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6.0 Progestin - only pill

6.1 Method

It is also known as minipill. It contains a small dose of progestational agent and must be taken every day at fixed time in a continous fashion.

6.2 Mechanism of action

With minipill, blood level of progestin is approximately 25% of that after COC consumption. This low level of progestin in circulation produces impact only on tissues which are very sensitive to female sex steroids. With minipill the gonadotrophins are not consistently suppressed, thus, contraceptive effect is more dependent upon endometrial and cervical mucus effects.

the endometrium involutes and becomes hostile to implantation

the cervical mucus becomes thick and impermeable to sperms

anovulation occurs in 60% of women on mini pill; the remaining ovulate normally.

tubal physiology may be affected

6.3 Advantages

can be used in nursing mothers 6 weeks after childbirth

women take one pill every day with no break, which is easier to understand than taking 21 day combined pill and then a break of 7 days

no estrogenic side-effects

less progestin related side-effects e.g. acne, and weight-gain

helps to prevent benign breast disease, PID, endometrial and ovarian cancer

6.4 Disadvantages

strict patient compliance is required

menstrual irregularity or amenorrhoea

may cause headache and breast tenderness

6.6 Contraindications

breast-feeding mother less than 6 weeks post-partum.

current deep vein thrombosis/ pulmonary embolism

current or past history of breast cancer

active viral hepatitis and liver tumours

patient on drugs likely to affect metabolism of the drug

6.6 Drug Inter-actions

Relatively lower dose of progestin administered in minipill, warrants against its use in patients on medications that increase liver metabolism. These drugs include :

- Rifampicin

- Phenobarbitone

- Phenytoin

- Primidone

- Carbamazepine

- Ethosuximide

- Griseofulvin

- Troglitazone

Intrauterine device (IUD) is a small, flexible plastic frame to be inserted into the uterine cavity.

6.7 Instructions to the client

it should be started on the first day of menses and back-up method must be used for 7 days.

the pill should be taken at the same time every day.

if the pill is forgotten or gastro-intestinal illness impairs absorption, the minipill should be resumed as soon as possible and a back-up method should be used immediately and until the pill has been resumed for at least 2 days.

if more than 3 hours late in pill taking, a back-up method should be used for 48 hours.

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