The Progestogen-only pill: your contraception guide

You’re probably familiar with ‘the pill’. In fact, you may already use or have used it at some point in your life. 

But did you know that when it comes to birth control pills you have more options than you might realise? Since the 1960s, people have been using the combined pill and the progestogen-only pill (PoP) to prevent unplanned pregnancy.

Although they share the same goal, these pills have quite different effects on your body. Choosing the right pill for you and your body is extremely important.

Have you ever heard of the mini pill, progestogen-only pill or PoPs? No? Well, you’re in the right place then! These are all names we use for a type of pill that doesn’t contain any oestrogen.

The progestogen-only pill (PoP) is a type of contraceptive pill. Some progestogen-only pills, like Hana, work by inhibiting ovulation (egg release) and, when taken correctly, are over 99% effective at preventing pregnancy. Progestogen-only pills also alter your cervical mucus, making it hard for sperm to travel into your uterus during or after sex. 

For the pill to be most effective, you need to take it at the same time every day, without taking a break between packs. 

The purpose of any contraception is to help prevent pregnancy. There are plenty of benefits to choosing the progestogen-only pill.

In contrast to the combined pill, progestogen-only pills like Hana can be used by women who cannot take oestrogens, or do not want to, and by women who are breast-feeding – as long as they are medically suitable. 

From 2021 you can buy Hana over the counter in your local pharmacy or online, following a consultation with a pharmacist. So you can say goodbye to doctor’s appointments and waiting around for your prescriptions. Say ‘Hello’ to Hana, and quicker, more convenient, access to a contraceptive pill.

Pharmacist and sexual-health expert Deborah Evans* says, “It’s important to remember that neither pill protects you against sexually transmitted infections (STIs). So if you’re having sex with a new partner or partners, make sure you use extra protection such as condoms or dental dams. You should consider getting checked regularly for STIs.”

There are two types of progestogen-only pill available at the moment: traditional mini pills and those that contain desogestrel, like Hana.

So what is desogestrel and how can it affect your body?  Desogestrel is a synthetic type of female sex hormone known as a progestogen.

The desogestrel progestogen-only pill works in two ways to prevent unplanned pregnancies by:

1. Helping to stop ovulation (egg release – so sperm have nothing to fertilise) and
2. Thickening your cervical mucus

You can think of this as having two lines of defence against unplanned pregnancy.

When it comes to taking desogestrel, sticking to your routine is key to effectiveness. You should take your pill at the same time every day, 365 days a year.

There are a few things you can do to remind yourself to take your pill, such as:

• Keeping it somewhere you will see it everyday, such as by your bathroom sink. (Wherever you store Hana, make sure it is out of the reach of children and that it is stored below 30℃.)
• Setting a daily reminder on your phone.

It’s very important to take your pill at the same time every day. 

If you are less than 12 hours late, take the delayed pill straight away and take your further pills as usual. Hana can still protect you from pregnancy.

However if you are more than 12 hours late taking it, you will no longer be protected against unplanned pregnancies. 

If you are more than 12 hours late, take the most recently missed pill straight away and leave any earlier missed pills in the strip. Take your further pills as usual. Use extra contraception (e.g. condoms) for the next 7 days. 

Missing tablets at any time in the cycle can reduce the efficacy of Hana and risk pregnancy but if you have missed one or more tablets in the first week of taking Hana and had sex in the week before missing the tablets, the risk you may get pregnant is higher than any other time in your cycle. Ask your pharmacist for advice.

If you miss more than one tablet in your pack, across consecutive days, you only need to take one of your missed tablets. Then you can continue taking your pill as normal but you will need to use a barrier method of contraception (such as condoms) for 7 days.

You can find even more information about Hana and how to take it in your package leaflet, which you can view online here.

Unlike some combined pills, where you have a week each month without taking pills and normally have a period, with the progestogen only pill you take it continuously without a break. When you finish one pack, you begin another straight away.

Your periods may continue as usual. However, up to 50% of people who take the progestogen-only pill containing desogestrel experience irregular bleeding. This often happens in the first few months while your menstrual cycle adjusts.

Between 20 and 30% of those using the progestogen-only pill report more frequent periods, while 20% experience less bleeding or amenorrhoea. Amenorrhea is a technical term meaning that your periods stop altogether. 

Heavier or more frequent bleeding usually settles down after a few months of taking the pill. If you experience this and it doesn’t subside within a few months, then it is worth discussing this with your doctor to ensure there are no other reasons for the bleeding.

Do not use Hana if you are pregnant, or think you may be pregnant. Take a pregnancy test or talk to your pharmacist, doctor or family planning nurse if your period is late after missing any pills in the last month, or if you think you may be pregnant. If you become pregnant, stop taking Hana and see your doctor.

“No method of contraception is 100% effective” Deborah tells us “But if you discover you’re pregnant whilst taking the pill then you’re understandably likely to be anxious. The most important thing is to speak to your doctor to understand your options.”

The only way to know for certain that you’re pregnant is to take a pregnancy test, especially if you don’t have regular periods.

If you are pregnant, there is no evidence that the desogestrel pill negatively affects foetal development. 

If you find out you’re pregnant on the pill, it’s important to speak to your doctor as soon as possible. You should stop taking your pill straight away. Your doctor will check you over, talk you through your options, and refer you for further help or support.

Taking your pill at the same time every day is the best way to maximise efficacy. The progestogen-only pill may be less effective if you:

• Leave breaks between packs of pills
• Take it at different times every day
• Have been vomiting or had diarrhoea (in this case, you should use alternative contraception during your illness and at least 7 days after your illness has passed)

We’ve all heard stories about side effects of using the mini pill and some of us have experienced them first hand. Everyone is different and can experience different side effects – or none at all. 

The good news is that progestogen-only desogestrel pills, like Hana, are generally well tolerated. Changes to your menstrual cycle also tend to calm down within a few months of using the pill.

Common (affecting up to 1 in 10 people)

• Irregular menstruation or amenorrhoea (no periods)
• Altered mood
• Depressed mood
• Decreased libido (sex drive)
• Headache
• Nausea
• Acne
• Breast tenderness
• Weight gain

Uncommon (affecting up to 1 in 100)

• Vaginal infection
• Difficulty wearing contact lenses
• Vomiting
• Dysmenorrhoea (painful periods)
• Ovarian cysts
• Tiredness
• Hair loss

Rare (These may affect up to 1 in 1,000 women)

• Rash
• Hives
• Painful blue-red skin lumps (erythema nodosum)

If you are finding it difficult to manage any of these side effects, it may be worth speaking to your pharmacist or doctor or looking for an alternative form of contraception. You can also report side effects via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or the MHRA Yellow Card app in Google Play or Apple App Store.

You can get progestogen-only pills from the pharmacy, from the GP or at a sexual health clinic. 

Until recently, you needed to make an appointment with your doctor, or a sexual health clinic, and get a prescription to get the pill. 

While this might not be a major inconvenience, this does require a bit of planning. If you can’t get a doctor’s appointment or there are delays with your prescription, this could disrupt taking your pill every day at the same time.

With Hana, no prescription is no problem. Hana is available to buy over the counter in your local pharmacy or online, following a consultation with a pharmacist. 

A pharmacist, like Deborah, will make sure the pill is suitable for you and that you know how to take your pill properly. “Our job is to make sure you have plenty of information and support when getting your pill,” says Deborah, “So feel free to ask us anything and be reassured that we will respect your privacy and confidentiality.”

This means that, as long as the PoP is suitable for you, you can drop in and pick up Hana after answering some questions for the pharmacist.