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