The Mini Pill (Progesterone-only Pill, POP)

The mini pill contraceptive uses a man-made version of naturally-occurring progesterone to protect you from pregnancy. The mini pill is 99% effective if you use it perfectly. However, since some people miss doses of their pills, the effectiveness across all people using it is around 91%.

You can buy the mini pill online from ZAVA by completing our simple questionnaire. We have different types of mini pill and other contraceptive options available, so you can find what’s right for you.

The mini pill (progesterone only pill) is a contraceptive pill that contains only progesterone as the active ingredient. It’s an ideal contraceptive method if you cannot take oestrogen. Both progesterone and oestrogen are types of female sex hormones that your body naturally produces.

Mini pills contain synthetic (man made) progesterone, such as desogestrel or levonorgestrel. There are several mini pill brands available, such as Cerelle and Cerazette.

The mini pill works by giving your body a steady dose of progesterone hormone.

Your menstrual cycle is regulated by changing levels of oestrogen and progesterone. By taking the progesterone-only pill regularly, the way your reproductive system works is changed to prevent unwanted pregnancies like it would if you were already pregnant.

The mini pill contraceptive can also thicken your cervical mucus to stop sperm from getting into your womb. It can also thin the lining of your womb, making it more difficult for an egg to implant and grow. This can cause you to have much lighter periods, which is one of the mini pill’s benefits.

How long does the mini pill take to work?

If you take the mini pill within the first 5 days of your period starting, it will work straight away to protect you from pregnancy. If you start the mini pill contraceptive after or before this window, you’ll need to use condoms for 2 days while you continue to take it.

It takes around 7 days for the pill to provide full contraceptive protection. A missed mini pill will interrupt this process and it will no longer be 99% effective.

Remember that the mini pill does not protect you against sexually transmitted infections (STIs). Only barrier contraceptives like condoms can protect you against STIs when you’re having sex.

According to research collected in the Faculty of Sexual & Reproductive Healthcare’s guidelines on the mini pill, it is over 99% effective when taken perfectly but around 91% effective across everyone who takes it since many people don’t take it properly.

This means that if 100 sexually–active people use the mini pill for 1 year:

• perfectly, potentially 1 of them will get pregnant
• but not perfectly, around 9 of them will get pregnant

The effectiveness of the mini pill depends on how you take it. Taking the mini pill as prescribed and at the same time each day will improve how effective it is. A number of clinical studies have looked at the question ‘how effective is the mini pill’.

➤ See our page “how effective is the pill” for more information.

The mini pill can do more than just prevent pregnancy. There are several benefits of the mini pill, which can include:

• a lighter period or no period at all, which makes it a great choice for treating heavy or painful periods and premenstrual syndrome (PMS)
• it can be taken if you are breastfeeding, overweight, have a history of blood clots, or have high blood pressure
• it’s a safer method of oral contraception for women over 35 who smoke
• it doesn’t interrupt sex

The average rating of the progesterone-only pill is 2.7 out of 5, but this may differ depending on which type of mini pill you use. Most patients who use the mini pill report having a lighter period or no period at all, which can help with PMS symptoms. During the first 1 to 6 months, side effects were reported the most, especially spotting between periods and mood changes. This decreased for most women when continuing with treatment.

Patient reviews can be a good way to get an idea of what a medication is like, but the only way to know for sure how you will react to the mini pill is to try it yourself.

The POP pill can have disadvantages, although these may not apply to everyone, such as:

• it can cause side effects
• you must remember to take it every day, within a 3 or 12 hour window, for maximum effectiveness
• it doesn’t protect against STIs, which means you will still need to use a condom when having sex with a new or casual partner
• your periods can change, such as becoming lighter, irregular or more frequent than before

When looking at the mini pill vs the combined pill, the main difference is their active ingredients. Combined pills contain both oestrogen and progesterone, whereas the mini pill contains only progesterone. If you are already taking the mini pill, switching to a combined pill is safe and easy.

They both work in a similar way by giving your body a steady dose of hormones. Both pills cause changes to your reproductive system which help to prevent unwanted pregnancies. You can get pregnant again after you stop taking the pill.

The way you take a combined pill is different to how you take a mini pill. With a combined pill you take it every day and often have placebo pills, or take a break for up to 7 days during a 28 day cycle. With the mini pill, you take it every day without any breaks during a 28 day cycle.

With the mini pill, you need to take it at the same time each day, within the same 3 hour or 12 hour window. With the combined pill, you need to take it at the same time each day within the same 24 hour window.

The mini pill is not better or worse than the combined pill, it may just be more suitable if you cannot take oestrogen or if you get side effects while taking the combined pill.

“Both pills are equally effective as long as you take them properly. There’s no easy answer to “what is the safest birth control pill?”, both can be safe as long as a healthcare professional has approved treatment for you. To ensure your treatment is safe, give honest answers during your treatment assessment and order your pill through a trusted source.” – Dr Babak Ashrafi, Clinical Lead for Service Expansion at ZAVA.

