Progestogen-only Pills FSRH Jan 2016)

Question 1

“Progestogen-only Pills”
Factors affecting efficacy
enzyme-inducing drugs

Answer 1

• Advice: to switch to progestogen-only injectable or intrauterine contraception.
• For short durations of enzyme-inducing treatment (<2 months) women can continue the POP providing they use additional precautions during treatment and for 28 days afterwards.
• Women wishing to start the POP after stopping enzyme-inducing drugs should be advised to use condoms until 28 days after the last dose of enzyme-inducing drug.

Question 2

“Progestogen-only Pills”

Eligibility

Answer 2

Few medical conditions restrict the use of the POP. Health professionals should be familiar with the most up-to-date UKMEC

Question 3

“Progestogen-only Pills”
Health benefits and concerns
dysmenorrhoea.

Answer 3

DSG pill may offer some benefits

Question 4

“Progestogen-only Pills”
Side effects
bleeding patterns

Answer 4

• Changes in bleeding patterns associated with the POP are common and women should be informed about such changes.
• There is no evidence that changing the type and dose of POPs will improve bleeding but it may help some individuals.

Question 5

“Progestogen-only Pills”

Follow-up and ongoing use

Answer 5

• Give: up to a 12-month supply at their first & follow-up visits.
• Follow-up should be tailored. Advice: to return at any time if problems arise.
• can be used until 55 years when natural fertility loss can be assumed for most women.
• Alternatively, if over 50 years and amenorrhoeic, continue POP & FSH tested on two occasions 6 weeks apart. If both FSH >30 IU/l, suggestive of ovarian failure & continue POP or barrier method for one further year.

Question 6

“Progestogen-only Pills”
Efficacy
Adherence

Answer 6

• If used consistently and correctly, more than 99% effective.
• Women should be advised that regular pill taking is required for efficacy and to take the pill at a time of day that will best suit them to promote adherence.

Question 7

“Progestogen-only Pills”
Factors affecting efficacy
weight

Answer 7

• Available evidence has not shown an increased risk of pregnancy in POP users with a heavier body weight or a higher BMI.
• There is insufficient evidence to support a dose of more than one pill per day for women who are heavy or overweight.

Question 8

“Progestogen-only Pills”
Factors affecting efficacy
Desogestrel

Answer 8

DSG pills may have potential benefits over traditional POPs because

• • ovulation is inhibited in up to 97% of cycles and
• • they have a 12-hour window for missed pills.

Question 9

“Progestogen-only Pills”
Factors affecting efficacy
Vomiting

Answer 9

If a woman vomits within 2 hours of pill taking, another pill should be taken as soon as possible. If the subsequent pill is missed, additional precautions are required until 48 hours after pill taking has been resumed.

Question 10

“Progestogen-only Pills”
Health concerns,
cardiovascular disease
breast cancer

Answer 10

limited available evidence does not support an association between

• • cardiovascular disease and use.
• • breast cancer and use.
  • – However, due to the limited available evidence, an increased risk cannot be completely excluded.
  • – Any increased risk is likely to be small and to reduce with time after stopping.

Question 11

“Progestogen-only Pills”

Mood changes

Answer 11

reported but there is no evidence of a causal association between use and mood changes or depression.

Question 12

“Progestogen-only Pills”

pregnancy risk

Answer 12

around 1 in 10 pregnancies that do occur may be ectopic.

Question 13

“Progestogen-only Pills”

delay in return of fertility following discontinuation

Answer 13

• no evidence

- if pregnancy is not desired, other contraceptive methods should be used immediately following discontinuation.

Question 14

“Progestogen-only Pills”
Side effects
libido

Answer 14

• Studies lacking
• possible effect cannot be excluded;
• however, no association has yet been demonstrated.

Question 15

“Progestogen-only Pills”
Side effects
weight change.

Answer 15

Evidence does not support a causal association