5.4 Progestogen-only Pill

Question 1

Which has fewest contraindications COCP or POP?

Answer 1

POP has fewer CI and fewer risks.

Question 2

When is POP classed UKMEC 4?

Answer 2

When there is active breast cancer

Question 3

How effective is POP?

Answer 3

> 99% with perfect use, about 91% with typical use.

POP you do not have a break, you take it continuously.

Question 4

What are the types of POP?

Answer 4

• Traditional progestogen-only pill (e.g. Norgeston or Noriday)
• Desogestrel-only pill (e.g. Cerazette)

Question 5

When does a traditional POP and the Desogestrel-only pill count as a missed pill?

Answer 5

Traditional can only be delayed 3 hours. More than 3 hrs is a missed pill.

Desogestrel-only pill can be 12 hrs late. More than 12 hrs late is a missed pill.

Question 6

What is the MOA of traditional POP?

Answer 6

• Thickening the cervical mucus
• Altering the endometrium, less implantation
• Reducing ciliary action in the fallopian tubes

Question 7

What is the MOA of Desogestrel POP?

Answer 7

• INHIBITING OVULATION
• Thickening the cervical mucus
• Altering the endometrium, less implantation
• Reducing ciliary action in the fallopian tubes

Question 8

When can you start POP?

Answer 8

day 1-5 of cycle and protection is immediate.

other times then condoms for 48hrs (and check Hx not pregnant). (COCP is 7days)

Not harmful to pregnancy but do a test in 3 weeks.

Question 9

Can you switch between POPs?

Answer 9

Yes, at anytime and no extra protection needed.

Question 10

When is the best time to switch from a COCP to a POP?

Answer 10

Change on day 1-2 of the hormone free period at the end of COCP pack.
No extra protection needed.

Question 11

Why might you switch suddenly switch from a COCP to a POP?

Answer 11

eg migraine with aura needs immediate switch (stroke risk)

Question 12

What happens if you switch COCP to POP on days 3-14 of pack?

Answer 12

• Condoms 48hrs
• If UPSI since day 3 then continue COCP for 7 days,
• If not poss start POP and consider EC and PT

Question 13

What happens if you switch COCP to POP on between 14 and 21 days of pack?

Answer 13

Have had continuous hormones for 7 days therefore:

- no additional protection needed

Question 14

What is a common side effect of POP?

Answer 14

Unscheduled bleeding, settle down after 3 months.

20% have no bleeding
40% have regular bleeding
40% have irregular, prolonged or troublesome bleeding

(investigate for STI, preg, cancer if persistent bleeding more than 3 months)
(not possible to predict)

Question 15

What are all the side effects of POP?

Answer 15

Unscheduled bleeding (20/40/40)

• breast tenderness
• headaches
• acne

Question 16

When is traditional POP a “missed pill”

Answer 16

More than 3 hours late for a traditional POP (more than 26 hours after the last pill)

(e.g. Norgeston or Noriday)
(Micronor, Norgeston, Noriday, Femulen)

Question 17

When is desogestrel-POP a missed pill?

Answer 17

More than 12 hours late for the desogestrel-POP (more than 36 hours after the last pill)

(e.g. Cerazette)

Question 18

What do you do if you have missed a POP pill?

Answer 18

Take pill as soon as you remember and continue next one at usual time (ie two in 24hrs)

Use condoms for 48hrs

If you have UPSI since missed pill or within 48hrs of starting then Emergency Contraception.

(D&V counts as a missed pill, so condoms until 48hrs on normal pill taking)