Different POPs contain different types of progestogen.

A POP can be:

• A traditional POP, with either the progestogen levonorgestrel or the progestogen norethisterone
• A POP with the progestogen desogestrel
• A POP with the progestogen drospirenone

If you’re not sure which progestogen is in your POP, check the leaflet inside your pack or ask your healthcare professional or online provider.

If 100 people who could get pregnant don’t use any contraception, 80 to 90 of them will get pregnant in a year.

If the POP is not always used perfectly, according to instructions, it’s about 93% effective. This means about 7 in 100 POP users will get pregnant in 1 year. Most POP users don’t take it perfectly all the time.

If the POP is always used perfectly, it’s over 99% effective.This means that fewer than 1 in 100 POP users will get pregnant in 1 year.

The most effective methods of contraception are those you don’t have to remember, such as the implant, the hormonal IUD or the copper IUD (coil). These are called long-acting reversible contraceptives (LARC). For more information, ask your healthcare professional or see LARC: The FPA Guide.

POPs work in a few ways:

• Desogestrel and drospirenone POPs stop your ovaries releasing an egg each month (ovulation). Most people using a traditional POP will still ovulate.
• All POPs thicken the mucus in your cervix (entrance to the womb).This makes it difficult for sperm to move through it and reach an egg. This is the main way traditional POPs work.
• All POPs make your uterus (womb) lining thinner so a fertilised egg is less likely to implant.

You can get the POP for free from:

• a contraception or sexual health clinic
• most GP surgeries
• some young people’s services
• many pharmacies

In some areas of the UK, you can order the POP for free from an online sexual health service. They can send it by post and may offer a click and collect service. You usually need to be 16 or over.

All advice and treatment from these services is free and confidential.

You can buy:

• desogestrel POPs from a pharmacy without a prescription. The pharmacist will have a short, confidential consultation with you.
• all types of POP from some online pharmacies, private online services and private clinics.

You don’t need a vaginal or breast examination or cervical screening (smear) test before you start using the POP.

Most people who need contraception can use the POP.

Your healthcare professional or online service will ask about your own and your family’s medical history. This is to make sure the POP is OK for you. Do mention any allergies, illnesses or operations you’ve had and any medicines you’re taking.

The POP may not be suitable for you if:

• you think you might be pregnant
• you take certain medicines – also see below –  will other medicines affect the POP?
• you’ve had weight-loss surgery
• you have a condition that causes malabsorption issues (where your gut can’t absorb nutrients effectively) such as Crohn’s disease.

It may not be suitable if you have, or had in the past:

• breast cancer
• heart disease or a stroke
• serious liver disease
• meningioma (a type of brain tumour).

In addition, a drospirenone POP may not be suitable if you:

• have serious kidney disease
• are being treated for Addison’s disease or for high potassium (hyperkalaemia), or you have risk factors for hyperkalaemia
• take potassium supplements.

Before using a drospirenone POP, some people may need tests to check for risks of kidney disease, particularly if you’re aged over 50.

If you’re healthy and there are no medical reasons for you not to use a POP, you can use it until your menopause or until you’re aged 55.

You do not need to use contraception after age 55, even if you’re still having some periods.

Some of the advantages of the POP are:

• The POP is useful if you can’t take oestrogens, like those found in the combined pill, contraceptive patch or contraceptive vaginal ring
• You can use the POP if you smoke and are aged 35 or over
• Some people may find it improves heavy or painful periods or premenstrual symptoms (PMS)
• You can use it if you’re breastfeeding

Some disadvantages of the POP are:

• Your bleeding pattern may change in a way that’s not acceptable to you – also see Will my periods change?
• You may get side effects when you first start taking the POP, such as spotty skin, breast tenderness, mood changes and headaches. These may stop within a few months
• You have to remember to take the POP at the same time every day
• The POP doesn’t protect you from sexually transmitted infections, so you may want to use condoms too

The POP is a very safe pill to take.

• Research on the risk of breast cancer and hormonal contraception use is complicated and hasn’t given definite answers. The available research suggests that use of any hormonal contraception (including the POP) does slightly increase breast cancer risk among current and recent users, but the risk remains small.
• Available evidence suggests that the POP doesn’t increase the risk of ovarian cancer or endometrial cancer.
• The desogestrel POP may slightly increase the very low risk of having a rare type of tumour in the brain called meningioma. Meningioma is almost always benign (not cancer) but sometimes needs an operation to remove it.

You can start the POP any time in your menstrual cycle if you’re sure you’re not pregnant.

If you start the traditional or desogestrel POP:

• On the first day of your period, you’ll be protected from pregnancy straight away
• Up to and including the fifth day of your period, you’ll usually be protected from pregnancy straight away. If you have a very short cycle or a cycle that changes, ask your healthcare professional or online provider about using additional contraception for the first 2 days
• At any other time, use condoms or avoid sex for the first 2 days of pill-taking

If you start the drospirenone POP:

• On the first day of your period, you’ll be protected from pregnancy straight away
• At any other time, use condoms or avoid sex for the first 7 days of pill-taking

When taking your first pill, choose a time of day that suits you.

