Contraception The Mini Pill

Overview

The mini pill is a daily birth control pill that contains just one hormone — a man-made version of progestogen, which is a hormone your body makes naturally. That is why it is also called the progestogen-only pill, or POP. Unlike the combined pill, it contains no oestrogen. You take one pill every day and there is no break week and no dummy pills. It works mainly by thickening the mucus at the neck of the womb so sperm cannot get through, and by thinning the lining of the womb.

Yes. The mini pill is one of the most widely used kinds of hormonal contraception in the world, and millions of people take it every day.

Anyone who could become pregnant and wants to avoid pregnancy. It is often chosen by people who smoke and are over 35, people who are breastfeeding, people who get migraines with aura, and people who have had a blood clot or have a higher risk of one. It is also used by people who simply prefer not to take oestrogen.

Symptoms

Common symptoms

• Changes in bleeding: spotting between periods, irregular bleeding, or periods that become lighter or stop. This is most common in the first 3 months and usually settles.
• Headaches, or a change in how often you get migraines.
• Tender or slightly swollen breasts.
• Feeling sick, bloating, or a change in appetite.
• Mood changes, or feeling more emotional than usual.
• Acne or oilier skin.
• A lower sex drive in some people.
• Small, harmless fluid-filled sacs on the ovaries (ovarian cysts) — these usually go away on their own.
• Many people notice no side effects at all.

Causes

Main causes

• The mini pill is not an illness, so it does not have a cause. It is a medicine you take to prevent pregnancy.
• It thickens the mucus at the neck of the womb (the cervix), which makes it very hard for sperm to swim through.
• It thins the lining of the womb, so a fertilised egg is less likely to be able to settle there.
• Some mini pills also stop the ovary from releasing an egg (ovulation). This is the main way the newer versions with a 12-hour window work.
• It does not contain oestrogen, which is why it suits many people who cannot take the combined pill.

Risk factors

• Taking a pill more than 3 hours late (or more than 12 hours late for the newer 12-hour-window pills).
• Being sick within about 2 hours of taking a pill, or having severe diarrhoea.
• Some other medicines, including certain epilepsy medicines, some HIV medicines, and the herbal remedy St John's wort.
• Weight-loss (bariatric) surgery, which can affect how well any pill is absorbed.
• A very high body weight can make some mini pills slightly less effective — worth discussing with your clinician.
• Forgetting pills now and then — this is the most common reason the mini pill fails, and it is very fixable with a good daily routine.

When to see a doctor

See a doctor urgently if:

• You might be pregnant, or a pregnancy test is positive.
• Severe pain on one side of the lower tummy, or tummy pain with bleeding and dizziness.
• Pain, swelling or redness in one leg.
• Sudden breathlessness or chest pain.
• A sudden severe headache or any change in your vision.
• Heavy bleeding that soaks through a pad in an hour.
• Yellowing of the skin or eyes.
• You have missed pills and need emergency contraception.

Book a routine appointment if:

• You want to start, stop or switch contraception.
• Side effects bother you, or have not settled after about 3 months.
• You are starting a new medicine, or thinking about buying a herbal remedy.
• A pill has been late or missed and you are not sure what to do.
• You need a repeat supply, or a yearly review with a blood pressure check.
• You would like an STI check.
• Your weight or blood pressure has changed a lot since your last review.

Diagnosis

There is no test for the mini pill. A doctor, nurse or pharmacist will ask about your health and your periods, check your blood pressure, and talk through your options. In many places you can get the mini pill from a pharmacy without an appointment.

Tests that may be done

• Blood pressure check.
• A weight or body mass index (BMI) measurement.
• A pregnancy test if there is any chance you could already be pregnant.
• An STI screen, if you would like one — it is usually free and confidential.
• A review of any medicines you take, including herbal ones.

What to expect at your appointment

The appointment is usually short — around 10 to 20 minutes. You will be asked about your periods, whether you get migraines, any history of blood clots, whether you smoke, whether you are breastfeeding, and what other medicines you take. You will be shown how to take the pill and what to do if you are late or miss one. You do not need an internal examination or a smear test to start the mini pill.

Treatment

The mini pill is not a treatment for a medical condition — it is a contraceptive you take for as long as you need it. There is nothing to cure and nothing to monitor day to day, apart from taking it on time and having a check-up roughly once a year.

