Mini Pill - Causes and Symptoms

The mini pill is an easy to use, quick and popular form of oestrogen-free contraception. It's available to women on prescription after a consultation with your doctor so that your suitability is established.

The mini pill is available from your GP, contraceptive clinics and some sexual health clinics. It's not available to buy over-the-counter. Once you have been prescribed the mini pill by your doctor you can order it online following a consultation.

The mini pill is extremely effective with a pregnancy prevention rate of over 99% when used correctly. It is highly unlikely to fail, but if it does the reason is usually because the woman has forgotten the pill or has been unwell.

Different types of mini pill

There are many different brands of mini pill and these are divided into two types.Both types of mini pill are oestrogen-free:

• Three hour progestogen-only pills including Micronor, Noriday, Norgeston and Femulen
• 12 hours desogestrel pills including Cerazette

How effective is the mini pill?

If you vomit or have severe diarrhoea within two hours of taking the mini pill you may not be protected against pregnancy. It's often necessary to use extra barrier contraception such as condoms during this time and for several days afterwards according to your type of mini pill.

Other medicines can also interfere with how the mini pill works. Antibiotics such as rifampicin and rifabutin can reduce its effectiveness. It's important to always tell your doctor or nurse that you are taking the mini pill so they can advise you on contraception cover.

Other medicines that reduce the mini pill's efficiency are:

• St John's Wort - a herbal remedy used to treat depression
• Epilepsy drugs
• HIV drugs called retrovirals. The mini pill may also prevent retrorvirals working correctly

These drugs interfere with the mini pill because they are enzyme inducers. Enzyme inducers speed up the function of your liver meaning the mini pill may not absorb properly.

If you have missed a pill and want to take an emergency contraceptive such as ellaOne it may interfere with how the mini pill works. You should speak to your doctor or pharmacist and use barrier contraception to ensure you do not fall pregnant.

As well as preventing pregnancy the mini pill has other benefits:

• The mini pill is suitable for women who cannot take oestrogen-based contraceptives. This includes the combined pill, the patch, the IUS, and the vaginal ring. It's available to women who are over 35, those who smoke and those who are overweight.
• There are considerably less side effects than the combined pill. Your risk of developing a blood clot does not rise with the mini pill.
• If your mini pill prevents ovulation, this can decrease the number of periods experienced. Some women find that even if their periods do not stop completely, they are lighter and less painful. Cerazette is more likely to prevent periods.
• The symptoms of PMS can lessen significantly. This includes pain, mood swings, bloating and skin changes.
• The mini pill is completely reversible. Fertility is restored as soon as you stop taking the pills. It's a good option for women who are considering a family in the near future.
• The mini pill doesn't interrupt sex. Barrier methods are still required to prevent STIs, but the mini pill takes away the stress and inconvenience of barrier contraception in relationships.
• It helps women relax and enjoy sex without the worry of pregnancy.
• It's possible to take the mini pill when you are breastfeeding. Trace hormones of progestogen have been shown to have no effect on breastfeeding infants.
• The mini pill is simple to take, readily available and widely used due to its effectiveness rate and availability to most women.

Oral contraceptives prevent sperm from fertilising an egg. The mini pill uses progestogen to thicken cervical mucus and stop sperm entering the womb. It also thins the womb lining so an egg cannot grow there.

Newer versions of the mini pill that contains the hormone desogestrel can prevent ovulation in 97% of menstrual cycles. Mini pills that contain other types of progestogen hormones are less likely to stop ovulation but are still over 99% effective at preventing pregnancy.

• Taking the mini pill is very simple. You swallow it whole with a drink. The pill is so small you are also able to swallow it without water.
• If you struggle to swallow pills you can take it with food, being careful not to break or chew the pill.
• Make sure you take it at the same time each day. Strips are printed with the days of the month to help you remember.
• If you are swapping from another form of hormonal contraception, you should take the mini pill immediately after the final combined pill or when your current method ends. There is no need to wait for a period.

