Progestogen-only pills, or “minipills,” contain only progestogen and are safer for certain groups of women, such as those who are breastfeeding or over 35 and smoke. They prevent pregnancy by thickening cervical mucus and thinning the lining of the uterus, but must be taken at the same time every day to be effective. Side effects are similar to combination pills and may include acne, headaches, and weight changes.
Progestogen-only pills are birth control pills that contain progestogen only, the synthetic version of the hormone progesterone, instead of containing estrogen and progesterone, as combination pills do. Pills that contain only progestogen are often called minipills due to their lower hormone levels than regular oral contraceptives. Progestogen-only pills prevent ovulation in about half of the women who take them. They also help prevent pregnancy by thickening cervical mucus, making it more difficult for sperm to reach an egg, and by thinning the lining of the uterus, making an egg less likely to implant if fertilized.
Breastfeeding women often take progestogen-only pills to prevent pregnancy. The low dose of progestin and the absence of estrogen make the pills safe for breast milk. Progestogen-only pills are also safer for women over 35, especially if they smoke. Combination pills can lead to serious complications, including blood clots, in older women who smoke, so minipills are safer. Other women who may use progestogen-only pills include those with diabetes, high blood pressure, heavy menstrual periods or sickle cell disease, as well as women who want an easily reversible form of birth control, because fertility usually returns very quickly after discontinued use of progestogen-only pills.
Pills that contain only low doses of progestin have a higher failure rate than combination pills. With perfect use, progestogen-only pills are approximately 99.5% effective, which is only slightly lower than the rate of combined pills. However, mini-pills must be taken at the same time each day to constitute perfect use. Women should strive to take any birth control pill at the same time each day, but it’s especially important with mini-pills because they can drastically decrease their effectiveness if you take them even a few hours late. Progestogen-only pills are 92-95% effective with typical use.
Missing a progestogen-only pill increases your risk of pregnancy much more than missing a single combined pill. Women who take their mini-pill more than three hours after their usual time should use back-up contraception for at least 48 hours. If a pill is completely missed, the woman should use a back-up method until the next menstrual cycle to reduce the risk of pregnancy. Unlike combination pills, women who take minipills cannot take two the next day to make up for a missed pill.
The side effects associated with progestogen-only pills are similar to the side effects of combination pills. The most common side effects include acne, headaches, nausea, breast tenderness and weight changes. Some women also have irregular menstrual periods, depression or ovarian cysts. Most side effects are minor, and many of them resolve on their own after several weeks or months of taking the pills.
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