The mini-pills (or POPs - progestogen-only Pill) are getting their popularity from day to day. The reason is that POPs give very satisfactory contraception effect, but its side effects and health risks appeared to be less than those of ordinary pills. It is due to the fact that POPs contain only one hormone (not two like ‘ordinary’ or ‘combined’ pill has) – progestogen. Mini pill has no estrogen at all that profoundly reduces the chances of dangerous side effects.

So, let’s run through the most popular mini pills in order to be aware of everything concerning their advantages and disadvantages: Camila, Ovrette (or Norgestrel), Ortho Micronor, Norgeston, and Cerazette.

Camila, Ovrette and Ortho Micronor are progestogen-only pills that contain norethisterone; Norgeston contains levonorgestrel and Cerazette – desogestrel, the active ingredient, which is a synthetic progestogen, similar to the natural progestogen produced by the body.

1. These mini pills affect the natural mucus at the neck of the womb (that are called cervix). Norethisterone and levonorgestrel increases the thickness of this mucus, making it more difficult for sperm to move and meet (so to fertilize) the egg.
2. Norethisterone and levonorgestrel also change the endometrium - the quality of the womb lining, thus making almost impossible for the fertilized egg to successfully implant onto the wall of the womb.
3. These active ingredients may prevent the release of an egg from the ovaries (especially when use regularly). But it may not occur.

The different situation is with the new mini pill – Cerazette. Its active synthetic progestogen ingredient desogestrel works almost as ordinary pill primarily by preventing the release of an egg from the ovary (ovulation) plus all the above mentioned.

• Consult your health care provider to choose the proper mini pill for you (he or she is sure to know about POP more than all the articles authors all together). Discuss the side effects of each POP (you will read about it lower) and ask what POP is suitable for you in the best way.
• Get the proscriptions for several packs (and don’t quit taking them without your doctors approval) and read the leaflet inside the packet.
• Start taking the tablet on the first day of your next period with or without food. This will protect you from pregnancy immediately and you won't need to use any additional methods of contraception. (taking pill on any day of your cycle would not give you this ‘immediate’ issue). Just pick your own time of day when you start on the POP and from then on, you need to stick to that time.
• Make the process of taking the pill very comfortable for you and easy to remember, as you should take it EVERY day on a continuous basis (unlike the ‘combined’ pill) at the same (or around it) time. It is very important for the effectiveness of preventing pregnancy.
• If you forget to take a pill, you should take it as soon as you remember and then take the next one at your normal time. If the delay is more than 12 hours - you will not be protected against pregnancy and you should use an extra barrier method of contraception for the next two days (for example, condoms). If you happened to have unprotected sex in the two days after missing a pill – the chances are too high and after consultation with your doctor you should take ‘the morning after pill’ (emergency contraception). This information may be different than that of manufacturer's leaflet provided with your pills, but it is a UK Family Planning Association's recommendations (see references).
• Vomiting within three to four hours of taking a pill is greatly reduces the contraception effect.
• This contraceptive pill will not protect you against STD (sexually transmitted diseases).

• changes in menstrual bleeding - periods tend to be irregular (or just stops – don’t worry)
• if you did become pregnant while taking the mini-Pill, there is a chance that the pregnancy might be outside the womb (but with Cerazette the chances to have ectopic pregnancy are much smaller)
• you may have skin problems
• nausea and vomiting, dizziness
• headaches/migraine may occur
• you could get tender breasts
• you may experience changes in sex drive
• there's a small risk of cysts in the ovaries – of course, it’s best not to use the POP if you’ve already had an ovarian cyst
• depression
• weigh gain

Be aware of the fact that women using hormonal contraceptives appear to have a small increase in the risk of being diagnosed with breast cancer (in comparison with women who do not use these contraceptives).

Immediately stop taking the pills (after consulting your doctor first) if you get severe migraines, stabbing pains in the legs, disturbance in vision, significant rise in blood pressure, pain on breathing or coughing, itching of the whole body, yellowing of the skin or whites of the eyes (jaundice), severe abdominal complaints or if you get pregnant.

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Consult your doctor when you are taking other medicines, especially antiepileptic medicines, barbiturates, the herbal remedy St John's Wort and some others, as they reduce the blood level of this contraceptive, making it less effective at preventing pregnancy. If you regularly take any of these medicines perhaps you should not take POP while this time, in case you are prescribed a short course of any of these medicines you should use an alternative method of contraception (together with POP).

Don’t forget to consult your health care provider when you want to switch on POP from ‘combined’ pill, or after the miscarriage. After you choose the right POP for you – enjoy your life thus remembering to take everyday pill…

Valentyna Ant.

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