What To Do If You Miss A Mini Pill

Pregnancies on the mini pill can happen because the woman has forgotten her pill or been unwell. In order to have a 99% effectiveness rate, the mini pill needs to be taken correctly. However, missed pills are common.

If you forget your mini pill you should follow these instructions:

If you are taking the three-hour mini pill and are less than three hours you should take it as soon as you remember. If you are taking the 12-hour desogestrel mini pill and are less than 12 hours late you should take it immediately. Take your second pill at the original time. You are still covered against pregnancy within these boundaries. If you are more than three or 12 hours late then you run the risk of pregnancy.

Take your missed pill, or the most recent missed pill if you have forgotten two or more, as soon as possible. You will need to use extra barrier contraception:

• Missed three hour pills require barrier contraception for two days to allow the cervical mucus to re-establish.
• Missed 12 hour desogestrel pills such as Cerazette require seven days of extra barrier contraception to ensure ovulation is regulated.

Starting the mini pill

If you start the mini pill on the first day of your period you will be covered against pregnancy immediately. If you start five or more days after the start of your period you will need to use extra barrier contraception until you have taken two pills correctly. If you are using the desogestrel 12-hour pill (Cerazette) you should use additional barrier contraception for seven days.

You are able to start the mini pill at any point during your period but you will need barrier contraception according to your pill type.

• Choose a time of day that suits you. Many women take their pill before they go to sleep, whilst others take it in the morning. It's important to choose a convenient time because the mini pill should be taken at the same time each day.
• You must take a pill every day to prevent pregnancy.
• Once you have finished the strip of pills, continue to the next strip without taking a break. Mini pills are designed for daily use. Only combined pills are taken for three weeks followed by a seven-day break.

After giving birth you can take the mini pill on day 21 and have cover straight away. Speak to your doctor first before taking the mini pill after giving birth. If you have had an abortion or miscarriage you are able to start the mini pill up to five days afterwards. After this time you will need extra barrier contraception for two or seven days.

There are some side effects associated with the mini pill, but these are less severe than contraceptives that include oestrogen.

Side effects include:

• Ovarian Cysts. These are usually fluid-filled and disappear without treatment or symptoms. Often women are unaware of their presence.
• Breast cancer. Women taking the mini pill have a slightly higher risk of developing breast cancer. After ten years the risk returns to normal. The risk is very small, but women with a history of breast cancer or a family link should avoid the mini pill.

Other more common side effects are often mild and wear off after a few months use. They include:

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

Oestrogen used in the combined pill raises the risk of side effects but because the mini pill contains only progestogen, it is suitable for most women. If you smoke, have high blood pressure, have previous blood clots, are over 35, are overweight or have migraines you can still take the mini pill. Women can continue to take the mini pill until they are 55 or until menopause provided they remain healthy.

There is no evidence that the mini pill can cause problems to a pregnancy, but women who believe they are pregnant should discontinue the mini pill. In contrast, the mini pill is safe to take during breastfeeding; it does not interfere with milk production because it is oestrogen-free. The mini pill can be started 21 days after giving birth.

You may not be able to use the mini pill if you have heart disease, liver disease, breast cancer, ovarian cysts, lupus (SLE) or unexplained vaginal bleeding. Your doctor will advise you on your suitability and suggest an alternative if necessary.

The mini pill is a prescription medicine and as with all medicine prescribed by a doctor, it can have some disadvantages.

You may experience spotting between periods or have more frequent periods although this often settles down after a few months of use. Many women find the benefits of the mini pill are worth persevering with the early side effects.

The mini pill doesn't protect you against STIs such as syphilis and chlamydia. Only a male or female condom can protect you from sexually transmitted infections (STI). If you're worried about STIs, you can ask for a screening from your doctor or visit your local sexual health clinic to rule out any infections. Most STIs are easily dealt with but can develop health complications if left untreated.

You need to take the mini pill at the same time each day. This can be inconvenient to women who work shifts or for those with busy lives. If you are ill or need to take other medications the mini pill may not work properly.