Dr Fox only supplies combined hormonal contraceptives (COC) and other POPs that you have been taking regularly for 12 months prescribed by your usual contraceptive provider.

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