Progestin-Only Oral Contraceptives (Mini-Pills): Generic and Brand Names
Available Formulations in the United States
The progestin-only pills (POPs) currently available in the United States contain either norethindrone or drospirenone as the active progestin component. 1
Traditional First-Generation POPs
- Norethindrone 0.35 mg is the traditional progestin-only pill formulation widely available in the U.S. 1
- This formulation requires strict timing adherence—must be taken at the same time each day, with only a 3-hour window before backup contraception is needed 1
- Common brand names for norethindrone POPs include Camila, Errin, Heather, Jolivette, Micronor, Nora-BE, and Nor-QD (though some may no longer be actively marketed) 1
Fourth-Generation POPs
- Drospirenone 4 mg (brand name Slynd) is the newer fourth-generation progestin-only pill available in the U.S. 1
- Drospirenone POPs have antiandrogenic and anti-mineralocorticoid properties, which may help mitigate blood pressure increases 1
- This formulation offers a longer window for missed pills compared to norethindrone formulations 1
International Formulations (Not Available in U.S.)
- Desogestrel 75 mcg is available in other countries and provides more consistent ovulation inhibition than traditional POPs, with contraceptive effectiveness comparable to combined oral contraceptives 2, 3
- Levonorgestrel 30 mcg is another international formulation mentioned in older literature 2
Key Clinical Distinctions
Mechanism Differences
- Traditional norethindrone POPs work primarily by thickening cervical mucus rather than consistently inhibiting ovulation 1
- Drospirenone and desogestrel formulations provide more consistent ovulation suppression 1, 2
Timing Requirements
- Norethindrone POPs must be taken within a 3-hour window; if taken more than 3 hours late, backup contraception should be used for 48 hours 1
- Drospirenone POPs allow a 12-hour tolerance window for missed pills 1, 2
Clinical Indications for POPs
POPs are particularly appropriate for women with contraindications to estrogen-containing contraceptives: 1
- Breastfeeding women (safe during lactation) 1, 4
- Women with positive antiphospholipid antibodies 5, 1
- Women with systemic lupus erythematosus with moderate or severe disease activity 5, 1
- Women with hypertension or cardiovascular risk factors 1
- Women with history of venous thromboembolism (POPs do not increase VTE risk) 5, 1
Important Counseling Points
- POPs do not protect against sexually transmitted infections; condoms should be recommended for STI protection 5, 1
- Irregular bleeding is the most common side effect and the primary reason for discontinuation in up to 25% of users 6, 3
- Traditional POPs have higher typical-use failure rates than other hormonal methods due to strict timing requirements 1
- POPs are completely reversible with no negative effect on long-term fertility 1