The progestogen-only pill

The mini pill contains progestogen but no oestrogen. It may be an option if you can’t use contraception with oestrogen in it. A clinician still needs to check that it suits you. In US information it’s called a progestin-only pill.

Start with the name on your packet

The NHS puts progestogen-only pills into three types: traditional, desogestrel and drospirenone. CDC’s US guidance lists norethindrone, norgestrel and drospirenone. When you check what to do, the medicine name matters more than the nickname “mini pill”.

These pills thicken the mucus at the cervix (the opening of the womb), which makes it harder for sperm to reach an egg. They can also stop ovulation (the release of an egg) and thin the womb lining. How reliably they stop ovulation differs between types.

The NHS says the pill is over 99% effective if you always take it correctly, and 91% effective if you don’t. CDC says instead that approximately seven out of 100 users get pregnant in the first year with typical use. These estimates differ. They describe what happens across groups of people and can’t tell you exactly how well you’ll be protected.

Why late-pill windows differ

The traditional pill gives you less time to take a late pill than desogestrel does. Drospirenone gives you longer again. Check the leaflet for your exact product, as the rules may differ from a pill you took before. What to do also depends on how much time has passed.

If a pill is late or missed, talk to a pharmacist soon and have the packet with you. You may need emergency contraception, and your pill can affect which type suits you. Ask what to do about the next pill and whether you need extra protection. Don’t try to work this out from a period estimate.

Vomiting or severe diarrhoea can stop your body absorbing the pill. Ask a pharmacist what the leaflet says for your pill and the illness you’ve had. Some medicines and herbal remedies can also affect how well the pill works, so mention those too.

Bleeding changes and other effects

Bleeding can get lighter, come more often or stop altogether. You may also have spotting between periods. At an appointment, say how often you bleed and how it affects your day. Be clear about what you’d like help with.

Some people report acne, mood changes, weight gain or changes in sex drive. The NHS says there isn’t enough evidence to show the pill causes these. You can still ask for help if they bother you.

The NHS also describes ovarian cysts, which are sacs of fluid on the ovaries. These often go away without treatment and usually cause no symptoms, though they can cause pain in the pelvis. Sudden or severe pain needs the urgent check described below. The NHS also notes a possible link with breast cancer. It says the evidence is limited and any rise in risk is very small. A pharmacist or doctor can talk through any worries.

Breastfeeding and checking suitability

You can use the progestogen-only pill after giving birth and while breastfeeding. Ask your maternity clinician, pharmacist or contraception service when to start and whether you need extra protection. The instructions depend on the pill type and timing.

Tell the prescriber if you’ve had breast cancer, liver or kidney problems, a stroke or heart and blood vessel disease. The NHS lists these as reasons the pill may not suit you. Some medicines and potassium supplements matter especially with drospirenone. A pharmacist or doctor can go through the whole list with you.

In the US, one type is available without a prescription. Even so, read the product information and talk to a pharmacist or doctor about your health conditions and other medicines. The pill doesn’t protect against STIs, but condoms can add that protection.

When to ask for help

Call 999 now (UK), or your local emergency number (US and elsewhere), for sudden intense tummy pain with marked dizziness, fainting or collapse.

Contact an urgent GP service or NHS 111 now (UK), or urgent medical care (US and elsewhere), for sudden severe pain in your pelvis or tummy with nausea or vomiting. Get urgent advice now from these services for pain low in your tummy mainly on one side if you could be pregnant, even without a positive test. Don’t assume the pill or a cyst is the cause.

Contact a pharmacist or sexual health clinic today (UK), or a pharmacist, doctor or contraceptive service (US and elsewhere), if a pill is late or missed and you may need emergency contraception.

Book an appointment with your GP or pharmacist (UK), or your doctor or pharmacist (US and elsewhere), if bleeding changes or other side effects are a problem for you.