Types
35-pill pack: 300 µg levonorgestrel or 350 µg norethindrone
28-pill pack: 75 µg norgestrel
Mechanisms of Action
- Thicken cervical mucus, preventing sperm penetration
- Suppress ovulation
- Change endometrium, making implantation less likely
- Reduce sperm transport in upper genital tract (fallopian tubes)
Benefits
Contraceptive
- Effective when taken at the same time every day (0.5–10 pregnancies per 100
women during the first year of use)
- Immediately effective (< 24 hours)
- Pelvic examination not required prior to use
- Do not interfere with intercourse
- Do not affect breastfeeding
- Immediate return of fertility when stopped
- Few side effects
- Convenient and easy-to-use
- Client can stop use
- Can be provided by trained nonmedical staff
- Contain no estrogen
Noncontraceptive
- May decrease menstrual cramps
- May decrease menstrual bleeding
- May improve anemia
- Protect against endometrial cancer
- Decrease benign breast disease
- Decrease ectopic pregnancy
- Protect against some causes of PID
Limitations
- Cause changes in menstrual bleeding pattern (irregular bleeding/spotting initially) in
most women
- Some weight gain or loss may occur
- User-dependent (require continued motivation and daily use)
- Must be taken at the same time every day
- Forgetfulness increases failure
- Resupply must be available
- Effectiveness may be lowered when certain drugs for epilepsy (phenytoin and
barbiturates) or tuberculosis (rifampin) are taken
- Do not protect against STDs (e.g., HBV, HIV/AIDS)
Who Can Use POPs
- Women of any reproductive age
- Women of any parity including nulliparous women
- Women who want effective protection against pregnancy
- Women who are breastfeeding and need contraception
- Women who are postpartum and not breastfeeding
- Women who are postabortion
- Women who smoke (any age, any amount)
- Women who have blood pressure < 180/110 or blood clotting problems
- Woman who prefer not to or should not use estrogen
Conditions Requiring Precautions
CONDITION |
RECOMMENDATION |
| Stroke (current) |
Women recovering from a stroke should avoid using POPs
unless other more appropriate methods are not available or acceptable. |
Who Should Not Use POPs
- Women who are pregnant (known or suspected)
- Women with unexplained vaginal bleeding (until evaluated)
- Women who cannot tolerate any changes in their menstrual bleeding pattern
- Women taking drugs for epilepsy (phenytoin and barbiturates) or tuberculosis (rifampin)
- Women with current or past history of breast cancer
- Women who cannot remember to take a pill every day at the same time
When To Start
- Day 1 of the menstrual cycle
- Anytime during the menstrual cycle when you can be reasonably sure the client is not
pregnant
- Postpartum:
- after 6 months if using LAM
- after 6 weeks if breastfeeding but not using LAM
- immediately or within 6 weeks if not breastfeeding
- Postabortion (immediately)
Management of Common Side Effects
SIDE EFFECT |
MANAGEMENT |
| Amenorrhea (absence of vaginal bleeding or spotting) |
Check for pregnancy.
If not pregnant, no treatment is required except
reassurance. Explain that blood does not build up inside the uterus or body with
amenorrhea. The continued action of small amounts of the progestin shrinks the
endometrium, leading to decreased menstrual bleeding andin some women, no bleeding at all.
Finally, advise client to return to clinic if amenorrhea continues to be a concern.
If intrauterine pregnancy confirmed, counsel client
regarding options. Stop POPs if pregnancy will be continued and assure her that the small
dose of progestin will have no harmful effect on the fetus.
If ectopic pregnancy suspected, refer at once for complete
evaluation.
Do not give hormonal treatment (COCs) to induce withdrawal
bleeding. It is not necessary and usually is not successful unless 2 or 3 cycles of
COCs are given. |
| Vaginal bleeding/Spotting |
If no problem found and client not pregnant, counsel client that
bleeding/spotting is not serious and usually does not require treatment. Most women can
expect the altered bleeding pattern to become more regular after 6 to 12 months. If
the client is not satisfied after counseling and reassurance, help her choose another
method. |
Client Instructions
- Take 1 pill at the same time each day.
- Take the first pill on the first day of your menstrual period. If you
start POPs after the first day of your period, but before the seventh day, use a backup
method for the next 48 hours.
- Take all pills in the pack. Start a new pack on the day after you take the last pill.
- If you vomit within 30 minutes of taking a pill, take another pill or use a
backup method if you have sex during the next 48 hours.
- If you take a pill more than 3 hours late, take it as soon as you remember. Use a
backup method if you have sex during the next 48 hours.
- If you forget to take 1 or more pills, you should take the next pill when you remember.
Use a backup method if you have sex during the next 48 hours.
- If you miss 2 or more menstrual periods, you should come to the clinic to check to see
if you are pregnant; do not stop taking the pills unless you know you are pregnant.
General Information
- Changes in menstrual bleeding patterns are common, especially during the first 2 or 3
cycles. They often are temporary and rarely are a risk to health.
- Other minor side effects may include weight gain, mild headaches and breast tenderness.
These symptoms are not dangerous and gradually disappear.
- Certain drugs (rifampin and most anti-epilepsy drugs) may reduce the effectiveness of
POPs, and for this reason the client should tell her health care provider if she starts
any new drugs.
- POPs do not provide protection against STDs, including the AIDS virus. If either partner
is at risk, they should use condoms as well as POPs.
WARNING SIGNS FOR
PROGESTIN-ONLY PILL (POP) USERS
- Delayed menstrual period after several months of regular cycles (may be a sign of
pregnancy)
- Severe lower abdominal pain (may be a symptom of ectopic pregnancy)
- Heavy bleeding (twice as long or twice as much as normal) or prolonged bleeding
(more than 8 days duration)
- Migraine (vascular) headaches, repeated very painful headaches or blurred vision
Contact health care provider or clinic if you develop any of the
above problems. |
Who Can Provide
- Physicians
- Nurses, Midwives, Paramedics
- Community-based Workers
- Pharmacists
Where They Can Be Provided
- Hospitals
- Clinics
- Health Posts
- Community-based Distribution Programs
- Pharmacies
- Private Offices
 
|
