The mini pill

What is the mini pill?

The minipill is a medicine used to prevent unwanted pregnancy for women. They are also known as contraceptives. In contrast to the combination pill, the conventional "anti-baby pill", the minipill is a pure progestin preparation, so the minipill does not contain any estrogen. The minipill is recommended for women who do not tolerate preparations containing estrogen; there are also other indications for the choice of this hormonal contraceptive.

Active ingredient and effect

There are already several generations of the mini pill, all of which are characterized by the lack of estrogen. They differ in their progestin derivative.

The most commonly used preparations are minipills with levonorgestrel or the newer desogestrel preparations. Levonorgestrel works by changing the lining of the womb. As a result, a fertilized egg cannot implant itself in the mucous membrane.
Levonorgestrel also thickens the mucus in the cervix, which prevents sperm from entering the uterus and prevents fertilization.

Desogestrel also prevents ovulation, known as ovulation. Preparations with levonorgestrel must be taken at exactly the same time every day so that contraception protection exists.

Levonorgestrel is also found in high doses in the morning-after pill, an emergency contraceptive for unprotected sexual intercourse or breakdowns in contraception.

Differences between mini-pill and "normal pill"

The conventional birth control pill or simply “pill” is also a hormonal contraceptive.
In contrast to the minipill, however, the active ingredient is a combination of the hormones estrogen and progestin. The minipill and its representatives, on the other hand, only contain the hormone progestin.

The minipill has a lower dose and, as an estrogen-free variant, is particularly recommended for women who do not tolerate combination preparations. However, side effects can also occur when using the minipill.

The mini pill must be taken at the same time every day if possible to guarantee full safety. This is especially true for the minipill with the progestin levonorgestrel.
The contraceptive safety of the mini pill is high and can be compared with that of the conventional combination pill.

The minipill is also recommended for women who have an increased risk of thrombosis, such as smokers. Breastfeeding mothers can also use the mini pill.

Read more on this topic: Hormonal birth control methods.

Benefits of the mini pill

The mini pill is an alternative for women who do not tolerate the estrogen-containing combination pills well.
As a rule, the minipill is better tolerated, but side effects can also occur when taking the minipill.

The mini pill is also considered to be relatively safe during breastfeeding. The production of breast milk is not influenced by estrogen-free preparations such as the minipill, and only a small part of the active ingredient is passed into breast milk.

The minipill is also recommended for women who have an increased risk of thrombosis. If taken reliably without delay, the contraceptive protection of the mini pill is comparable to that of the combination pills.
It is also taken continuously.

Many women also report reduced or absent menstrual bleeding. This effect can level off after a few months, at the beginning menstrual disorders are more likely.

Disadvantages of the mini pill

There have been several generations of the mini pill. The minipill with the progestin levonorgestrel in particular does not tolerate any shift in intake. In order to guarantee adequate contraception protection, this mini pill must be taken at exactly the same time every day.

The mini-pill with desogestrel has a tolerance of a maximum of twelve hours. The minipill demands a high level of discipline from its users.

The minipill can also have side effects. Spotting and intermenstrual bleeding can occur, as well as delayed menstrual bleeding.
Headache, acne, nausea and vomiting, dizziness, depressive mood and loss of libido also occur as common side effects. Weight gains can occur.

Although the risk of thrombosis is lower than with conventional preparations, it is still increased when taking the minipill.

This article might also interest you:Thrombosis while taking the pill.

Indications for the mini pill

The minipill is recommended for women who experience significant side effects from taking combination pills.

An intolerance to estrogen manifests itself, for example, by weight gain, mood swings up to a depressive mood, loss of libido, migraines, headaches, nausea or breast tenderness.

The minipill is also recommended for women with a high risk of thrombosis or for breastfeeding mothers who want to use hormonal contraception.

Side effects

As with any medicine, taking the minipill can be associated with side effects that not every user experience.

Although the doses of the active ingredients are lower than that of the combination pill, side effects may occur that make it necessary to discontinue or change the contraceptive.

