Progesterone Only Pill (POP)

Question 1

What are the 3 methods of progestogen only contraception?

Answer 1

Progestogen-only method of contraception:

1. Progestogen-only pill
2. Progestogen-only implant
3. Progestogen-only injection

Question 2

Briefly describe the mechanism of action of the progestogen-only pill (POPs)

Answer 2

POPs have five independent modes of action:

1. Suppression of ovulation- this occurs in varying degrees
2. Suppression of mid-cycle peaks of luteinizing hormone and follicle-stimulating hormone
3. Production of ‘hostile, blocked’ mucus, resulting in poor sperm penetration
4. Reduction in the number and size of endometrial glands and inhibition of progesterone receptor synthesis in the endometrium, preventing implantation
5. Reduction in the activity of cilia in the Fallopian tube

Question 3

What is the most common regime for POPs?

Answer 3

POPs should be taken daily at the same time each day for 28 days, with no pill-free interval.

Question 4

What are the indications for POPs?

Answer 4

• Contraception for women in whom estrogen-containing contraceptives are contraindicated

Question 5

What are the advantages of POPs?

Answer 5

• Very effective when taken correctly and is more effective than barrier methods of contraception
• Sex need not be interrupted to use the POP
• Used by women for whom the combined oral contraceptive is not suitable
• May reduce the risk of endometrial cancer
• Normal fertility returns when the POP is stopped

Question 6

What are the disadvantages of POPs?

Answer 6

• Pills must be taken at the same time each day, or within 3 hours
• Adverse effects (such as unscheduled bleeding and breast tenderness) may be experienced by some women when they first start a POP
• Does not protect against sexually transmitted infections (STIs).

Question 7

What are the side effects of POPs?

Answer 7

• Menstrual irregularities
• Mood swings
• Increase in acne
• Breast discomfort

Question 8

What are the risks of POPs?

Answer 8

• Ovarian cysts
• Ectopic pregnany
• Breast cancer

Question 9

What is the efficacy of POPs?

Answer 9

• POPs used perfectly→ 0.3% of women will conceive within the first year of use due to method failure.
• POPs used typically→ 9% of women will conceive within the first year of use due to method failure or user failure

Question 10

What contra-indications are associated with POPs?

Answer 10

• Breast cancer
• Undiagnosed vaginal bleeding

Question 11

What is the guidance if POPs is missed?

Answer 11

• If the woman has missed any POP, she should:
  
  • Take a pill as soon as possible
  • Take the next pill at the normal time
  • Use a barrier method of contraception for the next 48 hours, unless she is less than 6 months postpartum, fully breastfeeding, and amenorrhoeic
• Consider prescribing emergency contraception if unprotected sexual intercourse has taken place after the missed pill and within 48 hours of restarting the POP

Question 12

Briefly describe the assessment for POPs

Answer 12

• Check the UK Medical Eligibility Criteria
• Check the woman’s cervical screening history to ensure that she has attended routine screening appointments