A B O U T   Y O U R   M E D I C I N E

ORAL PROGESTOGEN only Contraceptives

Oral progestogen-only preparations may be an alternative where oestrogens are thought to be unsuitable, for example for older women, heavy smokers, those with prolactinomas, hypertension, valvular heart disease, diabetes mellitus and migraine. Although the failure rate is higher than the combined oestrogen-progestogen contraceptives they are still very effective medicine. Menstrual irregularities (especially heavy bleeding) are more common but tend to resolve with long term usage.

Femulen^® ,Micronor^®, Microval^®, Neogest^®, Norgeston^®, Noriday^®

The progestogen-only pill is taken once a day, every day, without a break as long a s contraception is required. Additional contraceptive precautions (a sheath or a cap plus spermicide) should be used for the first 14 days of the first pack. You should aim to take your pill at the same time each day. If you forget to take your pill, then it is advised that you take it as soon as you remember and then take the next pill at the correct time, even if that means taking two pills on the same day. If the pill was more than 3 hours overdue then you are not protected. You should continue taking the pill regularly but also use another method of contraception (e.g. sheath) for the next 7 days. Vomiting and diarrhoea can interfere with the pill’s absorption and reduce its contraceptive power. In such instances additional contraception should be used along with your normal pill taking for 7 days.

This has been a very controversial issue ever since the birth pill was introduced. Although it is accepted that there is an increased risk of blood clots forming in the veins compared with non-users of the pill, the incidence is very small with modern low-oestrogen combined pills and lower still in those on progestogen-only pills. Clearly other factors which increase the risk of blood clots such as obesity, immobility and smoking must also be taken into account when assessing the overall risk. If there has previously been a case of thrombosis this may be of concern but there is no evidence that the presence of varicose veins (which are very common) should prevent anyone taking any form of oral contraceptive.

This has received a great deal of publicity in the media in the past and women are understandably concerned given the incidence of breast cancer in the United Kingdom. Large studies which have been undertaken by the government's safety watchdog (The Committee on Safety of Medicines) have failed to confirm anything other than a slightly increased risk after many years of continuous use. There is therefore a need for regular breast screening including self-examination of the breasts for the appearance of lumps. However breast lumps are much more common than breast cancers and your doctor will frequently be able to re-assure you should you find them. You should pay special attention to regular breast checks if you have had problems with breast lumps in the past.

Stomach upsets including nausea, vomiting and abdominal discomfort, and weight gain and breast tenderness may occur when treatment is first started but usually disappear on continuation of treatment. Headaches, mood disorders and changes in sexual desire (libido) and appetite are occasionally reported. In some people the oral contraceptive will cause a rise in blood pressure and this should be checked by your Doctor from time to time.

It is stated in Patient Information Leaflets which accompany oral pill that conditions such as breast lumps, breast tenderness, mental depression, varicose veins, porphyria, melanoma, epilepsy and liver disease may all worsen on the pill. Some of these conditions are very rare but if you suffer from them you will be all too aware of what they are. Do not assume that you will be affected but do consult your Doctor if you believe that this has happened. It may be necessary to discontinue treatment in some cases.

It is likely that if you have fibroids in your womb or endometriosis that the pill will cause further problems. Seek medical advice if you are uncertain about this.

All progestogen-only contraceptives are suitable for use before major operations.

The effectiveness of the progestogen only pill may be reduced by interaction with certain drugs such as carbamazepine, griseofulvin, phenytoin, phenobarbitone, primidone, topiramate, rifabutin and rifampicin

Oral contraceptives should be kept in the packs in which they are supplied. All products are stored at room temperature.

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Ó NHS Tayside; 2006; version 1.0

Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.