Self-care at home

• Take your pill at the same time every day. A phone alarm helps a lot.
• Link it to something you already do daily, such as brushing your teeth or breakfast.
• Keep a spare pack at home, or in your bag, so you are never caught out.
• If you are sick within about 2 hours of taking a pill, follow the leaflet in your pack and use condoms as well until you have taken pills correctly for 2 days.
• If a pill is late, take it as soon as you remember, keep taking the rest as normal, and use condoms until you have taken pills correctly for 2 days. A pharmacist or sexual health clinic can advise you.
• Use condoms as well to protect against STIs.
• Tell any doctor, nurse or pharmacist that you are on the mini pill before you start a new medicine.

Medical treatments

There is no cure needed. If side effects are hard to cope with, your clinician can help you adjust. Options include swapping to a different mini pill that allows a wider time window, moving to another progestogen-only method such as an implant, an injection or a hormone-releasing coil (a small device put into the womb), or switching to the combined pill if oestrogen is safe for you. Condoms and fertility awareness are also options. Your clinician will talk through the good points and the downsides of each, so you can choose what suits you best.

When is surgery considered?

Surgery is not part of using the mini pill. If you are considering a permanent method of contraception, such as sterilisation, your clinician can discuss this with you separately.

Living with this condition

Once you are in the habit, the mini pill fits easily into daily life. The main thing is consistency — a steady time each day is what keeps it working at its best. Bleeding changes can be annoying at first, so keep some period supplies with you. After the first few months things usually settle, and many people find their periods become lighter or stop completely, which many people see as a bonus.

Lifestyle tips

• Smoking does not make the mini pill unsafe in the way it can with the combined pill, but stopping smoking is good for your overall health — your clinician can help.
• Alcohol is fine in moderation; being very drunk can make you forget a pill, so plan ahead.
• If you travel across time zones, ask your pharmacist how to keep your timing right.
• Keep spare pills in your hand luggage rather than checked bags on a flight.
• Consider keeping a backup condom or two with you.

Diet and exercise

There is no special diet to follow while on the mini pill. It can be taken with or without food. Normal exercise is fine and encouraged. If you have long gaps between meals or a stomach bug, follow the advice in your leaflet, as vomiting and severe diarrhoea can affect how well a pill is absorbed.

Mental health and emotional wellbeing

Some people notice mood changes when they start hormonal contraception, and others feel no difference at all. If you feel low, anxious or not yourself, do not just put up with it — talk to your GP or sexual health clinic. Sometimes a different method suits you better. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line straight away.

Prevention

This article is about a way to prevent pregnancy, so prevention works a little differently. The mini pill is very effective when taken correctly: with perfect use it prevents more than 99 in 100 pregnancies, and with typical everyday use about 91 to 99 in 100, depending on the type and on how consistently it is taken. The newer versions with a 12-hour window work about as well as the combined pill. If you miss a pill, follow the leaflet and use condoms until you have taken pills correctly for 2 days. The mini pill does not protect against STIs — only condoms do that.

Screening programmes

Taking the mini pill does not change when you need cervical screening (smear tests) — go when you are invited. STI screening is free and confidential at sexual health clinics, and worth doing if you have a new partner or are worried. You should also have your blood pressure checked at least once a year while you are on the pill.

Complications

If left untreated

• If you stop taking the mini pill, or take it inconsistently, you can become pregnant — this is the main risk.
• If you do become pregnant while on the mini pill, there is a slightly higher chance the pregnancy is ectopic (growing outside the womb). This is rare but serious, so seek urgent help for severe one-sided tummy pain or shoulder-tip pain.
• Side effects such as irregular bleeding or low mood can continue if you do not discuss them with a clinician.
• Blood clots are possible with any hormonal contraception, but the risk with the mini pill is very low.
• The mini pill gives no protection against STIs, so condoms still matter.

Long-term outlook

The mini pill is a safe, well-studied and reliable option for many people. Most side effects settle within the first few months, and if they do not, there are plenty of other methods to try. Whatever happens, you are in control — you can stop at any time and your natural cycle usually returns quickly. If anything worries you, your GP, pharmacist or sexual health clinic can help you find the option that feels right.

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