In this module, we will only discuss POP and Depo-Provera. IUS will be discussed in a separate module, please see "LARC".

​

Progestogen-only Pill (POP)

 

• Types of POPs are available:

  • Traditional POPs

  • eg: Noriday (Norethisterone- NET), Microlut (Levonorgestrel-LNG)

• Contain small doses of synthetic progesterone with no estrogen.

• Both contain 28 pills in a packet and are taken continuously with no pill-free period.

• Typical use Failure Rate is 9%.

• No delay in fertility return following the discontinuation.

• Safe in patients with migraine.

• No association with headache, cardiovascular disease (MI, VTE or stroke) or breast cancer.

• Change in the bleeding patterns is common:

  •  2 in 10 women have no bleeding.

  •  4 in 10 women have regular bleeding and

  •  4 in 10 women have irregular bleeding.

• Mood changes can occur.

​

Mechanism Of Action (POP)

• Suppression of ovulation

  • up to 60% of levonorgestrel (LNG) users

  • up to 97% of desogestrel (DSG) users

• Variable dampening effect on the mid-cycle peaks of LH and FSH

• An Increase in cervical mucous viscosity

• Reduction in the number and size of endometrial gland

​

​

Eligibility(POP)

INDICATION

• Breastfeeding

• Women at high risk of estrogen based contraindication

• Older age group women

• Women with cardiovascular/ hypertension condition

 

CONTRAINDICATION

• Breast cancer

• Undiagnosed per vaginal bleeding

• Suspected pregnancy

• Liver tumours

• Acute liver disease

 

 

Starting The POP

• Take one POP at or around the same time every day without a pill-free period.

• POP can be started day 1 to day 5 of the menstrual period without the need of any other added contraceptive method for the next 48 hours.

• If started at any time (pregnancy excluded) additional contraception is advised for the next 48 hours.

• POP can be initiated immediately postpartum.

• POP can be started immediately after a miscarriage.

​

​

​

Missed Pills Regime POPs

• Traditional POPs (3-hours Window)

• If more than 3 hrs late, ie more than 27 hrs from the last pill OR

• Desogestrel POPs (12-hours window)

• If more than 36 hrs late since the last pill:

  • A) The last pill should be taken as soon as remembered, if more than one pill has been missed, ONLY one pill should be taken.

  • B) The next pill should be taken at the usual time. This may mean that 2 pills are taken in one day.

  • C) Additional Contraceptive Precautions (condoms or avoidance of sex) are advised for 2 days (48hrs) after restarting the POP.

  • D) Emergency contraception is indicated if unprotected sexual intercourse occurred after the missed pill and within 48 hrs of restarting the POP.

​

​

Progesterone-only Injectables (Depo-Provera)

​

• Intramuscular progestin are Depo medroxy progesterone acetate (DMPA) 150mg and norethisterone enanthate (NET-EN).

• DMPA is an aqueous suspension and is in a prefilled syringe. It needs to be vigorously shaken to ensure complete suspension of the content.

• NET-EN is a thick, oily fluid that needs to be drawn out to syringe. The ampule needs to be emerged in warm water to reduce the viscosity prior.

• Both are administered intramuscularly into the upper outer quadrant of the buttock or in the deltoid as an alternative

• Typical use Failure Rate is 6%

• Use may be continued till age 50 years.

• Concurrent use of other medications does not reduce its efficacy (including antibiotics or liver enzymes)

• There is no association of DMPA use with mood swings, libido and headache.

• It alters the bleeding patterns and may cause amenorrhoea amongst users after 1 year of usage. (70%)

• There is a small association of weight gain amongst users after 6 months. However, the weight gain is mostly due to water retention.

• There may be a small loss of bone mineral density (BMD) which will recover after discontinuation, however there is no evidence of an increase in bone fracture risk.

• Possible delay in fertility return after 1 year of usage.

​

Long Term Use of Progesterone-only Injectable

• Women using DMPA who wish to continue use should be reviewed every 2 years to assess individual situations and to discuss the benefits and potential risks

• Women are generally advised to switch to another method at age 50.

• There is no need to stop DMPA in long-term users as long as its use is within WHOMEC 1 or 2.

​

​

Eligibility (Progestogen-only Injectables)

INDICATION

• Breastfeeding

• Women at high risk of estrogen-based contraindication

• Women of older age group

• Women with cardiovascular / hypertension condition

• Can be used in patients <18yrs after consideration of other methods

CONTRAINDICATION

• Breast cancer

• Undiagnosed per vaginal bleeding

• Suspected pregnancy

• Liver tumours

• Acute liver disease