Progestin-Only Oral Contraceptive Pills (POP)

Stack of Birth control pill in 28 pill packages.

The progestin-only pill (POP) is a type of birth control pill (oral contraceptive) that only contains progestin. It may be prescribed for young and adults who can’t take estrogen due to an underlying medical condition, sensitivity or because of an unwanted side effect. POPs are used for birth control but also for treating menstrual period problems, cramps, endometriosis, and other conditions.

How do Progestin-only pills work?

Progestin is a hormone that primarily works by changing the cervical mucus and the lining of the uterus.

How effective are Progestin-only pills?

Progestin-only oral contraceptives are an effective method of birth control, but they don’t prevent the spread of sexually transmitted infections. If progestin-only oral contraceptives are used perfectly (every single day at the same exact time) only 1 out of a 100 young adults will become pregnant over the year. With typical use (not taken at the same time every day), 7 out of 100 adults become pregnant over a year. POPs may be slightly less effective than the combined birth control pill which contains both estrogen and progestin because the timing is so important.

Before you take Progestin-only pills, tell your healthcare provider(s) if you:

  • Have an allergy to progestin or any other medications
  • Are taking any other prescription or nonprescription (over-the-counter) medicine
  • Have ever had breast lumps, liver disease, or diabetes
  • Smoke
  • Are pregnant or want to become pregnant
  • Take anticonvulsant or seizure medicine

How do I take Progestin-only pills?

Take one pill every day AT THE SAME TIME. Your healthcare provider may tell you to start the Progestin-only pill on the first day of your period or the first Sunday after your period begins. If you’re sexually active, be sure to use a backup barrier method of birth control (condom) for the first 7 days after starting the Progestin-only pill to prevent pregnancy. You should always use condoms to decrease your risk of getting a sexually transmitted infection (STI).

nor-qd pillThe “Mini-Pill”

One type of POP is sometimes called “the mini-pill” and is a low-dose progestin every day. The progestin dose is substantially lower than the dose found in many combination birth control pills with estrogen and progestin. This pill pack contains 28 active pills, meaning there are no placebo or inactive pills in the pill pack.

What should I do if I miss a dose of the mini-pill?

  1. Take the missed pill as soon as you remember, (you can take 2 pills in one day but spread them apart), and then go back to taking the pill at the regular time.
  2. If you are more than 3 hours late taking your pill, either don’t have sex or use a backup method of birth control for the next 48 hours.
  3. If you have missed more than one pill, you take two pills in one day, but do not exceed two pills in a day. It’s also important that you don’t stop taking the pill, keep taking it (as you normally would). Don’t have sex or use a backup method of birth control (condom) until you can talk with your health care provider.
  4. If you become sick with vomiting or severe diarrhea within three hours after taking the Progestin-only pill, keep taking the pill every day. Do not have sex, or use a back-up method (condom), until 2 days after the vomiting has stopped. Call your health care provider if you have any concerns.

Possible side-effects of the “mini-pill”:

  • Spotting or break-through bleeding can last for a few days until your body gets used to the medicine, or for as long as you are taking it.
  • Not having a period is also common, but up to half of users continue to have monthly periods.
  • Other side effects, such as acne, mood swings, nausea, dizziness, bloating, weight gain, headache, and/or hair thinning are rare.

Most of the time side effects are mild. However, if you have heavy bleeding that lasts longer than usual and/or severe pain in your belly, call your healthcare provider right away. Most women have no periods while taking POPs. If you are sexually active and have no periods, talk to your provider, they may recommend taking a pregnancy test every 2 to 3 months, just to be sure you are not pregnant.

Types of progestin-only pills: There are many brands of Progestin-only Pills (POP) but most of them all contain the same dose and the same active ingredient – norethindrone, 0.35 milligrams (mg)  daily.

Some Brand Names:

  • Camila®
  • Heather®
  • Jolivette®
  • Nor-Q.D.®
  • Norethindrone®

Drospirenone Pills

Another type of POP is called Slynd® and has a progestin called drospirenone 4 mg daily. Unlike the mini-pill that has norethindrone 0.35 mg daily, drospirenone pill packs have 24 “active” pills and 4 “in-active” pills at the end of the pack do not contain hormones.

What are some major differences between drospirenone (Slynd) and norethindrone?

  1. Drospirenone (Slynd®) pill packs include 4 placebo pills, thus some may experience bleeding during this time frame. Your healthcare provider may instruct you to skip the placebo pills and take drospirenone continuously; this may cause minimal or no more bleeding.
  2. Drospirenone has a similar effect to approximately 25mg of spironolactone. Spironolactone is a medication that is often prescribed at much higher doses as a diuretic or acne treatment. Because of this potential and similar activity, drospirenone may place people at risk for different conditions such as hyperkalemia (high potassium). Certain medications or conditions can increase the risk of high potassium, so talk to your healthcare provider to see if you are at risk.
  3. Drospirenone has a 24-hour window, unlike norethindrone, meaning if you are more than 3 hours late with taking your pill, but you take it within 24 hours, you don’t need to use a backup method of contraception such a condom. This is because drospirenone pills are more likely to consistently suppress ovulation in addition to all the other effects that the progestin hormone has on decreasing pregnancy.