Who is eligible for the Progestin-Only Pill (POP)?

Who Can Take Progestin-Only Pills (POP)

Progestin-only pills (POPs) are suitable for most women, including those with contraindications to estrogen-containing contraceptives, as they have fewer restrictions and a more favorable safety profile compared to combined hormonal contraceptives. 1

Eligible Populations

Age Groups

• POPs are safe for women of all ages, from menarche through menopause (Category 1) 1
• Particularly suitable for women over 35 years who smoke, as they don't carry the cardiovascular risks associated with combined hormonal contraceptives 1

Reproductive Status

• Safe for nulliparous women (Category 1) 1
• Appropriate for parous women (Category 1) 1
• Can be used by breastfeeding women as early as immediately postpartum (Category 2 if <1 month postpartum, Category 1 if ≥1 month postpartum) 1, 2
• Can be used by non-breastfeeding women immediately postpartum (Category 1) 1

Medical Conditions Where POPs Are Particularly Beneficial

• Women with history of venous thromboembolism (VTE) or risk factors for VTE (Category 2) 1, 3
• Women with hypertension (Category 1 for controlled hypertension; Category 2 for severe hypertension) 1
• Women with obesity (Category 1, regardless of BMI) 1
• Women with migraine with or without aura (safer than combined hormonal methods) 1, 4
• Smokers of any age and smoking intensity (Category 1) 1

Special Populations

Postpartum Women

• Safe for immediate use in non-breastfeeding women postpartum (Category 1) 1, 5
• For breastfeeding women <1 month postpartum (Category 2) - benefits generally outweigh risks 1, 2
• For breastfeeding women ≥1 month postpartum (Category 1) - no restrictions 1, 2

Post-Abortion

• Can be started immediately after abortion (first or second trimester) (Category 1) 1
• Can be started immediately after septic abortion (Category 1) 1

Women with Cardiovascular Risk Factors

• Women with multiple cardiovascular risk factors (Category 2) 1
• Women with adequately controlled hypertension (Category 1) 1
• Women with elevated blood pressure (systolic 140-159 mmHg or diastolic 90-99 mmHg) (Category 1) 1
• Women with severe hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg) (Category 2) 1

Considerations and Limitations

Effectiveness Considerations

• Requires strict adherence to timing (must be taken at the same time each day) for maximum effectiveness 1, 4
• Higher typical use failure rate (9%) compared to long-acting reversible contraceptives (<1%) 2, 6

Medical History Considerations

• Women with history of ectopic pregnancy (Category 2) - can use POPs but should be counseled about slightly increased risk 1
• Women who have had bariatric surgery with malabsorptive procedures (Category 3) - may have reduced effectiveness 1

Timing of Initiation

• Can be started at any time if reasonably certain the woman is not pregnant 1, 4
• If started within first 5 days of menstrual cycle, no backup contraception needed 1, 4
• If started >5 days since menstrual bleeding began, backup contraception needed for 2 days 1, 4
• For postpartum women who are not breastfeeding, can start immediately (Category 1) 1, 5
• For breastfeeding women, can start immediately postpartum (Category 2 if <1 month, Category 1 if ≥1 month) 1, 2

Common Pitfalls and Caveats

• POPs must be taken at the same time each day (within a 3-hour window) for optimal effectiveness 1, 4
• Irregular bleeding patterns are common and a leading cause of discontinuation - proper counseling about this side effect can improve adherence 4, 6
• Despite being appropriate for many women, POPs are underutilized in the United States (only 0.4% of reproductive-aged women) 6
• Women taking medications that induce liver enzymes may experience reduced contraceptive effectiveness 1