The mini-Pill (progestogen-only Pill, or POP)
In 2005, the mini-Pill is still nowhere near as popular as the 'ordinary' Pill. For every one woman taking the mini-Pill, there are more than 30 who use the 'real' Pill.
However, this progestogen-only Pill (POP) does provide very satisfactory contraception for over 100,000 British women – including a lot who can't take the Pill.
The POP's great advantage is that – as far as we know at present – its health risks appear to be less than those of the actual Pill.
Its two chief drawbacks are that it doesn't control your periods – and that it is rather less effective than the ordinary Pill.
Nevertheless, new versions of the mini-Pill are proving better at preventing pregnancy than the traditional type – and have an effectiveness which is not all that much below that of the Pill itself.
Why take the mini-Pill?
If you enjoy a good sex life, you almost certainly want to protect yourself against unwanted pregnancy. The mini-Pill can do that for you. But you have to remember to take it every single day of the year. No breaks at all - even when you're on your period.
Even the newest brand of POP is not quite as effective as the ordinary Pill, but the mini-Pill is a good deal freer of side effects than the Pill.
And it's particularly useful for some groups of women who shouldn't take the Pill or for whom it is a little risky - for instance:
- new mums who are breastfeeding
- diabetics
- women who smoke
- women whose blood pressure has gone up on the Pill
- older women.
However, it does have some disadvantages, and we'll tell you about them in a moment.
What is the mini-Pill?
There's a lot of confusion about this name. Many women don't understand it - and, regrettably, even a few doctors have got the wrong end of the stick about it! The mini-Pill is not just a low-dose version of the Pill. Unfortunately, lots of women who are taking low-dose brands of the Pill think they are on the mini-Pill, but they aren't.
No, the POP is quite different from the ordinary or 'combined' Pill. Unlike the ordinary Pill it contains just one hormone - not two. That hormone is a progestogen (often mistakenly called a 'progesterone'.)
A progestogen - which is an artificially manufactured hormone - is very like progesterone, which is one of the female hormones the body produces. Unlike the 'ordinary' Pill, the mini-Pill contains no oestrogen at all.
The ordicnary Pill is composed of these two hormones:
- an oestrogen (spelt 'estrogen' in the USA and some other countries)
- a progestogen.
That's why it's so often called 'the combined Pill'. It is the oestrogen in the ordinary Pill that is responsible for many of its side effects - including some of the rare but very serious ones. So going on the mini-Pill, instead of the Pill, immediately reduces your chances of dangerous side effects.
How does the mini-Pill work?
The POP stops you from getting pregnant by doing three things:
- it thickens the secretions round the neck of your womb - this makes it very difficult for the sperm to get through.
- it makes the lining of the womb thinner, and so less 'receptive' to ova (eggs).
- Some of the time, it stops you ovulating (releasing an egg). The latest mini-Pills (such as Cerazette) do this most of the time, which makes you even less likely to get pregnant.
How effective is it?
It's not quite as efficient in protecting you against pregnancy as the ordinary Pill, but it is pretty good. If 100 sexually active women took the mini-Pill regularly for a year, less than two of them would get pregnant. This makes the POP about as effective as the coil .
However, newer types of mini-Pill - such as Cerazette – probably have a failure rate of only about 1 per cent per year. But take care: much depends on your ability to take the tablet every single day at roughly the same time each day. If you can't manage this (and it isn't easy!), you'll increase your risk of pregnancy.
How do I take it?
Yes, you really must take the mini-Pill at roughly the same time of day, every day - even when you are menstruating.
You can pick your own time of day when you start on the POP. For instance, you might decide to take it at 12 noon, or when you're having your supper. But from then on, you need to stick to that time. A few women actually arrange for 'mini-Pill alarms' to sound each day on their mobiles!
If you're more than three hours late in taking the tablet, you could fall pregnant. (But with the newish POP called Cerazette, it is said that you can get away with being 12 hours late; I do not recommend making a habit of this.)