Take 1 POP each day at the same time until you finish all the pills in the pack.

• Traditional and desogestrel POPs have 28 active pills in each pack. They can be taken in any order as all the pills are the same.
• Drospirenone POPs have 24 active pills (with hormone) and 4 hormone-free placebo pills in each pack. It’s important to take the pills in the right order. You take 1 active pill every day for 24 days, then 1 hormone-free pill every day for 4 days.

For all POPs, once you finish a pack, start a new pack the next day with no break between packs.

For the POP to work, it’s important to take it:

• no more than 3 hours after your chosen time for traditional POPs
• no more than 12 hours after your chosen time for desogestrel POPs
• no more than 24 hours after your chosen time for drospirenone POPs

If you remember later than this, you’ve missed a pill. Also see:

• What if I miss a traditional pill?
• What if I miss a desogestrel pill?
• What if I miss a drospirenone pill?

If you vomit within 2 hours of taking a traditional POP or within 3 to 4 hours of taking a desogestrel or an active drospirenone POP, it may not be absorbed.

• Take a replacement pill as soon as you feel well enough
• If you take the replacement pill within 3 hours (traditional POP), 12 hours (desogestrel POP) or 24 hours (drospirenone POP) of your usual pill-taking time and you’re not sick again after taking it, you’ll still be protected from pregnancy. Take your next pill at the normal time
• If you take the replacement pill 3 or more hours (traditional POP), 12 or more hours (desogestrel POP) or 24 or more hours (drospirenone POP) after your usual pill-taking time then you’ve missed a pill. See below
• If you’re sick after taking your replacement pill, get advice from a doctor, nurse or pharmacist

If you have very severe diarrhoea, this may make the POP less effective. Keep taking your pill as usual but treat each day that you have severe diarrhoea as if you’d missed a pill. Also see:

• What if I miss a traditional pill?
• What if I miss a desogestrel pill?
• What if I miss a drospirenone pill?

If you’re less than 3 hours late:

• Take a pill as soon as you remember
• Take your next pill at the usual time
• You’re still protected from pregnancy

If you’re 3 or more hours late:

• Take a pill as soon as you remember. If you’ve missed more than 1, only take 1 pill
• Take your next pill at the usual time. This may mean taking 2 pills in 1 day. This isn’t harmful
• You’re not protected from pregnancy. Continue to take your pills as usual but use condoms for 2 days (48 hours) after restarting your pill.

And:

• If you have unprotected sex from the time you missed a pill until you’ve taken the pill correctly for 48 hours, you may need emergency contraception. Get advice from a doctor, nurse or pharmacist straight away
• Consider doing a pregnancy test 21 days after you last had unprotected sex

If you’re less than 12 hours late:

• Take a pill as soon as you remember
• Take your next pill at the usual time
• You’re still protected from pregnancy

If you’re 12 or more hours late:

• Take a pill as soon as you remember. If you’ve missed more than 1, only take 1 pill
• Take your next pill at the usual time. This may mean taking 2 pills in 1 day. This isn’t harmful
• You’re not protected from pregnancy. Continue to take your pills as usual but use condoms for 2 days (48 hours) after restarting your pill.

And:

• If you have unprotected sex from the time you missed a pill until you’ve taken the pill correctly for 48 hours, you may need emergency contraception. Get advice from a doctor, nurse or pharmacist straight away
• Consider doing a pregnancy test 21 days after you last had unprotected sex

If you’re less than 24 hours late:

• Take a pill as soon as you remember
• Take your next pill at the usual time
• You’re still protected from pregnancy

If you’re 24 or more hours late taking a pill or starting a new pack:

• Take a pill as soon as you remember. If you’ve missed more than 1, only take 1 pill
• Take your next pill at the usual time. This may mean taking 2 pills in 1 day. This isn’t harmful
• If you missed an active pill, you’re not protected from pregnancy. Continue to take your pills as usual but use condoms for 7 days after restarting your pill
• If you missed any of the last 7 active pills in the pack, finish the active pills as usual but don’t take the 4 hormone-free (placebo) pills. Start a new pack of pills as soon as you’ve finished the active pills. Put the 4 unused hormone-free pills in the bin

And:

• If you have unprotected sex from the time you missed an active pill until you’ve taken the pill correctly for 7 days, you may need emergency contraception. Get advice from a doctor, nurse or pharmacist
• If you missed 1 or more of the first 7 active pills in the pack and you had unprotected sex during this week and/or during the previous 4 days of hormone-free pill-taking, you may need emergency contraception. Get advice from a doctor, nurse or pharmacist

And:

• Consider doing a pregnancy test 21 days after you last had unprotected sex

Some medicines may make all types of POP less effective at preventing pregnancy, including:

• Medicines called enzyme-inducers. This includes some medicines used to treat epilepsy, migraine, HIV and TB
• The herbal medicine St John’s Wort
• Some weight-loss injection medicines (also sometimes used to treat diabetes) such as tirzepatide (Mounjaro). When starting tirzepatide, you need to use condoms as well as the POP for the first 4 weeks. You also need to use condoms as well as the POP for 4 weeks after each dose increase of tirzepatide
• An antifungal medicine called griseofulvin
• A medicine called lamotrigine, sometimes used to treat bipolar disorder or epilepsy

If you take any medicines that may make the POP less effective, talk to your healthcare professional. Consider changing to a contraception method that won’t be affected by the medicines you’re taking.

