Mini Pill

One of the main reasons women are unable to use the combined contraceptive pill is because it contains oestrogen which raises some risks. The mini pill does not contain oestrogen.

All brands of mini pill use progesterone in differing strengths to prevent pregnancy. Other cont progesterone only contraceptives are the contraceptive implant, the injection and the IUS.

Some newer brands of the mini pill have a higher dose of progesterone. These mini pills can also prevent ovulation and thin the womb lining in some women.

Effectiveness

The mini pill is extremely effective with over 99% effectiveness when it's taken correctly. The mini pill should be taken every day at the same time. If you are sick or have severe diarrhoea then the pill may not work and you should use barrier contraception for two days following the end of your sickness.

Types of mini pill

There many different brands of mini pill but they can be broadly categorised as 'three-hour pills' and '12-hour pills'. Both are oestrogen free.

• Three hour pills are the older type but they are effective and prevent over 99% of pregnancies.
• 12 hours pills contain desogestrel, a type of progesterone. This contains a higher dose and can prevent periods as well as provide protection against pregnancy.

Versatility of the mini pill

Whereas the combined pill contains oestrogen and raises risks of side effects, the mini pill is suitable for most women.

If you smoke, have high blood pressure, have had blood clots, are over 35, overweight or have aura- migraines (that is a migraine with visual disturbance) you will not be prescribed the combined pill, however, you are able to use the oestrogen free mini pill.

You can continue to take the progesterone only mini pill until menopause, provided your health is stable.

Your doctor may not prescribe the mini pill if you have or have had breast cancer, liver or kidney disease, ovarian cysts, lupus or vaginal bleeding that can't be explained. However, the benefits of the mini pill can outweigh the slight risks in some cases. Your doctor will discuss the options with you.

The mini pill should be taken every day at the same time. You do not have a break between packs as you would with the combined pill.

The mini works by altering your hormones so that cervical mucus thickens and the womb lining thins. This means fertilisation does not take place, and should it occur, the womb lining is not able to sustain a fertilised egg.

Newer versions containing the progesterone desogestrel can prevent ovulation in up to 97% of menstrual cycles. Older versions with a smaller dose are less likely but can prevent periods in some women.

Taking the mini pill is quick and simple. You should swallow it whole with or without a drink. The pill is small so you can swallow it without liquid if needed. You can also take it with food if you find swallowing pills difficult.

Each strip of pill is printed with the days of the month to help you remember when to take your pill. It is important to take it every day at the same time to prevent pregnancy.

If it's your first time using hormonal contraception you should start taking the mini pill of the first day of your period. You will be covered against pregnancy immediately. If you start taking it at any other time, use barrier contraception such as a condom for seven days. This allows the progesterone time to act on your hormones.

If you are swapping from another form of hormonal contraception, there is no need to wait for a period. Start taking the mini pill when you finish your current pack of combined contraceptives or remove your implant, patch, IUS, or ring. If you are considering contraception after pregnancy you can take the mini pill 21 days after birth. The mini pill does not affect breast milk production and there is no risk to your baby.

It helps to take your pill at a time of day that suits your lifestyle. If you are rushed in the morning consider taking it at bedtime. Setting an alarm on your phone will help you remember.

To be effective the mini pill should be taken every day, but missing a pill is common. You will still be protected against pregnancy if you follow these instructions.

• Three-hour pill - If you are less than three hours late, take your pill straight away and you're still covered. More than three hours late means you run the risk of pregnancy. Take the forgotten pill straight away and use barrier contraception for two days.
• 12-hour pill - If you are less than 12 hours late take your missed pill as soon as possible. You are still covered against pregnancy. If you are more than 12 hours late you should take the missed pill as soon as possible and use barrier contraception for two days.

These guidelines apply to periods of vomiting and diarrhoea which can mean your pill does not absorb. Keep taking your pill and use barrier contraception after you finish being ill. The three-hour pills need two days of barrier contraception, but the 12-hour pill needs seven days. Make sure know what type of pill you are taking.

The mini pill is suitable for the vast majority of women, but on the rare occasion, your doctor will decide you are not suitable. This may be the case if you have:

• Heart disease
• Liver disease
• Breast cancer
• Ovarian cysts
• Lupus (SLE)
• Unexplained vaginal bleeding

If you are taking other medications either short or long term they may interfere with the effectiveness of the mini pill, or the mini pill may prevent them working correctly. These medications include antibiotics such as rifampicin and rifabutin which can reduce its effectiveness.

Other include:

• St John's Wort
• Epilepsy drugs
• HIV drugs called retrovirals
• The morning after pill

Always tell your doctor or pharmacist if you are taking the mini pill. They will tell you whether there is a contraindication with current medications.

Mini pill side effects

The mini pill has very few side effects because it does not contain oestrogen. It is usually the oestrogen component of combined hormonal contraception that raises risks and causes side effects.

Side effects of the mini pill may include:

• Ovarian Cysts
• Breast cancer. There is a very small raised risk that women taking the mini pill may develop breast cancer.

Other more common side effects include the following:

• Breast tenderness
• Acne
• Headaches and migraines
• Sex drive changes
• Nausea and vomiting
• Mood swings
• Weight changes
• Digestive upsets

These mild and common side effects often wear off as your body becomes accustomed to the change in hormones. If they have not settled down after three months speak to your doctor about changing to a different brand. Many women who do experience side effects say that the benefits of the mini pill outweigh any temporary mild side effects.

Mini pill and pregnancy

If you decide to conceive you can stop taking the mini pill and your fertility will return straight away. If you are pregnant you should stop taking the mini pill.

After giving birth you can become fertile again very quickly. The mini pill can be taken 21 days after giving birth and does not affect breastfeeding, unlike the combined pill which reduces breast milk flow. It's a popular contraceptive for new mothers.