The progestin-only birth control pill, aka the mini-pill, is an estrogen-free form of hormonal contraception. It’s often recommended for people who are breastfeeding or who can’t take estrogen because of other health issues. However, it’s slightly less effective than other types of hormonal birth control, and requires very precise usage to protect you from pregnancy.
IN THIS ARTICLE
- What is the mini-pill?
- How does the mini-pill work?
- How effective is the mini-pill for birth control?
- What are the pros and cons of the mini-pill?
- What are the side effects of the mini-pill?
- Can I get pregnant on the mini-pill?
- When can I take the mini-pill?
- What will happen if I skip a pill?
What is the mini-pill?
The progestin-only birth control pill, commonly called the mini-pill, is an oral contraceptive. Each pill contains a small amount of progestin, the synthetic form of the hormone progesterone. The pills come in packs of 28, and you take one pill every day so that you’re getting a steady dose of the hormone.
Unlike combination birth control pills (the Pill), the mini-pill doesn’t have any estrogen, just progestin. (Some types of mini-pill don’t come with a placebo week of pills, either.) The mini-pill is a good alternative for women who want to use oral contraceptives but who are breastfeeding or can’t take estrogen for some other reason.
How does the mini-pill work?
Progestin-only pills prevent pregnancy in a few different ways. The progestin in the mini-pill thickens the mucus in your cervix, making it hard for your sperm to get through to fertilize an egg. It also thins the lining of your uterus, making it less likely that an egg would implant there even if one did get fertilized. In some people – about 60 percent of users – the mini-pill will also stop ovulation.
Once you take a mini-pill, the progestin’s effect on your body lasts only about 24 hours. That’s why you have to be so careful about taking the mini-pill at the same time every day.
How effective is the mini-pill for birth control?
If you take the mini-pill at the exact same time every single day – what’s known as “perfect use” – it’s about 99 percent effective at preventing pregnancy. With typical use, meaning that you may make some mistakes like skipping a pill or not taking it at the exact same time every day, its effectiveness drops to 91 to 93 percent. (This is comparable to the combined hormonal birth control pill.)
If you’re exclusively nursing your baby (meaning that your baby is taking in no formula or solid food), still haven’t had a period, and are taking the mini-pill as directed, it’s nearly 100 percent effective during the first six months after giving birth.
That said, if you don’t take the mini-pill exactly as prescribed, the risk that you’ll get pregnant is much higher – as much as 13 in 100 – especially if you’re not breastfeeding. So, while the mini-pill is a reliable method of birth control for people who never miss any pills and follow the instructions to the letter, it’s not the best method for everyone.
Some meds and supplements might also affect how well the mini-pill works. If you take rifampin (which is used to treat infections like tuberculosis), certain anti-seizure meds, or drugs to treat HIV, talk to your doctor about other options.
What are the pros and cons of the mini-pill?
As with any type of medication, there are absolutely some benefits and downsides to the progestin-only pill. Understanding them can help you better evaluate whether it’s the right choice of birth control for you.
There are quite a few pros. Unlike the combination pill, progestin-only pills are considered compatible with breastfeeding right after birth by a host of organizations, including the Centers for Disease Control. Only small amounts of progestin pass into your breast milk, and research to date shows no adverse effects from progestin-only birth control on a baby’s weight gain, health, or development.
Unlike combined hormonal contraceptive pills, the mini-pill also doesn’t increase your risk of high blood pressure, making it a safer choice for people who have cardiovascular conditions like deep vein thrombosis (DVT). Its lack of estrogen also makes it a good choice for people who get worse migraines or higher blood pressure from combination birth control pills.
As with other forms of hormonal birth control, the progestin-only pill might also make your periods lighter or stop them altogether.
However, the mini-pill must be taken at the exact same time every day for maximum efficacy – which might be hard for some people to keep up with. If you think you’ll have trouble taking the mini-pill properly, consider using another method, such as the IUD or the birth control shot (Depo-Provera), both of which are very effective and compatible with breastfeeding.