Common side effects of the minipill include irregular menstrual bleeding, spotting or intermenstrual bleeding. The following are also frequently observed:
-Acne
- nausea, vomiting
-A headache
- breast tenderness, sexual aversion (Read about it too: Pain in the nipple)
-Dizziness
- Nervousness or depressed mood
-Weight gain.

In rare cases, skin changes such as hair loss, rashes or pigment spots occur.
You can read more about this topic here: Pigmentation disorders from taking the pill.

The user should be fully informed about possible side effects and consult her doctor or pharmacist if one or more side effects occur to a severe extent. In this case, a change of contraception may be indicated.

thrombosis

In general, the risk of thrombosis is increased for every woman who takes hormonal contraceptives. As a rule, however, the risk of thrombosis is estimated to be lower for the minipill than for the combination pill.

Women who smoke, are overweight or have a family history of thrombosis should seek detailed advice on contraception protection. At the slightest sign of thrombosis, therapy with the contraceptive must be discontinued and a doctor should be consulted.
Indications of a possible thrombosis are overheating and thickening of the extremities, tense pain, superficial vein markings or reddening. A deep vein thrombosis can result in life-threatening pulmonary embolism and must be treated.

Please also read our article on this Thrombosis while taking the pill.

Weight gain

A change in appetite and weight gain are considered possible side effects of the mini pill. Water retention (edema) can also lead to an increase in body weight.

It is difficult to predict how patients will react individually. Many women report that they get better when they switch to another contraceptive.

If the body weight increases or becomes overweight, the user should inform her doctor or pharmacist about the possible side effects of long-term medication.

Influencing the libido

Many women switch from the combination pill to the mini pill, as a side effect of a loss of libido, i.e. sexual displeasure, sets in.

However, libido can also be lost when taking the mini pill. To what extent the female libido is influenced by the use of a hormonal contraceptive is individual.

Sometimes it is worth changing the preparation to avoid this side effect.

Hair loss

In some cases, the minipill can lead to undesirable side effects with skin changes or hair loss.

Under certain circumstances, this can lead to diffuse alopecia, i.e. hair loss on the entire head. In the case of severe hair loss that does not normalize within three months, a change of preparation should be considered. In severe cases, a dermatologist should be consulted.

depression

In general, mood swings, depressed mood and depression are among the possible side effects of both combination preparations and the mini pill.

These are usually most pronounced at the beginning of the intake. Before changing, you should wait and see whether the symptoms go away as soon as the body has got used to the new hormonal situation.

In the case of severe depression and psychological stress, a change should be considered.

Read more about this: Causes of Depression.

Acne - Indication of the pill for acne?

In the case of acne, the use of the mini pill is not recommended.
However, there is definitely the possibility of using hormonal contraceptives for acne. Puberty is associated with a change in the body's hormonal balance. This change can be associated with acne in many teenagers. Hormonal contraceptives are sometimes used to get acne under control. The effectiveness of some hormonal contraceptives lies in their anti-androgenic effect, which leads to a reduced sebum production and an improved skin appearance.

The mini pill is not recommended for this. Acne is even considered a possible side effect of the mini pill. If acne is an indication for taking hormonal contraceptives, conventional combination products should be used. Here, the supply of estrogen has a positive effect on the complexion.

When should it not be given?

If you are hypersensitive to progestin and other substances it contains, the minipill should not be taken. The minipill should not be taken if you are already pregnant.
The minipill must not be taken if there is a thrombosis. Women with an increased risk of thrombosis or women with vascular changes, for example due to diabetes mellitus, should consult a doctor before use. Ingestion is contraindicated here.
The minipill should not be taken if you have liver disease or a liver tumor.Other malignant tumors, especially sex-hormone-dependent tumors such as breast cancer, are also considered an absolute contraindication.
If the vaginal bleeding is unexplained, the minipill must also not be taken. Women have to be very reliable in taking the minipill, because if you delay it for a few hours, contraception can no longer be guaranteed.

Pearl index

The Pearl Index is a measure of the safety of contraceptives. The lower the value, the safer the method. The Pearl indices are used to compare the safety of two contraceptives. The value of the Pearl Index corresponds to the proportion of 100 women who use a certain contraceptive for one year and still get pregnant.
However, the reliability of most contraceptive methods depends crucially on correct use. When used correctly, the minipill is considered very safe, comparable to the conventional combination pill. The Pearl Index for the minipill is 0.14 to 3. This means that 0.14 to 3 out of 100 women who use the minipill become pregnant every year. The differences are mainly due to ingestion errors, as the minipill leaves little room for maneuver and must be taken very reliably.

