What are progestin only pills and how do they work?

The progestin only pill (POP) is a type of birth control that uses progestin (a synthetic form of progesterone) to prevent pregnancy. Progestin works by thinning the lining of the uterus so that an embryo cannot implant itself and by thickening cervical mucus to make it difficult for sperm to travel through the cervix into the uterus and connect with an ovum (egg).

Progestin only pills, also known as ‘mini pills’ or ‘progesterone only pills’, are prescribed to women who: have migraines with aura, are breastfeeding, have high blood pressure, are taking blood pressure medications, have a history of blood clots or blood disorder that puts you at high risk of blood clots. POPs are NOT to be mistaken with combination birth control pills, which include both progesterone and estrogen –POPs do not have estrogen.

Progestin Only Pill

How to take the progestin only pill

First time taking the pill

When starting a POP for the first time you have to use a back up method of birth control, like condoms, for the first 2 days. After 48 hours you will be protected from pregnancy. Additionally, when starting the pill, pick a convenient time to take it because you will need to take it at the same time everyday. Unlike the traditional combination birth control pill, you do not have a week off from the pills. You must take one pill everyday within the same 3 hour window for the pill to be effective.

Timing matters

There is a very tight window with POPs, if you miss your dose by 3 hours you need to use a backup method like condoms for the next 5 days. If you’ve had sex in the past 3 or 5 days before you were late to take your pill, it is recommended that you take emergency contraception such as Plan B, or better yet Ella. Also know that you need to take the pill everyday, progestin only pill do not have a placebo week.

While this may make it harder to use perfectly, POPs are a great alternative for those with a health history of stroke, heart disease or migraines with aura. The key to this is just picking a good time to take the pill, and sticking to it.

There is also a new POP called SLYND that uses a different type of progesterone –drospirenone that is more flexible. However, this can be a more expensive option.

Worried women forgot the pill

What if I miss taking the progestin only pill?

If you do happen to miss your pill there are two scenarios. If you notice less than 3 hours after your regular dose time, simply take the pill immediately and you will still be protected against pregnancy. If you notice later than 3 hours after your regular dose time, you are not guaranteed pregnancy protection and you need to use a back up birth control method for 48 hours after your missed dose. If you have unprotected sex after your missed dose, you should take emergency contraception to protect from pregnancy.

Can everyone use progestin only pills?

The progestin only pill is not for everyone. If you are bad with medication management, and frequently miss pill dosages this is definitely not the best birth control option for you. Additionally if you are allergic to norethindrone (the most popular progesterone in POPs) then you should look into other options. Those who have or have had breast cancer should also not take progestin only pills.

Progestin only pills VS. Combined birth control pills

We’ve talked alot about progestin only pills, but what is the difference between POPs and combined birth control pills? Combined birth control pills are a combination of estrogen and progesterone vs POPs which only have progesterone. Combined birth control pills are not as finicky as POPs, they have a larger missed dose window and do not need a backup birth control after one missed dose. However, those who are over the age of 35 or have a health history of migraine with aura, blood clots or high blood pressure cannot take combined birth control pills –they can take POPs.

How effective is progestin only pill?

With perfect usage, POPs are 99% effective, however perfect usage does not mean typical usage. With typical usage POPs are 91% effective. It is always recommended to double up your birth control method by using condoms as well.

Side effects

There are downsides to using the progesterone only pill. The most important downside of the ‘standard’ progestin only pill, is that you HAVE to take at the same time every day. If you are late by 3 hours and you had sex in the past 5 days, then you will need emergency contraception to prevent pregnancy. And you will need to abstain from sex or use a back up (condom) for the next 2 days while the hormone ramps back up.

One potential disadvantage is that it may not be as effective as other types of birth control (IUD, implant, shot)- meaning you may have a higher chance of getting pregnant if you use this method compared to others.

Another possible issue is that because this type of pill only contains progestin, it may not be as helpful in managing your menstrual cycle as pills that contain both progestin and estrogen. This means that if you’re looking for a birth control pill to help with things like irregular periods and PCOS (polycystic ovary syndrome) , the progestin only pill may not be the best option.

As with all non-barrier methods, POP does not protect against sexually transmitted infections. We recommend using a condom if you are going to have sex and our founder Dr. Sophia Yen says “just assume everyone has an STI. No globos, no fiesta. No balloons (condoms), no party!”

Benefits

One major advantage of the progesterone only pill is that it does not contain estrogen like many types of birth control (ring, patch, and most birth control pills). Estrogen puts you at risk of blood clots in your chest, leg, brain (deep venous thrombosis) and strokes, heart attacks. Because the progesterone only pill does not contain estrogen, these side effects are much less likely.

Another plus of the progesterone only pill is that it can be a good option for people who can’t take birth control that contains estrogen for health reasons- for example, people with high blood pressure or a history of blood clots.

How to get progestin only pill

You can get the progestin only pill from any health care provider. If you do not have a health care provider you can get a prescription for a POP by your favorite expert doctors over at Pandia Health. When you fill out the doctor’s consultation form, our doctors will be able to see if you are a good candidate for POPs. Get started today!

Takeaway

Takeaway from this blog is that if you are someone who cannot take birth control pills containing estrogen… all is not lost! Progestin only pills are a great option for those with conditions like high blood pressure, blood clots or migraine with aura. It is important you are realistic with yourself about your ability to consistently take a pill at the same time. If you do not think you are able to consistently take a pill within the same 3 hour window daily, then POPs are not for you.