Certain health conditions are not compatible with the progestin-only pill. If you have lupus, liver disease, or breast cancer, you should not take the mini-pill and instead look for a different form of contraception. It also comes with some side effects, which you’ll read more about below. And it’s important to remember that the mini-pill, like other forms of hormonal birth control, does not protect you from sexually-transmitted infections or HIV.
What are the side effects of the mini-pill?
The most common side effect of the mini-pill is unpredictable light vaginal bleeding or spotting. This is even more common if you miss a pill or take your pills late. Your periods could also become irregular or stop altogether. A small percentage of women on the mini-pill have prolonged or heavy menstrual bleeding.
Breastfeeding women are less likely to have frequent or prolonged bleeding on the mini-pill. If you’re breastfeeding, you’re not likely to have regular periods for many months after giving birth. And taking the mini-pill might delay the return of your period even longer.
Less commonly, the mini-pill can cause headaches, breast tenderness, and nausea. More rare side effects include weight gain, mood changes, acne, and extra face and body hair.
Can I get pregnant on the mini-pill?
Yes. Even when taken perfectly, there is still a one in 100 chance that you can get pregnant. That chance can get as high as 13 in 100 if you frequently forget to take your pill on time, or miss taking it altogether.
If you decide that you want to try getting pregnant, all you have to do to reverse the effects of the mini-pill is to stop using it. Consider yourself fertile 24 hours after you take your last pill.
When can I take the mini-pill?
You can start taking the mini-pill right after delivery whether you’re breastfeeding, formula-feeding, or doing some combination of the two. If you’re exclusively breastfeeding (meaning your baby is drinking no formula, only breast milk), some doctors may ask you to wait six weeks after delivery to start the mini-pill. By that time, your milk supply should be well established.
If you decide to wait longer to start the mini-pill, you can start anytime you want, as long as you’re sure you’re not pregnant – that is, if you haven’t had sex at all since delivery or your last period, or if you’ve been consistently and correctly using another method of contraception. If you’ve started menstruating again, you can be sure you’re not pregnant by starting the mini-pill on the day you get your next period.
If you’re menstruating and you start the mini-pill on the first day of your period, you don’t need to use a backup method. If you start at any other time during your menstrual cycle you will need to use a backup method, such as condoms, at the outset. Some experts recommend using a backup method for the first 48 hours after starting the mini-pill, while others suggest using a backup for seven days.
As mentioned, it’s extremely important that you take your pill at the same time each day and never miss a pill. If you take your pill just three hours late, you’ll need to abstain from sex or use a backup method during the next 48 hours. (So set a regular alarm on your phone or other smart device to keep you accountable.)
When you’ve taken all the pills in the pack, you start a new pack of pills on the very next day. Unlike combination birth control pills, some types of mini-pill don’t have any “placebo” pills, meaning you need to take one every single day without a break if you want to stay protected from pregnancy.
You may not get your period when you’re taking the mini-pill or you may have irregular bleeding or spotting, but you still take a pill every day, whether you’re bleeding or not.
What will happen if I skip a pill?
Missing a pill or taking it incorrectly could result in pregnancy. If you miss taking a pill by three hours or more, take it as soon as you remember. Then keep taking one pill each day as usual. You’ll need to abstain from sex or use a backup method of contraception for the next 48 hours after you take the missed pill.
If you get sick with severe vomiting or diarrhea, your pill might not be absorbed properly. Count this as a missed pill. Keep taking your pills as normal but use a backup form of protection until two days after your vomiting or diarrhea stops.
If you feel at all confused about what to do, don’t hesitate to call your healthcare provider or the clinic that prescribed your pills. In the meantime, continue taking a pill each day and use backup contraception as well. If you suspect that you’re pregnant, call your provider.
Note: If you had unprotected sex before you were back on the mini-pill for 48 hours, using emergency contraception (such as Plan B) will reduce your risk of becoming pregnant. It can be used up to five days after unprotected sex, but it’s most effective if used in the first three days.
Unless you already have emergency contraceptive pills on hand, go to a pharmacy without delay – you can get some forms of emergency contraception without a prescription at any age.
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