Important Safety Information for Progestin-Only Pills

Progestin-only pills, also called POPs or mini-pills, contain a progestin hormone and do not contain estrogen. They are used to prevent pregnancy and may be considered for some patients who are not suitable for estrogen-containing contraceptives, depending on doctor review.

Progestin-only pills must be taken correctly and consistently. Some progestin-only pills have stricter timing rules than combined pills.

FDA labeling for norethindrone progestin-only pills states that pills should be taken at the same time every day and that backup contraception is needed for the next 48 hours whenever a progestin-only oral contraceptive is taken 3 or more hours late.

What progestin-only pills are used for

Progestin-only pills may be used for:

Preventing pregnancy
Patients who may not be suitable for estrogen-containing pills
Doctor-guided contraception during certain breastfeeding or postpartum situations, when appropriate

Your doctor will decide if a progestin-only pill is suitable for you.

Who should not use progestin-only pills

You may not be eligible for progestin-only pills if you:

Are pregnant or think you may be pregnant
Have current or past breast cancer
Have unexplained vaginal bleeding
Have severe liver disease or liver tumors
Are allergic to any ingredient in the product

Tell your doctor if you have any history of breast lumps, abnormal bleeding, liver disease, or suspected pregnancy before using a progestin-only pill.

How to take progestin-only pills

Take your pill exactly as directed on the product label or by your doctor.

General reminders:

Take one pill every day.
Take it at the same time each day.
Do not skip pills.
Continue taking pills even if you have spotting or irregular bleeding.
Start the next pack on time.

Timing is especially important for many progestin-only pills.

Missed pill information

For many traditional progestin-only pills, being more than 3 hours late may reduce protection. FDA labeling for norethindrone POPs advises using backup contraception for the next 48 hours when the pill is taken 3 or more hours late.

CDC guidance similarly recommends taking the missed progestin-only pill as soon as possible, continuing daily pills at the same time each day, and using barrier protection or avoiding sex until pills have been taken correctly for 2 consecutive days.

Some newer progestin-only pills, such as drospirenone-only pills, may have different missed-pill instructions. FDA labeling for Slynd states that missed pills can increase the chance of pregnancy and instructs users to follow the product’s specific missed-pill guidance.

Ask a doctor or pharmacist if:

You are more than 3 hours late for a traditional POP
You missed more than one pill
You started a pack late
You had unprotected sex after a missed pill
You are unsure which missed-pill rule applies to your product

Talk to a doctor before use

Before using a progestin-only pill, tell your doctor if you:

Are breastfeeding or recently gave birth
Have abnormal vaginal bleeding
Have breast cancer or a history of breast cancer
Have liver disease or liver tumors
Have ovarian cysts
Have depression or significant mood symptoms
Take anti-seizure medicines, tuberculosis medicines, HIV medicines, or herbal supplements such as St. John’s Wort

WHO guidance states that breastfeeding women less than 6 weeks postpartum can generally use progestogen-only pills, implants, and progestogen-only injectables as MEC Category 2, meaning advantages generally outweigh theoretical or proven risks.

Warning signs and emergency care

Seek urgent medical care if you experience:

Severe abdominal pain
Very heavy vaginal bleeding
Severe headache or vision changes
Chest pain or shortness of breath
Severe leg pain or swelling
Yellowing of the skin or eyes
Signs of pregnancy, especially with abdominal pain
Severe allergic reaction symptoms, such as swelling of the face, lips, tongue, or throat

Do not wait for an online consultation if you have emergency symptoms.

Common side effects

Common side effects may include:

Irregular bleeding or spotting
Missed periods
Headache
Nausea
Breast tenderness
Acne changes
Mood changes
Weight changes

Irregular bleeding is common with progestin-only pills. Contact a doctor if bleeding is heavy, prolonged, or concerning.