If you are switching from a mini pill that contains desogestrel to a combined pill, you do not need to use extra contraception. If you are switching from a mini pill that does not contain desogestrel, you’ve been taking it correctly and you’re sure you aren’t pregnant, you can start your new combined pill right away but you will need to use extra protection like condoms for 7 days (or 9 days if you’re starting Qlaira).

If your mini pill contains levonorgestrel or norethisterone and you are switching to a combined pill, you’ll need to use extra contraception (such as condoms) for the next 7 days if you have sex.

The different types of mini pill contain different active ingredients, which include desogestrel, levonorgestrel, and norethisterone. These are man made progesterones and work in the same way, but you may find that some types of mini pill give you fewer side effects than others.

Desogestrel mini pills

Desogestrel has a bigger, 12-hour window for taking your pill than other types of mini pill. It’s a third-generation progesterone, which means it has less androgenic (male hormone) effect.

Desogestrel progesterone-only pill names include:

• Cerelle
• Cerazette
• Hana
• Lovima
• Zelleta

Levonorgestrel mini pills

Levonorgestrel is a second-generation progesterone. This means it’s more androgenic, which makes acne more likely as a side effect but can also increase the chance of positive effects on periods. Norgeston is the main brand of levonorgestrel mini pill available in the UK.

Norethisterone is the third type of active ingredient used in mini pills. It’s a first-generation progesterone which puts it in the middle of the second and third generations in terms of androgenic effect. This means it has a middling chance of side effects like acne and positive effects on periods. Norethisterone can also be used to delay your period at higher doses, which aren’t used for contraception.

Norethisterone mini pills include:

• Noriday
• Micronor

The best mini pill brands depend on what you want to take the pill for and how well you tolerate the side effects. You may find that one mini pill works better for you than another. Below are some names of mini pills and more information about each one, so you can make a more informed decision about your contraception.

Cerazette, a mini pill with a 12-hour window for taking it:

• contains 75 micrograms of desogestrel
• can be taken within a 12 hour window without becoming less effective
• is similar to pills such as Cerelle, Hana, Lovima and Zelleta as they contain the same dose of desogestrel, but may contain other non active ingredients

Cerazette is a branded pill manufactured by Organon Pharma (UK) Limited and should be taken once daily.

Hana, the first over-the-counter contraceptive pill:

• contains 75 micrograms of desogestrel
• can be taken within a 12 hour window without becoming less effective
• is similar to pills such as Cerazette, Cerelle, Zelleta and Lovima, as they contain the same dose of desogestrel, but may contain other non active ingredients

Hana was the first POP pill that is available without a prescription, meaning you can get it over-the-counter. Like all other mini pills, it should be taken once a day to prevent pregnancy. It’s manufactured by HRA Pharma UK and Ireland Limited.

Noriday, a norethisterone pill:

• contains 350 micrograms of norethisterone
• must be taken in a 3 hour window to maintain maximum effectiveness
• is similar to the Micronor mini pill

Noriday is made by Pfizer and should be taken once daily for protection against pregnancy. You must take it within 3 hours of the day before, or at the same time every day.

Zelleta, another 12-hour mini pill:

• contains 75 micrograms of desogestrel
• must be taken within 12 hours of the day before to remain 99% effective
• is similar to pills such as Cerazette, Cerelle, Hana, and Lovima, as they contain the same dose but may contain other non active ingredients

Zelleta should be taken once a day to prevent pregnancy. It’s manufactured by Morningside Healthcare and is currently not available through ZAVA, although we offer many similar alternatives.

Taking the progesterone-only pill can be straightforward if you follow our simple steps. Your doctor will also let you know how and when to take the mini pill if this is your first time using it.

If you’re switching from the combined pill, we also have information on this below.

Starting the first mini pill – what to expect when starting the mini pill?

When to start the mini pill depends on your current situation, such as at what point in your menstrual cycle you are or whether you have been taking another pill.

If you can, start the first mini pill on the first day of your period. You’ll have contraceptive protection from the first day and do not need to use extra protection.

If you are starting the mini pill within the first 5 days of your period, you’ll be protected straight away too. However, if you start on or after the sixth day of your period or have a short or irregular menstrual cycle, then you’ll have to use protection, such as condoms, for 2 days.

If you’re switching from another mini pill:

• start taking the new pill at any point during the cycle.
• make sure you have not missed any pills, and take your new mini pill instead of your old mini pill at your usual time each day.

You will not need extra contraception.

If you’re switching from the combined pill and usually take a pill free break:

• start the mini pill the day after your last active pill and skip the placebo (inactive) pills.

If you’re switching from the combined pill and do not have a pill free break or placebo pills:

• start the mini pill the day after the last combined pill.

You will not need to use extra contraception.

