What prescription progestin-only pill (POP) can be used as a contraceptive?

Prescription Progestin-Only Pills (POPs) for Contraception

Progestin-only pills (POPs) are effective prescription contraceptives that can be used when estrogen-containing methods are contraindicated, though they are generally less effective than other progestin-only methods like implants, injections, or IUDs. 1

Available Prescription POPs

• Norethindrone (Micronor, Nor-QD, Camila, Errin) - 0.35 mg
• Desogestrel (not available in US) - 0.075 mg
• Drospirenone (Slynd) - 4 mg in 24/4 regimen

Effectiveness and Mechanism of Action

• POPs work primarily by:

  • Thickening cervical mucus
  • Thinning the endometrial lining
  • Possibly inhibiting ovulation (varies by formulation) 1

• Effectiveness rates:

  • Perfect use failure rate: 0.5% 2
  • Typical use failure rate: approximately 5% due to late or missed pills 2
  • Less effective than other progestin-only methods like implants (0.05%), injections (0.3%), or IUDs (0.1-0.2%) 1

Administration Guidelines

• Traditional POPs (norethindrone):

  • Must be taken at the same time every day, within a 3-hour window 3
  • If a dose is missed by >3 hours:
    • Take one pill as soon as possible
    • Continue taking pills daily at the same time
    • Use backup contraception for 2 consecutive days
    • Consider emergency contraception if unprotected intercourse occurred 3

• If vomiting or severe diarrhea occurs within 3 hours of taking a pill:

  • Take another pill as soon as possible
  • Continue regular schedule
  • Use backup contraception until 2 days after vomiting/diarrhea resolves 3

Ideal Candidates for POPs

POPs are particularly suitable for:

• Women with contraindications to estrogen-containing contraceptives 1
• Women with cardiovascular risk factors or hypertension 1
• Breastfeeding women 1
• Perimenopausal women 4
• Women who prefer an oral contraceptive method but cannot use combined pills 5

Contraindications

POPs should not be used in women with:

• Current breast cancer
• Severe cirrhosis
• Unexplained vaginal bleeding 1

Common Side Effects and Management

• Irregular bleeding patterns are the most common complaint 6
  • Counseling about variable bleeding patterns improves acceptance and compliance 5
• Other side effects are generally minimal compared to combined hormonal contraceptives
• No increased risk of thromboembolism or stroke 1

Clinical Considerations

• POPs are not typically recommended as first-choice contraceptives for healthy adolescents due to the need for strict adherence to timing 3
• Women who frequently miss POPs should consider alternative methods less dependent on user compliance (IUD, implant, or injectable) 3
• Condoms should be used concurrently to provide protection against sexually transmitted infections 1
• Certain medications may compromise POP effectiveness 1

Follow-up Recommendations

• No routine follow-up visit is required specifically for POP use 3
• At routine visits, providers should:
  • Assess satisfaction with the method
  • Evaluate any changes in health status or medications
  • Consider assessing weight changes if the patient is concerned 3

POPs provide an important contraceptive option for women who cannot or prefer not to use estrogen-containing methods, though users must be counseled on the importance of consistent timing and potential irregular bleeding patterns to maximize effectiveness.