Mini Pill

If taken correctly, the mini pill is a very effective form of contraception providing near-total (99%) protection against unplanned pregnancy.

The mini pill contains only progestogen, which is why it is also often referred to as the progestogen-only pill (POP). This is the main difference between the mini pill and ’the pill’ (the combined pill). In addition to this, there is no seven-day break from taking the pills when using a POP, as with ‘the pill’.

Mini pill brands

There are multiple mini pill brands available in the UK, with more being introduced on a regular basis. Cerazette is perhaps the most well-known mini pill brand, containing the progestin desogestrel. There are lots of mini pills containing desogestrel (75mcg), and they all work in the same way and are as effective as Cerazette.

Noriday is the name of another popular mini pill which contains norethisterone. Norethisterone is a steroid hormone (progestin) also used in a medicine specifically designed to delay periods.

These mini pills can be initiated online via a written consultation with a doctor. It is important to provide accurate and up-to-date medical details so that the right mini pill can be prescribed to you. You can also discuss your options with your GP or a nurse.

The mini pill is highly effective when used correctly because it works in a numberof ways to help stop pregnancy:

• it thickens the cervical mucus, making it difficult for sperm to get through and fertilise the mature egg
• it makes the lining of the uterus thinner and therefore less receptive to holding a fertilised egg (the egg cannot implant itself)
• helps prevent ovulation, but does not block the eggs completely

These pills need to be taken at the same time daily to remain effective.

Can I delay my period with the mini pill?

No. Although some POPs contain the same ingredient as the period delay tablet Norethisterone, you cannot delay your period with the mini pill as you can with a combined contraceptive method.

Some women do not get a period at all when taking the mini pill. If you are interested in contraception that can delay periods, a combined hormonal contraceptive method, like the combined pill or vaginal ring, might be better for you (if deemed suitable).

The mini pill is suitable for women that for whatever reason should not take a contraceptive containing oestrogen, such as the combined pill.

Oestrogen is linked to a greater risk of some serious side effects such as blood clots and is therefore considered less safe for some women to take. Women that typically should not use contraception containing oestrogen, could benefit from using the mini pill:

• women over 35 years of age and smoke
• very overweight or obese women
• women who have high blood pressure (hypertension) or problems with blood circulation
• women who get migraines with aura
• women who take certain medicines*

* See the list of some of these below.

Can I take it while breastfeeding?

Yes, the mini pill is considered a safe contraceptive for both the mother and child while breastfeeding. It is recommended to start taking the first pill on day 21 after giving birth for immediate protection. If you start taking it later, you should use additional contraception (such as a condom) until you have taken the mini pill for 2 days.

Progestogen in the mini pill can be transferred via breast milk, but is harmless to the baby. You may also have other contraceptive options after birth and while breastfeeding too.

And what if I currently take other medications?

If starting any new treatments, it is important to be aware of how these can interact with any medications you might already take. The following can interfere with effectiveness of the mini pill:

• treatments for tuberculosis
• epilepsy medication
• antibiotics
• anti-fungal treatments
• St John’s Wort
• antiviral medicines, including HIV/AIDS treatments
• antacids for heartburn and indigestion

If you take any of these types of treatments, you should speak to your doctor about what contraception is best suited for you or how to protect yourself against unwanted pregnancy until you have finished your treatment course.

The mini pill is taken at a specific time daily, without a seven-day break. Each pill packet contains 28 pills, each of them containing the same dosage of the hormone progesterone. These pill packs should be taken back to back, at the same time every day to remain effective. If not taken correctly, the chance of getting pregnant on the mini pill increases.

Here is a summary of how to take it to avoid pregnancy:

• you must take each pill at the same time everyday (max. 3 or 12 hours late*)
• do not take a seven-day break
• start the next pack straight after (next day) after taking the last pill of the pack
• every blister pack is clearly marked with the days

* Traditional mini pills such as Noriday, containing norethisterone, need to be taken within a 3-hour window every day, which means it can be ineffective if you take it a few hours later than your usual time or the previous day. Mini pills containing desogestrel (such as Cerazette), can be taken up to 12 hours late without the efficiency decreasing.

It could be beneficial to set a daily reminder on your phone to take it so you do not forget. It is also important to pick a time where you know you will be able to take it every day.

You should also store your medicine correctly, in a dry, dark place below 30 degrees Celsius, to ensure that the medicine does not lose its efficiency.

This will depend on which mini pill you use. There are two different types of mini pills available today, the traditional one and the one containing desogestrel.