When is smelting security established?

If you start taking the minipill on the first day of the cycle, i.e. on the first day of your menstrual period, you are protected from pregnancy from the start of taking it.

If you start taking it later, contraception is not guaranteed for the first seven days. Additional barrier methods should be used here.

Read also: Ovulation despite the pill

Are there any without estrogen?

The minipill is a hormonal contraceptive that is basically estrogen-free. The progestin contained is either levonorgestrel or desogestrel and other new progestins.

The minipill should not be confused with the so-called micropill. This is a combination preparation, i.e. it contains a combination of estrogen and progestin. In contrast to the conventional combination pill, it contains a lower dose of estrogens, by definition less than 50 micrograms per coated tablet.

dosage

The minipill should be taken exactly according to the doctor's instructions. Usually one pill is taken a day, it is taken continuously without a break.

The pill must be taken at the same time each day, if possible, so that there are 24 hours between the pills. Even small deviations can affect the effectiveness and the safety of the minipill.

price

The price of the mini pill varies depending on the provider and the pack size. The price for a 3-month pack is around € 30.

Mini pill and alcohol

As a rule, alcohol does not remove the contraceptive pill.

Problems arise as soon as the full absorption of the active substance by the body is not guaranteed. If the consumption of alcohol causes diarrhea or vomiting, for example, the active ingredient may be removed from the body beforehand.

Increased alcohol concentration in the blood also often leads to forgetting to take it. This is associated with a high risk of unwanted pregnancy, especially with preparations containing levonorgestrel, since they must always be taken at exactly the same time.

Even when consuming alcohol, you can avoid possible contraceptive failures by using a condom.

Please also read our article on this Pill and alcohol - are they compatible?

Forget your pill once - what to do?

Even if only one tablet is taken late, the protection against conception may be impaired. The minipill with levonorgestrel, in particular, must be taken a maximum of two hours after the usual intake time.

If a tablet is forgotten, take it as soon as possible. In addition to the mini pill, other contraceptive methods should be used for the next seven days.

If you had sexual intercourse in the previous seven days before you forgot, it may have resulted in an unwanted pregnancy. In this case, contact a doctor immediately.

With the newer mini pills with the active ingredient desogestrel, the reliability of contraception is impaired as soon as the tablet is taken more than twelve hours too late. In this case, too, additional barrier methods should be used in the following seven days. Here, too, there is the possibility of having become pregnant unintentionally through sexual intercourse in the previous week.

Please also read our article on this Forgot pill - what to do?

Interactions - Which drugs make the pill stop working?

There may be interactions when taking two medicines. There are medicines that can affect the effectiveness of the minipill and make it impossible to prevent contraception. If the doctor prescribes a medication, it is essential to point out the use of hormonal contraceptives.

The following drugs can affect the effectiveness of the minipill: anti-epileptic drugs such as hydantoins, barbiturates, primidone, oxcarbazepine, topiramate, felbamate and other drugs used to treat epilepsy, drugs used to treat tuberculosis such as rifampicin.

Other antibiotics can also influence the effectiveness of the pill, for example preparations that disrupt the intestinal flora in patients. This is especially true for penicillin, tetracyclines, cephalosporins or chloramphenicol.

In addition to antibiotics, a large number of antivirals impair the effectiveness of the minipill, including ritanovir, rifabutin, efavirenz, nevirapine and nelfinavir. Griseofulvin, an antifungal agent against fungal infections, is also one of the questionable drugs.

The herbal medicine St. John's wort, which is sometimes used for mild to moderate depression, reduces the effectiveness of the pill by accelerating its breakdown. Activated charcoal can also reduce the absorption of the active ingredient and thus the protection against conception.

Please also read our article on this Which drugs affect the way the pill works?

Mini pill and antibiotics

If it is necessary to take an antibiotic, the prescribing doctor must be informed about the hormonal contraception. He can give further recommendations.

