Side effects, drug interactions, and suitability

Common side effects (more than 1 in 100)

• menstrual irregularities
• skin disorders
• breast tenderness
• nausea

Less common side effects (less than 1 in 100)

• dizziness
• mood disturbance
• appetite disturbance
• changes in libido

Breast cancer

Use of any progestogen-only method of contraception may be associated with a small increased risk of breast cancer similar to use of the combined pill.

Ectopic pregnancy (less than 1 in 100)

Up to 10% of pregnancies that occur in traditional POP users may be ectopic, so women should be informed to seek help if they have symptoms of possible ectopic pregnancy, e.g. lower abdominal pain, shoulder tip pain.

Advise women taking an enzyme inducer for >2 months to change to an alternative method. If short-term use (<2 months) is anticipated, the woman may continue POP use and take additional precautions e.g. condoms whilst taking, and for 28 days after discontinuing, the enzyme inducer. Alternatively, she could be prescribed a one-off dose of progestogen-only injection to cover the period of risk⁴.

Individuals using tirzepatide (Mounjaro®) and oral contraception should switch to a non-oral contraceptive method, or add a barrier method of contraception, for four weeks after initiation and for four weeks after each dose increase⁷.

History

Clinical history taking and examination allow an assessment of medical eligibility for POP using the UK medical eligibility criteria: https://www.cosrh.org/Public/Public/Standards-and-Guidance/uk-medical-eligibility-criteria-for-contraceptive-use-ukmec.aspx  

In this context the history should include: relevant social and sexual history (to assess risk of sexually transmitted infections – STIs), medical, family and drug history as well as details of reproductive health and previous contraceptive use.

Note^1,10: DRSP POP should not be used by individuals with:

• severe renal insufficiency,
• acute renal failure,
• hyperkalaemia,
• untreated hypoaldosteronism,
• users of potassium sparing diuretics, aldosterone antagonists, potassium supplements

Use with caution with mild/moderate renal impairment and treated hypoaldosteronism.

Examination

No routine examinations required in asymptomatic patients except check BP in people over 50 who are being considered for DRSP POP.

Blood tests

Check U&E in people with risk factors for chronic renal disease if considering DRSP.