Progesterone Only Contraception

---

What Are Progestin Only Contraceptives?

Progestin-only contraceptives (POCs) are hormonal methods that contain only synthetic progesterone (no estrogen). They are ideal for:

1. Breastfeeding women

2. Women with contraindications to estrogen (e.g., smokers >35 yrs, thromboembolic risk)

---

Types of progestin only contraceptives

Type	Form	Examples (India)	Duration of action
POP (Progestin-only pills)	Oral pill (daily)	Cerazette, Micronor (limited availability)	24 hours (daily use)
Injectable	IM /SC injection	DMPA – Antara (govt), Depo-Provera	3 months
Implants	Subdermal rod	Not widely available in India (e.g., Nexplanon abroad)	3–5 years
Hormonal IUD	Intrauterine device	Mirena, Emkay LNG, Kyleena	5 years

---

How do they work?

Progestin-only methods work mainly through:

1. Inhibiting ovulation- high progesterone levels, reduces the estrogen content in the ovaries, which in turn suppresses the Hypothalamus-pituitary-ovarian axis.

2. Thickening cervical mucus- making it harder for sperm to pass.

3. Thinning the endometrium- reducing implantation potential.

---

Comparison of various progesterone only contraception

Parameter	POP (Pill)	DMPA Injection	Implant	LNG-IUD
Cost (India)	₹200–600/month	₹100 (Antara) – ₹300 (private)	Not widely available (~₹5,000–7,000 abroad)	₹7,000–12,000
Prescription Needed?	Yes	Yes	Yes	Yes
Effectiveness	~91% (perfect use: 99%)	>94%	>99%	>99%
Ease of Use	Daily, same time	Once in 3 months	Once in 3–5 years	Insert once in 5 years
Compliance Issues	High – needs strict daily timing	Moderate	Low	Very low
Chance of Failure	Higher with missed doses	Rare with regular schedule	Very rare	Very rare
Menstrual Comfort	Irregular bleeding common	Irregular bleeding, amenorrhea	Irregular bleeding, then light periods	Reduced cramps, lighter/absent periods
Suitability in Breastfeeding	Yes	Yes	Yes	Yes

---

Advantages of POCs

1. Suitable in breastfeeding

2. Safe for women who cannot use estrogen, like women with history pod stroke, clots or thromboembolic events, severe cardiac disease, severe hypertension.

3. Certain progesterone only contraceptive offer long-term protection with minimal maintenance (implants, IUDs).

Disadvantages

1. As estrogen levels are suppressed by the progesterone, it can lead to irregular bleeding or spotting especially in the first few weeks of starting the contraceptive.

2. Requires strict timing for pills, as delays can increase break through bleeding.

3. Delay in return to fertility (especially DMPA), may take anywhere btw 9 months to a year, hence is not suitable for women desirous of fertility in the short-term.

References

1. Fraser IS. (1996). The effect of levonorgestrel-releasing IUDs on menstrual bleeding patterns. Obstet Gynecol Surv, 51(4): S34–S41.

1. Faculty of Sexual & Reproductive Healthcare. (2022). Progestogen-only pills. https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-ceu-clinical-guideline-progestogen-only-pills-aug22-amended-11july-2023-.pdf