Progestin Only Pills (POPs)

-Progestin-only pills (POPs) (Norethindrone in the USA and desogestrel outside of the USA) are one option for women who cannot or prefer not to use estrogen-containing contraception.

-The pills are dispensed in packs of 28 active pills, which are taken continuously.

-The progestin dose is substantially lower than the dose in any combination oral contraceptive.

-it is essential that the pill be taken at the same time each day to maximize contraceptive efficacy.

Mechanisms of Action:  thickening cervical mucus to inhibit sperm migration, suppressing ovulation, lowering the midcycle peaks of follicle-stimulating hormone and luteinizing hormone, slowing movement of an egg through the fallopian tubes, and thinning the endometrium.

-Typical failure rate: 9 percent

-Most common side effects of POPs: unscheduled bleeding, changes in menses

Contraindications:

Pregnancy

Breast Cancer

Abnormal uterine bleeding

Liver tumors, cirrhosis

Noncontraceptive benefits of POPs

lighter menstrual bleeding

reduced iron deficiency anemia

protection against endometrial cancer

reduction in risk of upper genital tract infections

-Only POP available in the United States: Norethindrone

Initiation: On the first day of menses. Use backup contraception (eg, condoms) if the patient starts POPs more than five days from the onset of menses.

Question: Can you use a POP in a patient taking lamotrigine? Yes