PROGESTOGEN ONLY PILL

Pills that contain very low doses of a progestin like the natural hormone progesterone in a woman’s body. Since
these pills do not contain oestrogen, they are safe to use throughout breastfeeding, and by women who cannot use
methods with oestrogen. Examples are Microlut, Ovrette.

Indications

  • Breastfeeding clients after 6 weeks postpartum (nonbreastfeeding clients can start POPs anytime after birth)
  • Women who cannot take COC but prefer to use pills
  • Women >40 years

Contraindications

  • Breast or genital malignancy (known or suspected)
  • Pregnancy (known or suspected)
  • Breast cancer >5 years ago, and it has not recurred
  • Severe liver disease, infection, or tumor
  • Taking barbiturates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, rifampicin, rifabutin,
    or ritonavir or ritonavir-boosted protease inhibitors. Use a backup contraceptive method as these medications reduce the effectiveness of POPs
  • Systemic lupus erythematosus with positive (or unknown) antiphospholipid antibodies
  • Undiagnosed vaginal bleeding

Disadvantages and common side effects

  • DOES NOT PROTECT AGAINST STIs
  • Spotting, amenorrhoea
  • Unpredictable irregular periods
  • Not as effective as COC
  • Medicine interactions: the effectiveness is reduced by medicines which increase hepatic enzyme activity

INSTRUCTIONS

  • Give 3 cycles of POP: Explain carefully how to take the tablets, and what to do if doses are
    missed, or if there are side-effects
  • Supply and show how to use back-up FP method for first 14 days of first packet, e.g. condoms or
    abstinence from sex
  • Ask client to return 11 weeks after starting POP
  • Use the last pill packet to show when this will be

MANAGEMENT OF SIDE EFFECTS OF POPS

No Monthly Periods

Assess for pregnancy

  • If not pregnant and/or breast-feeding, reassure that it is normal. Some women using POPs stop having monthly periods, but this is not harmful
  • If pregnant, reassure that the POPs will not affect her pregnancy, and refer her to ANC

Nausea/Dizziness

  • Nausea: suggest taking POPs at bedtime or with food
  • If symptoms continue, consider locally available remedies

Migraine/Headaches

  • Without Aura (e.g. hallucinations, hearing voices): able to continue using POPs voluntarily
  • With Aura: stop POPs and choose a method without hormones

Irregular Bleeding

  • Assess for pregnancy/abortion
  • Reassure that many women using POPs get irregular bleeding whether breast-feeding or not. It is not harmful
    and should lessen or stop after several months of use
  • Counsel on how to reduce irregular bleeding, e.g. making up for missed pills after vomiting or diarrhoea

If bleeding continues:

  • Give 400–800 mg ibuprofen every 8 hours after meals for 5 days when irregular bleeding starts
  • Check for anaemia and treat accordingly

If irregular bleeding persists or starts after several months of normal or no monthly bleeding:

  • Investigate other reasons (unrelated to POPs) and treat accordingly
  • Change to another pill formulation for at least 3 months
  • Or help client choose another method of family planning

Heavy or prolonged bleeding (twice as much as usual or longer than 8 days)

  • Assess for pregnancy/abortion
  • Reassure/comfort the patient
  • Give 800 mg ibuprofen every 8 hours after meals for 5 days when irregular bleeding starts
  • Or other non-steroidal anti-inflammatory drugs (NSAID)
  • Ferrous salt tablets (60 mg iron) to prevent anaemia
  • Educate on nutrition

If heavy bleeding persists:

  • Investigate other reasons (unrelated to POPs) and treat accordingly
  • Change to another pill formulation for at least 3 months
  • Or help client choose another method of family planning