What is the usage and guidelines for the minipill (progestin-only pill)?

From the Guidelines

The minipill (progestin-only pill) is a daily oral contraceptive that contains only progestin and no estrogen, making it suitable for women who cannot take estrogen-containing contraceptives, and it should be taken at the same time every day (within a 3-hour window) to maintain effectiveness, which is approximately 91-95% with typical use, as recommended by the most recent guidelines 1.

Key Points

• The minipill must be taken daily, with no placebo or break days, and users should take an active pill every day continuously.
• If a pill is missed by more than 3 hours, a backup contraceptive method should be used for the next 2 days for norethindrone or norgestrel POP, and 7 days for drospirenone POP, as per the latest recommendations 1.
• The minipill works primarily by thickening cervical mucus to prevent sperm entry and may also prevent ovulation in some users.
• It's particularly appropriate for breastfeeding mothers, women over 35, smokers, those with hypertension, history of blood clots, or migraines with aura.
• Side effects may include irregular bleeding, spotting, headaches, breast tenderness, and nausea.
• The minipill provides no protection against sexually transmitted infections, so condoms are recommended for STI prevention.
• Users should inform their healthcare provider about all medications they take, as certain drugs like some antibiotics, antiseizure medications, and St. John's Wort may reduce the minipill's effectiveness, as noted in previous studies 1.

Usage Guidelines

• The minipill can be started at any time, with a follow-up pregnancy test in 2-4 weeks if there is uncertainty about pregnancy, as recommended by the latest guidelines 1.
• No examination or test is needed before initiation of the minipill, except for measuring blood pressure for combined hormonal contraceptives.
• The minipill is a highly effective method of contraception, with a failure rate of approximately 9% with typical use, as reported in previous studies 1.

From the FDA Drug Label

INDICATIONS AND USAGE 1. Indications. Progestin-only oral contraceptives are indicated for the prevention of pregnancy. The following points should be discussed with prospective users before prescribing progestin-only oral contraceptives: • The necessity of taking pills at the same time every day, including throughout all bleeding episodes. • The need to use a backup method such as condoms and spermicides for the next 48 hours whenever a progestin-only oral contraceptive is taken 3 or more hours late • The potential side effects of progestin-only oral contraceptives, particularly menstrual irregularities. • The need to inform the clinician of prolonged episodes of bleeding, amenorrhea or severe abdominal pain. • The importance of using a barrier method in addition to progestin-only oral contraceptives if a woman is at risk of contracting or transmitting STDs/HIV.

The usage and guidelines for the minipill (progestin-only pill) are as follows:

• The minipill is indicated for the prevention of pregnancy.
• It is essential to take the pills at the same time every day, including during bleeding episodes.
• If a pill is taken 3 or more hours late, a backup method such as condoms and spermicides should be used for the next 48 hours.
• Women should be informed about potential side effects, particularly menstrual irregularities.
• They should also be advised to report prolonged episodes of bleeding, amenorrhea, or severe abdominal pain to their clinician.
• Additionally, the importance of using a barrier method in addition to the minipill should be emphasized if the woman is at risk of contracting or transmitting STDs/HIV 2, 2.

From the Research

Usage of the Minipill

• The minipill, also known as the progestin-only pill (POP), is a form of oral contraception that is used by women who prefer not to use combined oral contraceptives (COCs) or are ineligible for their use 3.
• It is a valuable option for women who are breastfeeding, as it does not affect milk production and is safe for use during lactation 4, 5.
• The minipill is also suitable for women who are in the postpartum period or have certain medical conditions that make COCs unsuitable 6, 3.

Guidelines for Use

• Women using the minipill may experience irregular bleeding patterns, including changes in frequency, duration, and intensity of bleeding 4, 5, 3.
• Counseling women about the potential bleeding disturbances associated with the minipill may improve compliance and acceptance 3.
• The minipill is effective in preventing pregnancy, with some studies showing similar contraceptive effectiveness to COCs 5, 3.
• Women should be informed about the benefits and disadvantages of the minipill and carefully evaluated for its use 7.

Special Considerations

• The minipill is a good option for women who experience estrogen-related adverse effects, such as headache, and prefer to use an estrogen-free oral hormonal contraceptive 3.
• It is also suitable for women who are at risk of cardiovascular events or have certain medical conditions that make COCs unsuitable 3.
• The minipill has been shown to be safe for use in the postpartum period and during breastfeeding, with no significant increase in risk of cancer or other adverse effects 6, 5, 3.