There are some medicines that should not be taken at the same time as using the drospirenone POP. These are:

• medicines called potassium-sparing diuretic
• potassium supplements

Always check with a healthcare professional before starting any new medicines, herbal remedies, or supplements.

If you’re given medicine by a healthcare professional, always tell them you’re using the POP.

The POP is not affected by commonly used antibiotics.

Your bleeding may change while you’re taking the POP. It’s common for it to be irregular and unpredictable.

Bleeding may be lighter and/or shorter, regular or irregular, and happen less often or more often than usual.

A few POP users will have bleeding that lasts longer than usual.

Sometimes bleeding stops completely while using the POP.

When you use a drospirenone POP:

• You may or may not get a bleed during the 4 days you take the hormone-free placebo pills.
• You may or may not get bleeding on days you’re taking the active pills.
• The total number of days bleeding or spotting is similar to people using a desogestrel POP.

These changes may be a nuisance but may settle down.

If you have any bleeding that’s a problem for you, talk to your healthcare professional. Changing to a different POP may help.

The POP can be started any time after the birth.

If you start the POP before day 21 after the birth, you’ll be protected from pregnancy straight away.

If you start the POP on or after day 21, use condoms or avoid sex for:

• the first 2 days of taking a traditional or desogestrel POP
• the first 7 days of taking a drospirenone POP.

It’s safe to breastfeed while you’re using the POP.

You can start using the POP straight after a miscarriage or abortion.

• If you start the traditional or desogestrel POP on or before day 5, you’ll be protected from pregnancy straight away. If you start later than day 5, use condoms or avoid sex for the first 2 days
• If you start the drospirenone POP on day 1 (the first day after the miscarriage or abortion) you’ll be protected from pregnancy straight away. If you start later than day 1, use condoms or avoid sex for the first 7 days

It’s easy to change from one POP to another, or to change to or from a different contraception method.

Talk to your healthcare professional about how to change methods, as you may need to use condoms or other contraception for a short time.

If you’ve taken all your pills correctly, haven’t been sick or had diarrhoea, and haven’t taken any medicines which might affect the POP, it’s unlikely you’re pregnant.

Keep taking your pills as normal. If you’re worried, ask your healthcare professional for advice or do a pregnancy test. Taking the POP doesn’t affect a pregnancy test. If you are pregnant, taking the POP won’t end the pregnancy and won’t harm the fetus.

The risk of having an ectopic pregnancy (where the pregnancy develops outside your uterus (womb), usually in a fallopian tube) is less in POP users than in people using no contraception at all.

If you have any signs of an ectopic pregnancy – such as a sudden or unusual pain low in your tummy – or if you think you might be pregnant, get medical advice from your GP or NHS 111 as soon as possible.

You can stop taking the POP at any time.

Your periods and fertility will go back to what’s normal for you straight after stopping the POP. It’s possible to get pregnant before having your first period after stopping.

If you don’t want to get pregnant, use another method of contraception as soon as you stop using the POP.

If you want to get pregnant, aim to start pre-pregnancy care – such as taking folic acid and vitamin D and stopping smoking and drinking alcohol – before you stop using the POP. Ask your healthcare professional for advice or see tommys.org/pregnancy-information

You can try to get pregnant as soon as you stop using the POP if you want to. You can also choose to wait until you’ve had one period after stopping the POP. This can make it easier to work out when you got pregnant.

When you first start the POP, you can be given up to 12 months’ supply, but some POP users may need a review earlier than this.

When you start the POP or get new supplies, you’ll be advised when to get your next review and new supply of POP.

A review may need to be done face-to-face for some people but can often be done online or by phone.

Contact your healthcare professional or online provider if you have any problems or concerns before your next review is due.

If you’ve had sex without contraception, or think your method might have failed, you can use emergency contraception.

Try to get emergency contraception as soon as possible after unprotected sex to give it the best chance of working.

A copper intrauterine device (IUD) is the most effective option. Some people will get pregnant even when they take emergency pills correctly.

• An emergency IUD (copper coil) can be fitted up to 5 days after sex, or up to 5 days after the earliest time you could have ovulated (released an egg).

• An emergency contraceptive pill with the active ingredient ulipristal acetate (UPA) can be taken up to 5 days (120 hours) after sex. UPA is not recommended when POP has been taken in the last 7 days because the POP could make the UPA pill less effective. POP should also not be taken for 5 days after taking a UPA pill.

• An emergency contraceptive pill with the hormone levonorgestrel can be taken up to 3 days (72 hours) after sex.

Emergency pills are available for free from sexual health clinics, GP surgeries and many pharmacies, or you can buy them from most pharmacies.

For more details see the FPA guide to Emergency Contraception here.