Title: Progesterone only pills or mini pills
Course: Level 3 - Family Planning > Section: Oral contraceptive methods

POPs are also called mini-pills, unlike COCs, do not contain any oestrogen, and therefore they can be used throughout breastfeeding and by women who cannot use methods with oestrogen (figure 6.2).

POPs work primarily by:

- Thickening cervical mucus (this blocks sperm from meeting an egg).
- Disrupting the menstrual cycle, including preventing the release of eggs from the ovaries (ovulation).

Fig.6.2. Progestin-only contraceptive.

How effective are POPs:
Effectiveness depends on the user.

For breastfeeding women: When pills are taken every day, less than one pregnancy per 100 women using POPs over the first year Side effects (that are temporary and not dangerous)

Side effects of POPs:

Changes in bleeding patterns including frequent bleeding, irregular bleeding, infrequent bleeding, prolonged bleeding, no monthly bleeding and for breastfeeding women lengthened postpartum amenorrhea, headaches, dizziness, mood changes, breast tenderness, abdominal pain and nausea.

Who can use POPs:

Women of any reproductive age or parity including women who:
- Are breastfeeding (starting as soon as six weeks after childbirth).
- Have or have not had children.
- Are not married.
- Are of any age, including adolescents and women over 40 years old.
- Have just had an abortion, miscarriage, or ectopic pregnancy.
- Smoke cigarettes, regardless of age or number of cigarettes smoked.
- Have anaemia now or had in the past.
- Have varicose veins.
- Are infected with HIV, whether or not taking antiretroviral medications.

Who can not use POPs:

Women who have the following conditions:

- Breastfeeding a baby less than six weeks old.
- A liver tumour, liver infection or cirrhosis.
- Blood clot in legs or lungs.
- Taking medications for seizures (barbiturates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate) or tuberculosis (rifampicin).
- Current or history of breast cancer.

When to start using POPs:

- Anytime it is reasonably sure that the client is not pregnant.
- No monthly bleeding - Any time it is reasonably sure that the client is not pregnant. A backup method needed for the first two days of taking pills.
- Immediately when switching from copper-bearing IUD or another hormonal method if the client has been using the previous method consistently and correctly. No need to wait for next monthly bleeding.
- The day after the client finishes taking emergency contraceptive pills
- Having menstrual cycles or switching from a non-hormonal method - within five days after the start of her monthly bleeding and no backup plan; or more than five days after the start of monthly bleeding - anytime it is certain that the client is not pregnant and a backup method for the first two days of taking pills
- In the postpartum:
  - Fully or nearly fully breastfeeding: 6 weeks after giving birth, and anytime between 6 weeks and six months if her monthly bleeding has not returned.
  - Partially breastfeeding: at 6 weeks after childbirth; if less than 6 weeks and monthly bleeding has returned a backup method until 6 weeks have passed since giving birth; if more than 6 weeks and monthly bleeding has not returned anytime it is reasonably certain that she is not pregnant and a backup method for the first 2 days;
  - Breastfeeding and monthly bleeding have returned as advised for women having menstrual cycles
  - Not breastfeeding: Anytime within four weeks after giving birth; beyond four weeks and monthly bleeding has not returned - any time it is reasonably sure that she is not pregnant plus a backup method for the first two days of taking pills; if monthly bleeding has returned as advised for women having menstrual cycles

- Post abortion (after abortion or miscarriage): Immediately or within seven days no backup method is needed. More than seven days after, any time it is reasonably certain that she is not pregnant and a backup plan for the first two days of taking pills.

How to use POPs:

The client should always take one pill each day. When she finishes one packet, she should take the first pill from the next packet on the very next day. There is no wait between packets.