What are the main adverse effects of progesterone-only oral contraceptive pills (OCPs)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 27, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

The main adverse effects of progesterone-only oral contraceptive pills (POPs) include irregular menstrual bleeding, hormonal side effects, and a potential slight increase in the risk of ectopic pregnancy, but they do not significantly increase the risk of blood clots, as supported by the 2020 American College of Rheumatology guideline 1. The most common side effect of POPs is irregular menstrual bleeding, which can manifest as spotting, prolonged bleeding, or amenorrhea, affecting up to 70% of users. Some users may experience hormonal side effects such as headaches, breast tenderness, mood changes, decreased libido, and acne. Additionally, some users may report nausea, although this is less common than with combined hormonal contraceptives, and weight gain, which is typically minimal. POPs can also cause functional ovarian cysts, which are usually asymptomatic and resolve spontaneously. It is essential to note that, unlike estrogen-containing contraceptives, POPs do not significantly increase the risk of blood clots, making them a suitable option for women with risk factors for thromboembolism, as stated in the 2020 guideline 1. However, they may slightly increase the risk of ectopic pregnancy if conception occurs while using POPs, as they can affect fallopian tube motility. The side effect profile varies between different progestin formulations, with newer progestins like desogestrel potentially causing fewer bleeding irregularities but more hormonal side effects. Most side effects are mild and tend to improve after the first few months of use as the body adjusts to the hormone. Key points to consider when prescribing POPs include:

  • Irregular menstrual bleeding is the most common side effect
  • Hormonal side effects can occur but are typically mild
  • No significant increase in the risk of blood clots
  • Potential slight increase in the risk of ectopic pregnancy
  • Suitable for women with risk factors for thromboembolism, as recommended by the 2020 American College of Rheumatology guideline 1.

From the FDA Drug Label

ADVERSE REACTIONS • Menstrual irregularity is the most frequently reported side effect. • Frequent and irregular bleeding are common, while long duration of bleeding episodes and amenorrhea are less likely. • Headache, breast tenderness, nausea, and dizziness are increased among progestin-only oral contraceptive users in some studies. • Androgenic side effects such as acne, hirsutism, and weight gain occur rarely.

The main adverse effects of progesterone-only oral contraceptive pills (OCPs) are:

  • Menstrual irregularity
  • Frequent and irregular bleeding
  • Headache
  • Breast tenderness
  • Nausea
  • Dizziness
  • Androgenic side effects such as:
    • Acne
    • Hirsutism
    • Weight gain 2

From the Research

Adverse Effects of Progesterone-Only Oral Contraceptive Pills (OCPs)

  • Menstrual disturbances, which can affect acceptability and lead to poor compliance and higher pregnancy rates 3
  • Abnormal uterine bleeding, a common but rarely dangerous side effect of hormonal contraception 4
  • Breakthrough bleeding, which usually subsides within a few months, but can persist in some cases 5, 4
  • Weight gain, although most studies have found little or no change in weight regardless of formulation 5, 6
  • Acne and hirsutism, which can be eliminated or improved by use of OCPs with low androgenic activity 5
  • Nausea and breast tenderness, which are primarily estrogen-related effects, but can occur with progesterone-only OCPs as well 5, 6
  • Headaches, which are not significantly different among various combined oral contraceptives, but can be affected by switching preparations or using a longer cycle of OC treatment 5, 6
  • Mood changes, which are a common, highly subjective complaint, but whose relationship to OC use is hard to assess 5, 6

Management of Adverse Effects

  • Counseling and reassurance are often adequate for managing adverse effects, especially during the first few months of use 6, 4
  • Switching to a different formulation or preparation can help alleviate some adverse effects, such as acne or headaches 5, 6
  • Supplemental estrogen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to treat abnormal uterine bleeding 4
  • Patient education and assessment of medical eligibility can help decrease the chance of unanticipated adverse effects 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

OC practice guidelines: minimizing side effects.

International journal of fertility and women's medicine, 1997

6
Research

Managing adverse effects of hormonal contraceptives.

American family physician, 2010

Related Questions

What is the best course of action for a 24-year-old female on Estrostep (ethinyl estradiol and norethindrone) oral contraceptive presenting with vaginal bleeding and breast tenderness?
What are the potential side effects of oral contraceptives (OCs)?
What is the management for breakthrough bleeding in patients on hormonal birth control (BC) medication?
What can be done to alleviate breast tenderness caused by hormonal birth control?
What are the recommendations for managing side effects associated with hormonal contraceptives, such as combined oral contraceptives (COCs) containing ethinyl estradiol (EE) and levonorgestrel (LNG)?
What is the cause of intermittent bleeding, with 2 weeks of bleeding followed by 2 weeks of no bleeding, in a patient taking daily progesterone (a progestin hormone)?
What is the cause of intermittent bleeding, with 2 weeks of bleeding followed by 2 weeks of no bleeding, in a patient with a history of amenorrhea (absence of menstruation) who is taking daily progesterone (a hormone replacement therapy)?
Do you order repeat blood cultures (BC) to confirm negative results in cases of Escherichia coli (E. coli) bacteremia, or is this practice only for gram-positive bacteremia?
Does a diagnosis of Group A Streptococcus (GAS) infection require ordering a Transesophageal Echocardiogram (TEE)?
What is the diagnosis and treatment for tibial (lower leg bone) occlusion?
What is the cause of anterior thigh pain 2 days after an anterior approach total knee arthroplasty, with anticipated swelling, no erythema, and no fever, in a patient taking Norco (hydrocodone) and ibuprofen every 6 hours, with ice applied every other hour, and physical therapy initiated?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question