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Mini-Pill

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Mini-Pill, Progesterone Only OCP, Progestogen Only Oral Contraceptive, Progestin Only Pill, Progestin-Only Pill, Micronor, Nor QD, Nor-QD, Ovrette, Noriday, Nora-BE, Jolivette, Camila, Errin, Femulen, Norgeston, Microlut, Cerazette, Jencycla, Slynd, Opill

  • See Also
  1. Oral Contraceptive
  2. Norethindrone
  3. Drospirenone
  1. Lactation
  2. Estrogen contraindicated
    1. See Oral Contraceptives
    2. Age over 35 years old and Tobacco use
    3. Migraine with Aura (risk of CVA)
    4. Venous Thromboembolism Risk
  • Contraindications
  1. Pregnancy
  2. Breast Cancer or Progestin-sensitive cancer
  3. Liver neoplasms
  4. Undiagnosed Abnormal Uterine Bleeding
  • Mechanism
  1. No Estrogen
  2. Progesterone only (activity varies by Progestin type)
  • Precautions
  1. Must be taken at the same time everyday (within 2 hours)
  2. Indications to use backup Contraception (e.g. Condoms) for 2 days
    1. Late dose - delay from typical daily dosing time of 3 or more hours
    2. Vomiting or severe Diarrhea within 4 hours of dose
  • Medications
  1. Norgestrel 75 mcg
    1. Activity: Low Estrogenic, moderate progestational, moderate androgenic, moderate endometrial
    2. Opill
      1. First Oral Contraceptive available OTC without a prescription (in U.S. 2024)
    3. Ovrette
      1. Withdrawn from market in 2005 (for business decisions)
  2. Norethindrone 350 mcg
    1. Activity: low Estrogenic, low progestational, low androgenic, low endometrial
    2. Micronor, Nor-QD, Nora-BE, Jolivette, Camila or Errin
    3. Noriday (UK)
  3. Drospirenone 4 mg (Slynd)
    1. Activity: Low androgenic
    2. Released in 2019 in U.S. at $200/month
    3. Marketed as having more maintained efficacy after a missed pill than Norethindrone
      1. Does not require back-up Contraception if missed pill is taken within 24 hours
    4. Risk of Hyperkalemia (anti-mineralcorticoid effect)
    5. Less unscheduled Abnormal Uterine Bleeding than with other Progesterone only contraceptives
    6. (2019) Presc Lett 26(10): 58
  4. Ethynodiol Diacetate 500 mcg
    1. Femulen (UK)
  5. Levonorgestrel 30 mcg
    1. Norgeston (UK)
    2. Microlut (Australia)
  6. Desogestrel 75 mcg
    1. Cerazette (UK)
  7. References
    1. Wikipedia
      1. http://en.wikipedia.org/wiki/Oral_contraceptive_formulations
  1. Ectopic Pregnancy increased Incidence
  2. Breakthrough Menstrual Bleeding (up to 50% of patients)
    1. Responsible for at least two thirds of the patients discontinuing Progestin only Oral Contraceptive
    2. Consider periodic NSAID for 5 days (Naproxen 500 mg twice daily, Ibuprofen 800 mg three times daily)
    3. Consider switching to Drospirenone (Slynd), which is associated with less unscheduled Abnormal Uterine Bleeding
    4. Consider switching to combination Oral Contraceptive
  3. Other common adverse effects
    1. Nausea
    2. Breast tenderness
    3. Headaches
  1. Medications that reduce Norgestrel levels and contraceptive efficacy
    1. St Johns Wort
    2. HIV Medications (e.g. Efavirenz)
    3. Antiepileptic Medications
  • Efficacy
  1. High failure rate compared with combination pills
    1. Consider more effective Progesterone-only options (Mirena IUD, Nexplanon Contraceptive Implant)
  2. Better efficacy then barrier methods
  3. Failure rates
    1. Perfect use: 0.5 to 2% failure rate
    2. Typical use: 5 to 9% failure rate
  • References
  1. (2024) Presc Lett 31(1): 1
  2. Torro (2024) Am Fam Physician 109(1): 90-1 [PubMed]