Is the mini pill right for me?

The mini pill is an oral contraceptive containing the hormone progesterone. Unlike combined pills, the mini pill does not contain oestrogen. 

The mini pill is suitable for most women, including:

• women over the age of 35 who smoke

• smokers

• breastfeeding women

• women with existing health conditions such as high blood pressure

If you’re thinking of going on the pill but already take medication, you should consult your doctor for advice first.

The mini pill may be a good choice if you: 

• Cannot take oestrogen. The mini pill contains only 1 hormone: progesterone

• Want to take the same dose of hormones each day

• Experience migraines. On the combined pill you have a 7 day break from the hormones you’re taking, whereas on the mini pill you take the same hormones every day. Changes in hormones can cause migraines or make them worse so taking the mini pill can help manage migraines

• Are breastfeeding. Oestrogen can increase your risk of blood clots and lower the quality and quantity of breast milk and as a result is not recommended for breastfeeding mothers who have given birth less than 6 weeks ago. As the mini pill contains only progesterone, it’s safe for you and your baby

• Smoke. Oestrogen can increase blood pressure and the chance of blood clots. As smoking also increases these risks, the combined pill is not recommended for smokers.  

• Have high blood pressure. The oestrogen in combined pills can increase blood pressure. The mini pill is not thought to have any effect on blood pressure

• Cannot get a blood pressure reading. If you do not know your blood pressure it’s safer to avoid a contraceptive pill which may increase it. The combined pill includes oestrogen which can increase blood pressure. 

• Have a family history of blood clots. Combined pills can increase the risk of blood clots due to the oestrogen they contain and are not recommended if you have a family history of blood clots in the lungs or legs

• Are over 35 and smoke. The combined pill is not recommended for women over 35 who smoke, so the mini pill is a safe alternative

• Think you may forget to restart the pill after a pill-free break and are happier taking a pill every day. On the mini pill there is no need to take a 7-day break 

The mini pill may not be the right choice of hormonal birth control for you for the following reasons:

• It can make acne worse. The mini pill only contains progesterone and this hormone causes the skin to increase its production of an oily substance that protects your skin called sebum. Too much sebum can block pores and cause spots. Some combined pills can clear up acne

• You need to take it at the right time. The mini pill must be taken at the same time every day to be effective. Most brands of the mini pill state that if you’re more than 3 hours late taking the pill it will be less effective

• It can cause changes to your period. The mini pill can cause your periods to become lighter, irregular or they may stop completely. You may also notice spotting between periods. The combined pill can also affect your periods. 

How does the mini pill work?

Unlike the combined pill, the mini pill only contains 1 hormone, progesterone. Progesterone is a female sex hormone that is naturally produced by your ovaries. 

Progesterone works by making the mucus at the entrance of the womb thicker so sperm find it difficult to reach an egg to fertilise it. The changes progesterone causes to the lining of the womb also makes it difficult for fertilised eggs to implant. Some mini pills also prevent your body releasing eggs (ovulating) at all.

If the mini pill is taken correctly, it’s 99% effective at preventing pregnancy. However, if you forget to take it at the same time every day or you forget to take it completely, this drops to 91%.

It’s also important to remember that no pill, including the mini pill, protects you against sexually transmitted infections (STIs). If you want to protect yourself from STIs as well as pregnancy you will need to use a condom when you have sex. 

What is the difference between the mini pill and the combined pill?

The main differences between the mini pill and the combined pill are:

• They contain different hormones. The combined pill contains 2 hormones, oestrogen and progesterone, while the mini pill contains only progesterone. For this reason, you may experience different side effects on the different types of contraceptive pill. It also means that if you cannot take oestrogen, the mini pill may be more suitable for you

• The time frame you must take them in is different. Mini pills should be taken at the same time each day. Most brands of mini pill must be taken within 3 hours of that time to stay effective (although some can be taken up to 12 hours after your usual time). The combined pill should also be taken at the same time every day but if you miss 1 pill and remember to take it within a 24 hour period the combined pill will still be effective at preventing pregnancy

• The mini pill has no 7 day break. You take the mini pill every day without a break, unlike the combined pill which you take every day for 21 days followed by a 7 day break. Some women find it easier to remember to take a pill every day, rather than stop and start

Before starting the pill, or switching your hormonal birth control, you should discuss the best option for you with your doctor.

What side effects can the mini pill cause?

Just like the combined pill, the mini pill can cause side effects, particularly within the first few months of taking it. Your body needs to get used to the new medication you are taking and adjust to the new level of hormones. In most cases, the side effects become easier to manage or wear off on their own after a few months.

The side effects you may have, if any, vary from person to person. What one person may experience when they take the mini pill may not be the same as you. 

The most commonly discussed side effects of the mini pill are:

• oily skin and acne

• irregular periods

• low sex drive

• fertility

• weight gain

• mood changes

How will the mini pill affect my skin?

Progesterone causes an increase in sebum production, an oily substance which helps protect the skin. However, large amounts of sebum can clog up pores and cause an outbreak of spots. Taking the mini pill can make acne worse if you already have it whereas the combined pill may help clear it up. But this varies from person to person. 

How will the mini pill affect my periods?

A common side effect of the mini pill is the changes it can cause to your menstrual cycle, especially in the first few months of taking it. The mini pill can cause periods to become lighter, irregular or they may stop completely. Some women also notice spotting or breakthrough bleeding between periods. These side effects usually get better after you’ve been taking the mini pill for 3 months and your body has adjusted to the changes in hormone levels. If you’re worried about side effects or anything at all related to taking the mini pill, you should speak to your doctor.

