Lloydspharmacy.com Health - The mini-Pill (progestogen-only Pill, or POP)

Written by Dr David Delvin, GP and family planning specialist

In 2008, the mini-Pill is still nowhere near as popular as the ‘ordinary’ Pill. For every one woman taking the mini-Pill, there are more than 30 who use the ‘real’ Pill.

However, this progestogen-only Pill (POP) does provide very satisfactory contraception for over 100,000 British women – including a lot who can’t take the Pill. Recent research suggests that that the mini-Pill is particularly popular with females over 35.

The POP’s great advantage is that – as far as we know – its health risks appear to be less than those of the actual Pill. But official advice is that it should not be taken by women with:

undiagnosed vaginal bleeding
severe artery disease
liver tumours
the rare disease porphyria
a history of breast cancer (with certain exceptions).

In addition, the latest instructions say that the mini-Pill should only be used ‘with caution’ by certain women – including those who have ever had an ectopic pregnancy. Your doctor or Family Planning nurse will advise you about this.

Its two chief drawbacks are that it doesn’t control your periods – and that it is rather less effective than the ordinary Pill.

Nevertheless, new versions of the mini-Pill seem to be better at preventing pregnancy than the traditional type and have an effectiveness that isn't all that much below that of the Pill itself.

Why take the mini-Pill?

If you enjoy a good sex life, you almost certainly want to protect yourself against unwanted pregnancy. The mini-Pill can do that for you. But you have to remember to take it every single day of the year. No breaks at all - even when you're on your period.

Even the newest brand of POP is not quite as effective as the ordinary Pill, but the mini-Pill is a good deal freer of side-effects than the Pill.

It's particularly useful for some groups of women who shouldn’t take the Pill or for whom it is a little risky - for instance:

new mums who are breastfeeding
diabetics
women who smoke
women whose blood pressure has gone up on the Pill
older women.

What is the mini-Pill?

There's a lot of confusion about this name. Many women don't understand it - and, regrettably, even a few doctors have got the wrong end of the stick about it!

The mini-Pill is not just a low-dose version of the Pill. Unfortunately, lots of women who are taking low-dose brands of the Pill think they are on the mini-Pill, but they aren't.

The POP is quite different from the ordinary or 'combined' Pill. Unlike the ordinary Pill it contains just one hormone - not two. That hormone is a progestogen (often mistakenly called a 'progesterone'.)

A progestogen - which is an artificially manufactured hormone - is very like progesterone, which is one of the female hormones the body produces. Unlike the 'ordinary' Pill, the mini-Pill contains no oestrogen at all.

It is the oestrogen in the ordinary Pill that is responsible for many of its side effects - including some of the rare but very serious ones. So going on the mini-Pill, instead of the Pill, immediately reduces your chances of dangerous side effects.

How does the mini-Pill work?

The POP stops you from getting pregnant by doing three things:

it thickens the secretions round the neck of your womb - this makes it very difficult for the sperm to get through
it makes the lining of the womb thinner, and so less 'receptive' to ova (eggs)
some of the time, it stops you ovulating (releasing an egg). The latest mini-Pills (such as Cerazette) do this most of the time, which makes you even less likely to get pregnant.

How effective is it?

It's not quite as efficient in protecting you against pregnancy as the ordinary Pill, but it is pretty good. If 100 sexually active women took the mini-Pill regularly for a year, less than two of them would get pregnant. This makes the POP about as effective as the coil (IUD).

However, newer types of mini-Pill – such as Cerazette – probably have a failure rate of only about 1 per cent per year. But take care: much depends on your ability to take the tablet every single day at roughly the same time each day. If you can’t manage this (and it isn’t easy!), you’ll increase your risk of pregnancy.

How do I take it?

You must take the mini-Pill at roughly the same time of day, every day - even when you are menstruating.

You can pick your own time of day when you start on the POP. For instance, you might decide to take it at 12 noon, or when you’re having your supper. But from then on, you need to stick to that time. A few women actually arrange for ‘mini-Pill alarms’ to sound each day on their mobiles!

If you're more than three hours late in taking the tablet, you could fall pregnant. (But with Cerazette, it's said that you can get away with being 12 hours late; I don't recommend making a habit of this.)

Obviously, the mini-Pill is not a great idea for you if:

you're not very good at taking tablets regularly
you're in a job - like being part of an airline crew - where hours are irregular and disrupted.

Also, if you’re significantly overweight (and particularly if you’re over 11 stone – that’s 70 kg), the POP may not be effective enough for you.

If you’re determined to try the POP, then Cerazette would probably be your best choice. Alternatively, a few doctors are willing to prescribe two mini-Pills per day for larger women. But very big people (over, say, 16-and-a-half stone – that’s 105 kg) really shouldn’t try the mini-Pill at all in my view, because the risks of falling pregnant are probably too great.