Obviously, the mini-Pill is not a great idea for you if:
- you're not very good at taking tablets regularly
- you're in a job - like being part of an airline crew - where hours are irregular and disrupted.
Also, if you're significantly overweight (and particularly if you're over 11 stone – that's 70 kg), the POP may not be effective enough for you.
If you're determined to try the POP, then the new one called Cerazette would probably be your best choice. Alternatively, a few doctors are willing to prescribe two mini-Pills per day for larger women. But very big people (over, say , 16-and-a-half stone – that's 105 kg) really shouldn't try the mini-Pill at all in my view, because the risks of falling pregnant are too great.
There are also some medical reasons why some women may be unsuitable for this method – please see below.
How do I get it?
Begin by going to a doctor or a Family Planning Clinic and asking them about the mini-Pill.. (In practice, FP Clinic staff tend to know more about POPs than almost anyone else.)
Discuss whether the mini-Pill would be suitable for you. Ask about the latest situation regarding side effects (see below).
If you decide to go ahead with the mini-Pill, you'll be given a prescription for several packs. Read the leaflet inside the packet. Then start taking the tablet on the first day of your next period - this will give you immediate protection.
However, if you're absolutely sure that you're not pregnant, you can start taking the mini-Pill on any day of your cycle – but you may not be protected immediately. Take the doctor's or nurse's advice about this.
If you're not having periods at the moment because you've recently had a baby, then you can start taking it immediately. (Don't do this if there's any suspicion that you might be pregnant again!)
What special categories of women take the mini-Pill?
Although nearly all women can use the mini-Pill if they want to, in practice it is commonly taken by people who would have difficulties with the ordinary Pill. These include:
- breastfeeding mums - mainly because the Pill tends to stop milk production.
- women who cannot take oestrogens.
- women over 35 to 40 years of age who have been medically advised not to take the Pill.
- women who are at special risk of heart disease or strokes - though these patients should definitely not take the mini-Pill without seeking specialist advice first.
- women who are heavy smokers - smoking and the ordinary Pill make a very dodgy combination, and may cause heart attacks or clots. If you can't give up cigarettes, your doctor might suggest that the POP is less of a risk for you.
What are the side effects of the mini-Pill?
At present, the POP seems to carry considerably less risk than the ordinary Pill – but please remember that while the long-term effects of the ordinary Pill have been extensively studied over nearly 50 years, the amount of research into long-term effects of the mini-Pill has been relatively small.
So it's possible that unsuspected side-effects might emerge later in the 21st century. Be guided by your doctor or Family Planning nurse as to the latest situation on unwanted effects.
The chief known side effects are:
- periods tend to be irregular, which can be a considerable nuisance.
- sometimes periods stop - this may be a worry to you, and you may need the reassurance of a pregnancy test.
- if you did become pregnant while taking the mini-Pill, there is a chance that the pregnancy might be ectopic, that is outside the womb - so if your period is late and you get pain in your lower tummy, contact a doctor fast (ectopics are said to be rarer with the recently-developed Cerazette).
- you may get spots on your skin.
- you could get tender breasts.
- there's a small risk of cysts in the ovaries – indeed, it's best not to use the POP if you've already had an ovarian cyst.
- nausea and headache sometimes occur.
Other rarer side effects are listed in the package insert leaflet.
Who shouldn't take the mini-Pill?
Doctors may refuse to prescribe the mini-Pill for you:
- if you have already had an ectopic pregnancy.
- if you have severe artery disease, or an abnormally high cholesterol or other blood fats.
- if you have breast cancer.
- if you have unexplained vaginal bleeding.
- if you've had one of certain rarer conditions – fuller details from your doctor or nurse.
What are the various kinds of mini-Pill?
There are several groups . So if one brand doesn't suit you (say, if it gives you bad spots on your face), you can easily switch to one from another group. At the time of writing (January 2005 ), there are seven brands available in Britain – and others in overseas countries. The British brands are:
Group 2
Group 3
Group 4 (the newest)
Femulen.
Norgeston.
Cerazette.
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