Progesterone Only Pill (POP) Flashcards
How does the pill-taking regime of the POP differ from the COCP?
- the POP is taken continuously without a pill-free week
- it contains progesterone ONLY
How do the risks / contraindications to the POP differ from the COCP?
- the POP has far fewer risks / contraindications associated with it
- the only UKMEC 4 criteria is active breast cancer
What are the 2 different types of POP?
traditional POP:
- e.g. Norgeston / Noriday
desogestrel-only pill:
- e.g. Cerazette
- the traditional POP is rarely used now
- they differ in their modes of action
When is a POP counted as a “missed pill”?
- the traditional POP is counted as a “missed pill” if it is > 3 hours late
- the desogestrel-only pill is a “missed pill” if it is > 12 hours late
What is the mechanism of action of the traditional POP and desogestrel-only POP?
both POPs:
- thicken the cervical mucus
- alter the endometrium so that it is less accepting of implantation
- reduce the ciliary action in the fallopian tubes
desogestrel pill ONLY:
- inhibits ovulation in addition
What is the mechanism of action of the traditional POP and desogestrel-only POP?
both POPs:
- thicken the cervical mucus
- alter the endometrium so that it is less accepting of implantation
- reduce the ciliary action in the fallopian tubes
desogestrel pill ONLY:
- inhibits ovulation in addition
What advice is given regarding contraception when starting the POP?
- no additional protection is required if the POP is started on day 1 - 5 of the cycle
- if started at any other time, condoms should be used for 48 hours
(it takes 48 hours for the cervical mucus to thicken enough to prevent entry of sperm)
What advice is given regarding the POP and unknown pregnancy?
- pregnancy testing should be performed to exclude pregnancy prior to starting the POP
- the POP can be started if there is a risk of pregnancy
- a pregnancy test should be taken 3 weeks after last UPSI
- EC prior to starting the POP may be required
When switching from the COCP to POP, in which situations can the POP be started without additional contraception?
- if the COCP has been taken continuously for > 7 days
- i.e. they are on week 2 or 3 of the pill pack
OR
- they are on day 1 or 2** of the **hormone-free period following a full pack of the COCP
What are the rules for switching from the COCP to the POP on:
- days 3 to 7 of hormone-free interval (HFI)
- first week of taking the COCP?
if they have NOT had UPSI since day 3 of HFI:
- start taking the POP immediately
- use condoms for the first 48 hours of taking the POP
if they HAVE had UPSI since day 3 of the HFI:
- continue taking the COCP
- switch to the POP after 7 days of the COCP have been taken consecutively
- they do NOT need to use condoms when starting the POP
What is the major side effect associated with the POP?
changes to the bleeding schedule
- unscheduled bleeding is common for the first 3 months and usually settles
- if irregular bleeding persists for > 3 months, other causes should be excluded
- e.g. pregnancy, STIs, cancer
How does the POP affect the bleeding schedule?
- 20% women will have amenorrhoea (no bleeding)
- 40% women will have regular bleeding
- 40% women will have irregular, prolonged or troublesome bleeding
What are the other side effects associated with the POP?
- breast tenderness
- headaches
- acne
(some women report changes to mood, weight + libido but guidelines state there is no evidence to support this)
What does the POP increase the risk of?
- ovarian cysts
- ectopic pregnancy (traditional POP only)
-
breast cancer
- risk returns to normal 10 years after stopping POP
What advice is given to women about bleeding when starting progesterone only contraception?
the bleeding pattern cannot be predicted
- around ⅓ women will have no / lighter bleeding
- around ⅓ women will have normal bleeding
- around ⅓ women will have irregular, heavier / prolonged bleeding
- the bleeding can settle after 3 months, so it may be worth persisting for this time