How will the mini pill affect my sex drive?

All pills, including the mini pill, work by changing hormone levels to prevent pregnancy. These hormonal changes can impact your sex drive. Progesterone usually lowers your sex drive but there are cases where women experience an increase in the desire to have sex. If you feel that the mini pill is affecting your sex life in a negative way you should discuss this with your doctor.

How will the mini pill affect my fertility?

The purpose of the mini pill is to prevent pregnancy only while you’re taking it. It has no effect on your long-term fertility. How long you take the mini pill for does not affect your ability to get pregnant after you stop taking it. Your chance of getting pregnant is the same as someone who has never taken any form of contraception before.

What are other side effects of the mini pill?

Other possible side effects of the mini pill are:

• feeling sick (nausea) and/or being sick (vomiting)

• breast tenderness

• breast enlargement

• headaches and migraines 

• cysts on your ovaries

• mood changes

If you’re worried about the side effects of the mini pill or they have been affecting you for longer than 3 months, you should talk to your doctor.

How will the mini pill affect my weight?

How do I take the mini pill?

The mini pill must be taken at the same time every day, within a specific time frame. If you do not take it within this time frame, you need to think of it as though you’ve missed a pill.

There are 3 different types of progesterone that the mini pill can contain and these affect the window within which it must be taken:

• levonorgestrel progesterone: 3 hours

• norethisterone progesterone: 3 hours

• desogestrel progesterone: 12 hours

The mini pill is taken every day for 28 days and then you start a new pack immediately after the old pack is finished. 

The best way to ensure you’re taking the pill correctly is to follow the instructions in the pack.

What are the different brands of the mini pill?

I’ve forgotten to take my mini pill. What should I do?

If you have missed a pill, you will need to read the patient information leaflet. What you need to do will depend on which brand of mini pill you use and when you should have taken your pill. If you’re still not sure what to do, it’s best to talk to your doctor immediately.

If you’re being sick (vomiting) or have diarrhoea and this occurs within 3 to 4 hours of taking your pill, you’ll need to treat this as a missed pill as the medication will not have been absorbed by your body properly.

If you’ve had unprotected sex in the 2 days before a missed pill, you’ll also need to use emergency contraception if you do not want to risk pregnancy.

I’m starting to take the mini pill. What do I need to know?

The mini pill can be started at any time during your menstrual cycle but where you are in the cycle will determine whether you’re protected from pregnancy immediately.

When you are starting to take the mini pill, choose a time of day to take the pill that you’re most likely to remember (you may find it useful to set a reminder).

If you start the pill on days 1 to 5 of your period (the first 5 days after your period starts), you will be immediately protected against pregnancy unless you have a short menstrual cycle. If you have a short menstrual cycle you will need to use additional contraception, like condoms, for the first 2 days of taking the mini pill.

If you start the mini pill at any other time during your menstrual cycle, you will also need to use additional contraception methods until you have taken the mini pill for 2 days to avoid pregnancy.

Starting the mini pill after birth

If there are no risk factors such as blood clots, the mini pill can be started immediately after giving birth. If you start taking it in the first 21 days after giving birth you’ll be protected from pregnancy immediately.

If you take it after day 21 following birth, you’ll need to use additional contraception, like condoms, until you have been taking the mini pill for 2 days.

We suggest that you talk to your doctor about contraception following birth.

How do I change to a different brand of mini pills?

It’s simple to change the brand of your mini pill. 

Start the new mini pill the day after taking the final mini pill in your current pack. Make sure you follow the instructions in the patient information leaflet for the new brand you’re taking.

You’ll be protected from pregnancy immediately as long as you’ve not missed any pills in the last 2 days, or taken them at a different time from usual.

How do I change from the combined pill to the mini pill?

Changing from the combined pill to the mini pill is straightforward. It’s best to swap from one type to another without having a break in between. When starting the new mini pill, take the first one the day after you take the last active pill in your combined pill packet. You should use a condom during sex for the first 2 days of taking the mini pill to prevent pregnancy. 

If you’re taking a pill that contains dummy pills in the pack, it's best to start the mini pill immediately after the last pill in the pack that contains active hormones. If you start the mini pill after the dummy pills you’ll need to use condoms for the first 2 days of taking the mini pill. 

If you’ve already started your pill-free break, you’ll also need to use condoms for the first 2 days when you have sex to prevent pregnancy. 

You should also read the instruction leaflet in the pill pack for further advice.

How do I come off the mini pill?

You can come off the mini pill straight away by no longer taking the tablets. If you want to prevent pregnancy you will need to use alternative contraception immediately. 

There are many reasons you may wish to stop taking the pill. Often it’s because you want to start a family or would like to try a different form of contraception. Whatever your reasons, it’s useful to know the changes you may experience when you stop taking the pill.

Where can I get the mini pill?

Can I get the mini pill online?

How long does the mini pill take to work?

Sources

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Contraceptives, hormonal. (2020) NICE [Accessed 09th July 2020]

How effective is contraception at preventing pregnancy? (2020) NHS [Accessed 10th July 2020]

Mini pill. (2020) UCL (Accessed 10th July 2020]

Recent Oral Contraceptive Use by Formulation and Breast Cancer Risk among Women 20 to 49 Years of Age. (2014) AACR [Accessed 09th July 2020]

Switching or Starting Methods of Contraception 

Your contraception guide. (2018) NHS [Accessed 10th July 2020]

Progestin-only Contraceptives: Effects on Weight. (2013) Cochrane Database Syst Rev [Accessed 09th July 2020]