Advantages and disadvantages of progestogen-only contraceptive pills

Advantages and disadvantages of POPs are listed in Advantages and disadvantages of progestogen-only contraceptive pills (POPs). Also consider other factors affecting choice of contraceptive method.

Table 1. Advantages and disadvantages of progestogen-only contraceptive pills (POPs)

Advantages

very effective (93% with typical use; 99.5% with perfect use)

suitable for Quick Start

safe to use immediately postpartum and during breastfeeding

few contraindications and precautions, and few serious risks associated with use; may be an alternative if estrogen is contraindicated

no adverse effect on bone mineral density, so can be used first line in adolescents and perimenopausal individuals

no delay in return to fertility after stopping

available on the PBS

Disadvantages

POPs containing levonorgestrel or norethisterone have a maximum pill interval of 27 hours, and are less effective in people with higher background fertility (those younger than 25 years) [NB1]

altered bleeding patterns

low continuation rate of levonorgestrel or norethisterone POPs (around 40% at 1 year in studies); data on real-life continuation rates of drospirenone POPs are limited

lack of noncontraceptive benefits for levonorgestrel or norethisterone POPs; the drospirenone POP appears to be helpful for dysmenorrhoea, and to increase the likelihood of amenorrhoea compared to levonorgestrel and norethisterone POPs

drug interactions

around 10% of pregnancies occurring in users of levonorgestrel of norethisterone POPs are ectopic; ectopic pregnancy is likely to be less common in users of the drospirenone POP (because it consistently suppresses ovulation)

other adverse effects [NB2]:

  • headaches
  • mood changes [NB3]
  • weight gain
  • breast tenderness
  • loss of libido
  • acne
Note:

PBS = Pharmaceutical Benefits Scheme; POP = progestogen-only pill

NB1: The maximum interval between drospirenone POPs is 48 hours (the same timing as applies to combined oral contraceptives).

NB2: These adverse effects have been reported by users of all forms of progestogen-only contraception, but evidence is insufficient to prove a causal effect. Many resolve within 3 months of starting the contraceptive.

NB3: An association between first prescription of an antidepressant and contraceptive use has been seen, but a causal link is not proven.