TAILIEUCHUNG - Progestogen-only pill

There are five varieties of progestogen-only pill (POP) available (Table 8): four are of the old type that variably inhibit ovulation, while the fifth, Cerazette, is a primarily anovulant product. The latter is very different and therefore is mainly dealt with at the end of this section. Unless otherwise stated the abbreviation POP will refer to the four old-type POPs. | Progestogen-only pill There are five varieties of progestogen-only pill POP available Table 8 four are of the old type that variably inhibit ovulation while the fifth Cerazette is a primarily anovulant product. The latter is very different and therefore is mainly dealt with at the end of this section. Unless otherwise stated the abbreviation POP will refer to the four old-type POPs. Table 8 Available POPs Product Constituents Course of treatment Noriday 350 pg norethisterone 28 tablets Micronor 350 pg norethisterone 28 tablets Femulen 500 pg etynodiol diacetate 28 tablets Norgeston 30 pg levonorgestrel 35 tablets Cerazette 75 pg desogestrel 28 tablets Mechanism of action and maintenance of effectiveness The mechanism of action is complex because of variable interactions between the administered progestogen and the endogenous activity of the woman s ovary. Outside of lactation when 68 their effectiveness is hugely enhanced see below fertile ovulation is prevented in 50-60 of cycles. In the remainder there is reliance mainly on progestogenic interference with mucus penetrability. This barrier effect is readily lost so that each tablet daily must be taken within 3 hours of the same regular time. If POPs are indeed taken regularly each day within that time span of 27 hours without breaks and regardless of bleeding patterns they are in practice as effective or as ineffective in typical use see Table 1 as COCs - especially for those aged 35 and over. Effectiveness In the UK the Oxford FPA study reported a failure rate of per 100 woman-years between the ages 25 and 29 but this improved to at 35-39 years of age and was as low as for women over 40 years of age. Realistically most users are probably not as meticulous as those married middle-class women. With regard to effect of body mass not BMI studies are suggestive but not conclusive that the failure rate of old-type POPs may be higher with increasing weight as was well established in early studies of .

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