Fertility Control - Progestogen-Only Pill (POP)

Question 1

What is the only UKMEC4 criterion of POP use?

Answer 1

Active Breast Cancer.

Question 2

What is the mechanism of action of Traditional POPs? (3).

Answer 2

1. Thickening cervical mucus.
2. Altering the endometrium to make it less accepting of implantation.
3. Reducing ciliary action in the fallopian tubes.

Question 3

What is the mechanism of action of Desogestrol? (4)

Answer 3

1. Inhibiting ovulation.
2. Thickening cervical mucus.
3. Altering the endometrium to make it less accepting of implantation.
4. Reducing ciliary action in the Fallopian tubes.

Question 4

What are the types of POPs? (2)

Answer 4

1. Traditional POP.

2. Desogestrol-Only Pill (Cerazette).

Question 5

How must the POP be taken?

Answer 5

Same time daily, with no pill-free period.

Question 6

Starting the POP :-

• Before Day 5.
• After Day 5.

Answer 6

1. Days 1-5 : Immediate Protection.
2. Other : Additional Contraception is required for 48 hours (cervical mucus needs to thicken enough to prevent sperm entering the uterus).

Question 7

Switching between Contraception :

• Between POPs;
• COCP to POP.

Answer 7

1. Between POPs : Immediately, with no need for extra contraception.
2. COCP to POP : Best time to change is pill-free period after finishing COCP pack. Switch immediately and use extra contraception (48 hours) if you have not had sex. If had sex, complete at least 7 consecutive days of the COCP before 48 hours of extra contraception before switching.

Question 8

What is a ‘Missed Pill’ for a:-

• Traditional POP.
• Desogestrol-Only Pill.

Answer 8

1. Traditional POP : More than 3 Hours Late.

2. Desogestrol-Only Pill : More than 12 Hours Late.

Question 9

How are ‘Missed Pills’ dealt with? (4)

Answer 9

1. Take missed pill ASAP and continue next pill as usual (even if taking 2 pills in 24 hours).
2. Take extra contraception for next 48 hours.
3. Use emergency contraception if they have had sex since missing pill or within 48 hours of restarting the regular pill.
4. Episode of Vomiting/Diarrhoea = Missed Pill so extra contraception is required for 48 hours.

Question 10

Adverse Effects of POP (7).

Answer 10

1. Main : Changes to Bleeding Schedule (common in 1st 3 months). If lasting longer, exclude other causes.
2. Breast Tenderness.
3. Headache.
4. Acne.
5. Increased Risk of Ovarian Cysts.
6. Small Risk of Ectopic Pregnancy (Traditional POPs).
7. Minimally Increased Risk of Breast Cancer that returns to normal after 10 years of stopping.