An attack of diarrhoea or vomiting can also prevent the mini-Pill from working effectively.

How do I get it?

Begin by going to a doctor or a family planning clinic and asking them about the mini-Pill. (In practice, family planning clinic staff tend to know more about POPs than almost anyone else.)

Discuss whether the mini-Pill would be suitable for you. Ask about the latest situation regarding side-effects.

If you decide to go ahead with the mini-Pill, you'll be given a prescription for several packs. Read the leaflet inside the packet. Then start taking the tablet on the first day of your next period – this will give you immediate protection.

However, if you’re absolutely sure that you’re not pregnant, you can start taking the mini-Pill on any day of your cycle – but you may not be protected immediately. Take the doctor’s or nurse’s advice about this.

If you're not having periods at the moment because you've recently had a baby, then you can start taking it immediately. (Don't do this if there's any suspicion that you might be pregnant again!)

What special categories of women take the mini-Pill?

Although nearly all women can use the mini-Pill if they want to, in practice it is commonly taken by people who would have difficulties with the ordinary Pill. These include:

breastfeeding mums - mainly because the Pill tends to stop milk production
women who cannot take oestrogens
women over 35 to 40 years of age who have been medically advised not to take the Pill
women who are at special risk of heart disease or strokes - though these patients should definitely not take the mini-Pill without seeking specialist advice first
women who are heavy smokers - smoking and the ordinary Pill make a very dodgy combination, and may cause heart attacks or clots. If you can't give up cigarettes, your doctor might suggest that the POP is less of a risk for you.

What are the side effects of the mini-Pill?

At present, the POP seems to carry considerably less risk than the ordinary Pill – but please remember that while the long-term effects of the ordinary Pill have been extensively studied over nearly 50 years, the amount of research into long-term effects of the mini-Pill has been rather less.

So it’s possible that unsuspected side-effects might emerge later in the 21st century. Currently, it is believed that the mini-Pill might carry a slightly increased risk of breast cancer.

The chief known side effects are:

periods tend to be irregular, which can be a considerable nuisance
sometimes periods stop - this may be a worry to you, and you may need the reassurance of a pregnancy test
if you did become pregnant while taking the mini-Pill, there is a chance that the pregnancy might be ectopic, that is outside the womb - so if your period is late and you get pain in your lower tummy, contact a doctor fast (ectopics are said to be rarer with Cerazette)
you may get spots on your skin
you could get tender breasts
there's a small risk of cysts in the ovaries – indeed, it’s best not to use the POP if you’ve already had an ovarian cyst
women sometimes report nausea and headache and also dizziness, depression and weight change.

Who shouldn't take the mini-Pill?

Doctors may refuse to prescribe the mini-Pill for you if you have one of the conditions listed at the beginning of this article. Also you may not be able to take the mini-Pill if you are on a drug that interacts with it and reduces its effectiveness.

What are the various kinds of mini-Pill?

There are several groups, so if one brand doesn't suit you (say, if it gives you bad spots on your face), you can easily switch to one from another group. At the time of writing, there are five brands available in Britain – and others in overseas countries. The British brands are:

Group 1 (both identical)

Micronor, Noriday.

Group 2

Femulen.

Group 3

Group 4 (the newest)

Cerazette.

If you are in doubt about any issues concerning the mini-Pill (POP), please don’t hesitate to consult a GP or a family planning clinic.

In December 2008, the Royal College of Obstetricians’ and Gynaecologists’ Faculty of Sexual and Reproductive Health Care issued new guidelines about the mini-Pill. The essence of them is as follows:

The mini-Pill should not be used by women who currently have breast cancer.
The health professional who is going to prescribe the mini-Pill should first take a ‘clinical history’ from the woman, to make sure it is safe for her.
Women should be told that, if taken properly, the mini-Pill is over 99 per cent effective.
They should be told that at present there is no evidence that one mini-Pill is better than another
If a woman is sick (vomits) within two hours of taking a mini-Pill, then another one should be taken as soon as possible.
Women who are using drugs called ‘liver enzyme-inducers’ must be told that the effectiveness of the mini-Pill may be reduced by them.
They should be advised that after stopping the mini-Pill, there is no delay in return of fertility.
They should be advised that the mini-Pill commonly causes changes in period patterns, and that 20 per cent of females will have no bleeding.
They should be told that there is no scientific evidence that the mini-Pill causes weight gain, depression, or headache.
The mini-Pill can be used up to age 55. If a woman wants to used it after that age, she should have her blood levels of hormone checked to see if it is still necessary.

Last updated 07.01.2009