The traditional mini pill has a ‘3-hour window’, while desogestrel types have a ‘12-hour window’. The ‘window’ refers to the maximum amount of hours you have to remember to take your pill after your usual time.

If you are less than 3 hours late taking your pill, take it immediately and you will still be protected against pregnancy.

If you are more than 3 hours late and are using one of the 3-hour mini pills (such as Noriday), take it as soon as you can, but you may not be protected against pregnancy. In this instance, you should also use a non-hormonal contraception method such as a condom for at least the next 2 days. If you are using a pill containing desogestrel (12-hour window), you will still be protected.

If you are more than 12 hours late taking it, you should still take it, but you may not be protected against pregnancy and you should use a non-hormonal contraceptive for at least the next 2 days to be protected.

You should count the hours from when you normally take your pill, or when you took the pill the day before.

Vomiting and diarrhoea

Vomiting or experiencing diarrhoea soon after taking the mini pill should often be treated as a missed pill.

If you vomit (are sick) within 2 hours of taking the mini pill, it has likely not been absorbed fully by your body, and you should take another pill straight away. If you are not sick again after taking the second pill you will still be protected against unwanted pregnancy. You should take the pill the following day at your normal time.

Severe diarrhoea over 24 hours may mean the tablets haven't been fully absorbed into your bloodstream and may have reduced efficacy.

For sickness and diarrhoea that lasts more than 24 hours, you should treat each day as a missed pill. You will need extra protection during intercourse for the next 2 days (48 hours) to ensure you are protected against pregnancy, or refrain from sex.

When you start taking the mini pill for the first time, you can do this while on your period (between day 1 and 5) it will protect you against pregnancy straight away. This only applies if you have a normal menstrual cycle.

If you have a short menstrual cycle or start taking it any other time during your cycle, you should take it for 2 days before you are fully protected. This means that unprotected sex can lead to an unplanned pregnancy, until you have taken it for 2 consecutive days.

It takes the mini pill 2 days to thicken the cervical mucus that prevents sperm from getting through or surviving. It takes the pill 7 days to stop ovulation. This is why the advice in the attached patient information leaflet might say 7 days.

As with all prescription medication, the progestogen-only pill may cause side effects, however, these are not harmful and usually clears up in a few months of taking it. Some of these include:

• breast tenderness and/or enlarged breasts
• a change in sex drive; either increased or decreased
• headaches and migraines
• acne
• fluctuations in mood (mood changes)
• harmless ovarian cysts (fluid filled sacs on the ovaries) - these can disappear on their own
• upset stomach, including nausea and vomiting*
• changes to menstruation cycle, flow and patterns, including absence of periods

*Please see guidance on what to do if you experience vomiting, as this may affect efficiency.

Whether the mini pill is linked with an increased risk of breast cancer or not is not yet confirmed by researchers. If it is, it is likely to be very small, and should reduce once you stop taking it.

It is said that the mini pill does not cause weight gain, and if users experience this, it is likely to be water retention in the body rather than fat gain.

Research that has been carried out found little evidence of weight gain using the mini pill when compared to other hormonal contraceptives.

Sadly yes. An irregular menstrual flow is a common side effect of the mini pill. Some women will experience irregular bleeding (spotting), some will experience a near-normal period-type bleeding monthly, and some women find that the mini pill stops their periods altogether.

If you experience bleeding on the mini pill and find this affects you, you can consult your doctor to discuss alternatives. If your bleeding is heavy or long-lasting, you should see your GP or another healthcare professional.

If the mini pill isn't for you, there is no need to worry. In this day and age there are a variety of contraceptive methods available:

• Progestogen-only alternatives
  An injection (Sayana Press) and the implant are examples of contraception similar to the mini pill as in they contain only progestogen. However, they do not to be taken daily as a pill
• Combined hormonal contraception
  The combined pill, the ring and the patch are all examples of contraception containing both an oestrogen and progestogen
• Non-hormonal
  A copper IUD and barrier methods such as male/female condoms are examples of hormone-free contraception

The mini pill, like other hormonal contraception, is obtained from a pharmacy with a doctor’s prescription. This is to ensure that your medical details are reviewed and you are suitable for this type of contraception.

In the UK, some brands are available without a doctor’s prescription, but a consultation must be had with a pharmacist to ensure the medicine is safe for you to take. You can also get the mini pill free of charge from pharmacies with an NHS prescription from your doctor.

From euroClinix, you can get the mini pill delivered already the next day with a doctor’s consultation and prescription included in the price. You can browse available mini pill names and brands available at the top of this page.