From the Guidelines
To start a progestin-only birth control pill regimen, begin taking the pill on the first day of your menstrual period for immediate protection, or start on any day with backup contraception for 2 consecutive days, as recommended by the CDC 1. When starting a progestin-only pill regimen, it is essential to take the pill at the same time every day without breaks between packs. Common progestin-only pills include norethindrone (Micronor, Nor-QD) 0.35mg and drospirenone (Slynd) 4mg.
- Key considerations for progestin-only pill regimens include:
- Taking a progestin-only pill more than 3 hours late (or 12 hours for Slynd) reduces effectiveness and requires backup contraception for 2 consecutive days, as outlined in the CDC's recommendations 1.
- Side effects may include irregular bleeding, headaches, breast tenderness, and nausea.
- Progestin-only pills are ideal for those who can't take estrogen, including breastfeeding women, smokers over 35, and those with certain medical conditions like hypertension or history of blood clots.
- The mechanism of action for progestin-only pills involves thickening cervical mucus to prevent sperm entry and sometimes preventing ovulation, offering about 91% effectiveness with typical use when taken correctly, as supported by the CDC's guidelines 1. It is crucial to follow the recommended regimen and guidelines to ensure the highest level of effectiveness and minimize potential side effects, as emphasized by the CDC's recommendations 1.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION The FDA drug label does not answer the question.
From the Research
Recommendations for Starting a Progesterone Only Birth Control Pill Regimen
- The progestogen-only pill (POP) is a suitable contraceptive option for women who have high blood pressure, either induced by use of combined oral pills or due to other causes, as long as it is well controlled and monitored 2.
- Women who are at risk of coronary heart disease due to the presence of risk factors like hypertension can use POP as a recommended method of contraception 2.
- It is essential to provide adequate and accurate information, along with detailed counseling, to women who are considering using progestin-only contraceptives (POCs), as well as periodic reinforcement of the information at regular clinic visits for those already using POCs 3.
- Clinicians should proactively address common concerns, such as potential effects on weight, mood, menstrual bleeding patterns, and bone mineral density, to improve the likelihood of adherence and continuation with POCs for routine birth control 3.
Considerations for Progestin-Only Contraceptives
- Progestin-only pills (Micronor and Ovrette), depot medroxyprogesterone acetate (DMPA) injections (Depo-Provera and depo-subQ provera 104), levonorgestrel intrauterine system (IUS) (Mirena), and etonogestrel implant (Implanon) are available options for routine birth control in the United States 3.
- Each of these methods has specific advantages, but also specific drawbacks that can result in discontinuation of treatment if users are not given adequate information about what to expect in terms of side effects 3.
- Estrogen-free progestin-only pills (POPs) are a valuable option in women who prefer to take an oral hormonal contraceptive but are ineligible for, or choose not to use, combined oral contraceptives (COCs) 4.
Potential Side Effects and Bleeding Disturbances
- Women on progestogen-only pills often experience abnormal bleeding patterns, with an increased frequency of bleeding, lengthened cycles, breakthrough bleeding, spotting, and prolonged bleeding 5.
- These menstrual disturbances are the most common quoted reason for discontinuation in up to 25% of users 5.
- Counseling women interested in using POPs about the variable bleeding patterns associated with this method may improve compliance and acceptance 4.