ProgestinOnly Pills POPs Session I Characteristics of POPs

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Progestin-Only Pills (POPs) Session I: Characteristics of POPs Session I, Slide 1

Progestin-Only Pills (POPs) Session I: Characteristics of POPs Session I, Slide 1

Progestin-Only Pills Objectives Participants will be able to: • List key messages for POPs

Progestin-Only Pills Objectives Participants will be able to: • List key messages for POPs • Describe the characteristics of POPs in a manner that clients can understand: a. What POPs are and how they work (mechanism and onset of action) b. Effectiveness c. General characteristics, especially as compared to combined oral contraceptive pills d. Health Benefits e. Possible side effects f. Relationship to breastfeeding Session I, Slide 2

Progestin-Only Pills Objectives Participants will be able to: • Demonstrate how to screen clients

Progestin-Only Pills Objectives Participants will be able to: • Demonstrate how to screen clients for eligibility for POP use • Describe when to start POPs • Explain how to use POPs, what to do when pills are missed, and when to return • Address common concerns, misconceptions, and myths • Explain how to manage side effects • Identify clients in need of referral to a higher-level health care provider for POP-related complications • Identify conditions that require switching to another method Session I, Slide 3

POPs Key Points for Providers and Clients Very safe. Take a pill at the

POPs Key Points for Providers and Clients Very safe. Take a pill at the same time every day. Good method while breastfeeding • Pills are not harmful for most women’s health. • They do not cause any serious health problems, cancer, or infertility or large changes in blood pressure. • Contains only progestin (sometimes called progestogen) hormones. Okay for women who cannot take estrogen. • Works mainly by thickening cervical mucus and also by stopping ovulation • “Would you remember to take a pill at the same time each day? ” • No need to do anything at time of sexual intercourse. • No break between packs. • For breastfeeding women, they do not affect the quality or quantity of breastmilk. They are not harmful to the baby’s health and do not affect infant growth. • Very effective if taken every day at the same time, especially combined with breastfeeding. But if woman forgets pills, even if she is breastfeeding, she may become pregnant. Session I, Slide 4

POPs Key Points for Providers and Clients Bleeding changes are common but not harmful.

POPs Key Points for Providers and Clients Bleeding changes are common but not harmful. No protection against STIs or HIV/AIDS. Can be given to a woman at any time to start later • Typically pills lengthen how long breastfeeding women have no monthly bleeding • For women having monthly bleeding, frequent or irregular bleeding is common • Side-effects often go away after first 3 months. • For STI/HIV/AIDS protection, also use condoms. • If pregnancy cannot be ruled out, a provider can give her pills to take later when her monthly bleeding begins. Session I, Slide 5

What Are POPs? Content and Types Content Types Only one hormone, progestin. Do NOT

What Are POPs? Content and Types Content Types Only one hormone, progestin. Do NOT contain estrogen. Sometimes called the “mini-pill” Common: norethistrone (norethindrone), levonorgestrel, desogestrel, Less Common: etynodial diacetate, lynestrenol Have similar effectiveness, safety, characteristics, and eligibility criteria Pills per pack 28: all active pills 35: all active pills (no break between packs) Session I, Slide 6

POPs: Mechanism of Action Suppresses hormones responsible for ovulation Thickens cervical mucus to block

POPs: Mechanism of Action Suppresses hormones responsible for ovulation Thickens cervical mucus to block sperm POPs have no effect on an existing pregnancy. Session I, Slide 7

Effectiveness of POPs In this progression of effectiveness, where would you place combined oral

Effectiveness of POPs In this progression of effectiveness, where would you place combined oral contraceptives (POPs)? More effective Implants Male Sterilization Female Sterilization Intrauterine Devices Progestin-Only Injectables Combined Oral Contraceptives Male Condoms POPs (breastfeeding) POPs (not breastfeeding) Standard Days Method Less effective Female Condoms Spermicides Session I, Slide 8

Relative Effectiveness of FP Methods Method # of unintended pregnancies among 1, 000 women

Relative Effectiveness of FP Methods Method # of unintended pregnancies among 1, 000 women in 1 st year of typical use No method 850 Withdrawal 220 Female condom 210 Male condom 180 Pill (COCs and POPs) Injectable IUD (CU-T 380 A / LNG-IUS) Female sterilization 80 (COCs) 70 (POPs alone) 10 (POPs and breastfeeding) 60 8/2 5 Vasectomy 1. 5 Implant 0. 5 Source: Trussell J. , Contraceptive Failure in the United States, Contraception 83 (2011) 397 - 404, Session I, Slide 9 Elsevier Inc. with POP+BF addition from Family Planning: A Global Handbook for Providers

POPs: Characteristics • Require taking one pill, every day, with no break between packs,

POPs: Characteristics • Require taking one pill, every day, with no break between packs, and at the same time every day, especially if not breastfeeding • Very effective when used correctly, especially for breastfeeding women • Safe for breastfeeding women and their babies • Bleeding changes are common but not harmful. • Can be stopped at any time • No delay in return to fertility • Controlled by the woman • Do not interfere with sex • Very few health risks • Do not provide protection from STIs/HIV • Have some potential side effects Source: Hatcher, 2011; WHO, 2010; CCP and WHO, 2018; Trussell , 2011. Session I, Slide 10

Breastfeeding and POPs: POPs have no effect on: • Onset or duration of lactation

Breastfeeding and POPs: POPs have no effect on: • Onset or duration of lactation • Quantity or quality of breast milk • Health and development of infant POPs can be taken immediately after delivery by both breastfeeding and non-breastfeeding women. Source: CCP and WHO 2018; Session I, Slide 11

POPs vs. COCs: Advantages • All pills the same-no pill color changes or days

POPs vs. COCs: Advantages • All pills the same-no pill color changes or days without pill taking • May be taken by women who cannot use estrogen • May by taken by breastfeeding women • Lower risk of complications such as stroke and blood clots • No impact on quality or quantity of milk for breastfeeding moms Source: Hatcher, 2011; WHO, 2010, CCP and WHO, 2018; Trussell , 2011. Session I, Slide 12

POPs vs. COCs: Disadvantages • For non-breastfeeding women: – POPs are not as effective

POPs vs. COCs: Disadvantages • For non-breastfeeding women: – POPs are not as effective as COCs and other hormonal methods – More likely to have menstrual bleeding changes (irregular, more frequent, or heavier bleeding) than women on COCs – More likely to develop ovarian follicles than on COCs, though these usually go away on their own. • Both need to be taken every day, but it is more important to take POPs at exactly the same time each day, especially for non-breastfeeding women. • POPs do not increase the risk of ovarian and endometrial cancers but not reduce the risk. COCs reduce the risk of ovarian and endometrial cancers. Source: Hatcher, 2011; WHO, 2010; CCP and WHO, 2018; Trussell , 2011. Session I, Slide 13

Possible Side-Effects If a woman chooses this method, she may have some sideeffects. They

Possible Side-Effects If a woman chooses this method, she may have some sideeffects. They are not usually signs of illness. • Many women do not have any side-effects. • Side-effects often go away after a few months and are not harmful. • Common (when not breastfeeding): irregular bleeding or spotting (bleeding at unexpected times), heavy or prolonged bleeding (twice as much as usual or longer than 8 days), no monthly bleeding • Less common: nausea, headache, tender breasts, dizziness, abdominal pain Session I, Slide 14