Vomiting and diarrhoea can change the effectiveness of the mini pill. If you throw up or have diarrhoea within 2 hours after taking the pill, you’ll need to use extra contraception while you’re sick and for:

• 2 days after, if you’re on the 3 hour mini pill (levonorgestrel or norethisterone)
• 2 days after, if you’re on the 12 hour mini pill (desogestrel)

Keep taking the mini pill as normal during this time.

Missed mini pill: what to do if you forget to take it?

If you forget to take a mini pill, take the missed pill as soon as you remember. This might mean taking 2 pills on the same day.

You’ll need to check what type of mini pill you are taking. Most mini pills can be taken within the same 12 hours each day, such as desogestrel pills Cerelle, Cerazette, Lovima and Hana. Noriday or Norgeston need to be taken within the same 3 hour window each day.

If you’re more than 3 hours or 12 hours late taking your mini pill, you’ll need to use extra contraception for the next 2 days, such as condoms.

If you’ve had unprotected sex in the past 7 days and missed a pill, it’s likely that you’ll need emergency contraception. Speak to your pharmacist or sexual health clinic if this happens.

You can buy the mini pill in the UK by getting a private prescription. This applies to online doctor services, such as ZAVA. Most mini pills are prescription-only medications (POM).

You can also buy certain brands of mini pill over-the-counter at your local pharmacy or online through ZAVA. Lovima and Hana are brands of desogestrel mini pills that are pharmacy-only medicines. This means a pharmacist will need to ask you a few questions before you can buy the pill.

How can I buy the mini pill online?

You can buy the mini pill through online pharmacy and online doctor services. To be safe, make sure the online services you buy from are registered with:

• the General Medical Council (GMC)
• the General Pharmaceutical Council (GPhC)

These are the official regulators of medical and pharmaceutical services in the UK.

You can buy the mini pill from ZAVA without needing an appointment. All you need to do is fill out a short consultation questionnaire. One of our doctors will review this questionnaire to make sure the mini pill is suitable for you.

We can then deliver the pill in discreet packaging to your home address or you can choose to collect it from your local Post Office.

Can I buy the mini pill over-the-counter? (Lovima and Hana)

Hana and Lovima are mini pills that are available to buy over-the-counter. Both Hana and Lovima contain 75 micrograms of desogestrel in each pill.

Your pharmacist will run through a few questions with you to make sure the mini pill is safe for you to take. This does not require an appointment and should take a short amount of time.

Getting the mini pill through the NHS

If you want to get the mini pill through the NHS, speak to a doctor or sexual health clinic about contraception. They can prescribe the most suitable pill for you and answer any queries you have about taking the mini pill. You can take this prescription to any UK pharmacy.

All contraceptive pills, patches and devices available on the NHS are free of any prescription charges, as long as they are prescribed for contraceptive purposes. You may need to pay a prescription charge if you are prescribed the contraceptive pill for another reason, such as treating acne.

You may experience some mini pill side effects when you first take the progesterone-only pill. These side effects are usually temporary and will not last very long.

Some side effects of the mini pill will go away after a few days of taking it, as your body gets used to the hormones. Other side effects may take a few weeks or months to get better.

If you’re concerned about any side effects, speak to a doctor or pharmacist.

Common side effects of the mini pill are:

• headache
• feeling sick
• acne
• mood changes, such as depression
• reduced sex drive
• breast tenderness
• irregular or no periods
• increased body weight

Uncommon side effects can affect up to 1% of women taking the mini pill. This means if 200 women take the mini pill, less than 2 women will experience these side effects.

Uncommon side effects of the mini pill include:

• tiredness
• vomiting
• painful periods
• hair loss
• vaginal infections such as thrush
• ovarian cysts

Women older than 40 have a higher risk of breast cancer than younger women. It’s important to check your breasts regularly and let your doctor know if you notice anything unusual.

The mini pill has a smaller risk of both blood clots and breast cancer compared to the combined pill. This might make it a better choice for you than the combined pill.

You can find out more information about side effects by reading the patient information leaflet that comes in your pack of mini pills.

Coming off the mini pill will not cause any side effects and you can stop taking it straight away. When you stop using the POP pill, you will:

• no longer be protected against pregnancy
• notice your periods going back to how they were before, although this may take several months
• be able to conceive straight away, but it can take a few months to get pregnant

You can also get the combined contraceptive pill if you still want to take a pill. You can find out more about the difference between the combined pill and the mini pill in the ‘What is the difference between the combined pill and the mini pill?’ section. If you don’t want to take hormones, you can also get non-hormonal birth control.

Other types of contraception methods include:

• male condom
• female condom
• diaphragm
• coil
• implant
• injection
• vaginal ring
• patch
• sterilisation
• natural family planning
• emergency contraception, like the morning after pill – please note this should not be used as a contraceptive pill

The mini pill may be right for you if you want to prevent pregnancy, are happy to take a daily POP pill or cannot take pills containing oestrogen. The only way to know for sure if the mini pill is right for you is to get a doctor or pharmacist to approve treatment and try it for yourself. You can always try another mini pill if the one you try has unwanted side effects.