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| The mini-Pill (progestogen-only Pill, or POP) |
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Written by Dr David Delvin, GP and family planning specialist
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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.
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 are proving 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 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
-
nausea and headache sometimes occur, as do 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 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.
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Last updated 19.08.2008
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