Progestogen-Only pill (POP)

Question 1

What is the progestogen only pill (POP)?

Answer 1

The progestogen-only pill (POP) is a type of contraceptive pill that only contains progesterone.

The POP is taken continuously, unlike the cyclical combined pills.

Question 2

Effectiveness of POP?

Answer 2

More than 99% effective with perfect use, but less effective with typical use (91%).

Question 3

The progestogen-only pill has far fewer contraindications and risks compared with the combined pill. True/false?

Answer 3

True

Question 4

What is the only UKMEC 4 (scenario where should not be used) criteria?

Answer 4

Active breast cancer

Question 5

2 main types of POP?

Answer 5

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

Desogestrel-only pill (e.g. Cerazette)

Question 6

What is regarded as a missed pill for traditional POP?

Answer 6

Cannot be delayed by more than 3 hours. Taking the pill more than 3 hours late is considered a “missed pill”.

Question 7

What is regarded as a missed pill for Desogestrel-only POP?

Answer 7

Can be taken up to 12 hours late and still be effective. Taking the pill more than 12 hours late is considered a “missed pill”.

Question 8

Mechanism of action for traditional POP?

Answer 8

Thickening the cervical mucus

Altering the endometrium and making it less accepting of implantation

Reducing ciliary action in the fallopian tubes

Question 9

Mechanism of action for desogestrel POP?

Answer 9

Inhibiting ovulation

Thickening the cervical mucus

Altering the endometrium

Reducing ciliary action in the fallopian tubes

Question 10

When should POP be started during cycle?

Answer 10

Day 1 to 5 of the menstrual cycle since it means the woman is protected immediately.

Question 11

The POP can be started even if there is a risk of pregnancy, as it is not known to be harmful in pregnancy. True/false?

Answer 11

True

Question 12

What should be done when switching between different POP’s?

Answer 12

Nothing much. POPs can be switched immediately without any need for extra contraception.

Question 13

When switching from COCP to POP, what are instructions dependant on?

Answer 13

The directions depend on what point they are in the COCP pill packet.

Question 14

When can patient switch from COCP to POP without need for any additional contraception?

Answer 14

Have taken the COCP consistently for more than 7 days (they are in week 2 or 3 of the pill pack)

Are on days 1-2 of the hormone-free period following a full pack of the COCP

Question 15

What is the most common adverse effect of POP?

Answer 15

Changes to the bleeding schedule

Question 16

Unscheduled bleeding is common when it lasts for what period of time?

Answer 16

Unscheduled bleeding is common in the first three months and often settles after that.

Where the irregular bleeding is persistent (for longer than 3 months), other causes need to be excluded (e.g. STIs, pregnancy or cancer).

Question 17

When on POP, all patients experience changes to bleeding schedule. True/false?

Answer 17

False

Approximately:

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

Question 18

What are other side-effects of POP?

Answer 18

Breast tenderness

Headaches

Acne

Question 19

What does POP also increase the risk of?

Answer 19

Ovarian cysts

Small risk of ectopic pregnancy with traditional POPs (not desogestrel) due to reduce ciliary action in the tubes

Minimal increased risk of breast cancer, returning to normal ten years after stopping

Question 20

For bleeding risk, roughly what portion of POP users have no/lighter, normal or high bleeding?

Answer 20

Third having lighter, less regular or no bleeding, a third having normal bleeding and a third having unscheduled, heavier or more prolonged bleeding

Question 21

Classification for missed POP?

Answer 21

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

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

Question 22

Episodes of diarrhoea or vomiting are managed as “missed pills”, and extra contraception (i.e. condoms) is required until 48 hours after the diarrhoea and vomiting settle.
True/false?

Answer 22

True