The effectiveness of the pill is partially reduced by antibiotics, especially rifampicin in the treatment of tuberculosis. A variety of other antibiotics can also make the minipill less effective.

By influencing the intestinal flora, the active ingredient of the minipill may not be completely absorbed and does not reach the necessary concentration in the blood to provide full contraceptive protection.

The contraceptive protection can be impaired, especially in the case of vomiting or diarrhea. For safety, women should use additional barrier methods.

Use during pregnancy and breastfeeding

According to non-hormonal contraceptive methods, the minipill is the product of choice for breastfeeding mothers. Taking the mini pill does not affect milk production. In addition, the proportion of active ingredient that is transferred to the infant through breast milk is comparatively low. So far, there is no evidence of impaired growth or development of the breastfed child.

In the event of pregnancy or suspicion of pregnancy, the minipill should not be taken or should be stopped. Continued use of hormonal contraceptives during pregnancy cannot completely rule out the possibility of deformities in the unborn child.

Mini pill and breastfeeding

If you want to use contraception while breastfeeding, you should usually use non-hormonal methods.

For women who still want to use hormonal contraception, the mini pill is the method of choice during breastfeeding. In contrast to combination products, the preparation does not affect milk production. A small part of the active ingredient reaches the baby through breast milk. The minipill should not be started before six weeks after delivery.
So far there is no evidence that taking the minipill in breastfeeding mothers has an effect on the growth and development of the infant. Women who are breastfeeding should discuss contraception options with their doctor.

Alternatives to the mini pill

The decision for a contraceptive should be discussed in detail with the gynecologist. Each method has advantages and disadvantages.

The conventional combination product, which contains the hormones estrogen and progestin, is considered an alternative hormonal contraceptive. The so-called micropill contains a far lower proportion of estrogens, but is not completely estrogen-free.

There are also other methods of contraception, such as the hormone patch, hormone injection or hormone implanters.

There is also the so-called vaginal ring, which is replaced every month. The so-called hormonal IUD offers three or five year protection, depending on the system.

There are also a variety of mechanical contraceptive methods, such as the condom, the femidom (the condom for women), the diaphragm and others.

Cerazette

Cerazette is a representative of the newer generation of mini pills. It is an estrogen-free preparation based on the progestogen desogestrel. It is usually a well-tolerated preparation with contraceptive protection comparable to conventional combination pills.

Cerazette is also a contraceptive method in tablet form. You should also deal with this promising form of contraception before you decide on a variant. For the most important information, read: Cerazette - the most important information at a glance

Desogestrel

Desogestrel is a new generation of estrogen-free mini pills.

In contrast to levonorgestrel, desogestrel also inhibits ovulation. It also affects the lining of the uterus and causes the mucus in the cervix to thicken, making it difficult for sperm to travel to the uterus.
Desogestrel has an advantage over levonorgestrel because, unlike levonorgestrel, it does not necessarily have to be taken at the same time. The contraceptive protection still exists if the intake is delayed by a maximum of twelve hours. Regular use every 24 hours provides the best protection.
Desogestrel offers contraceptive protection similar to conventional combination pills.

What should I watch out for when I stop taking the mini pill?

You can stop taking the minipill at any time. The contraceptive protection expires on the day of withdrawal. So if you still don't want to get pregnant, you have to resort to alternative contraceptive methods.

In the best case scenario, the discontinuation of the minipill should be discussed with the gynecologist beforehand. Some women may also experience side effects after stopping the minipill. The hormonal change may lead to irregular menstrual periods.

If you want to have children, you can stop taking the mini pill at any time. Basically, from this moment there is the possibility of becoming pregnant, but this does not have to work for every woman. If you do not become pregnant after weaning, despite wanting to have children, it may be advisable to consult a doctor.

Minopill for menopause

The risk of thrombosis and cardiovascular disease increases with age. Since combination products also increase the risk, they are not recommended. However, if you do not want to do without hormonal contraception methods, you can use the mini pill in this case.

According to current knowledge, they are associated with a lower risk of thrombosis. Sometimes the minipill is also used as a hormone treatment during menopause.