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:

• Breastfeeding women

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

Types of progestin only contraceptives

Type	Duration of action
POP (Progestin-only pills): Oral pill (daily), types include Cerazette, Micronor (limited availability)	24 hours (daily use)
Injectable: IM /SC injection, types include 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, types include Mirena, Emkay LNG, Kyleena	5 years

How do they work?

Progestin-only methods work mainly through:

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

• Thickening cervical mucus: Making it harder for sperm to pass.

• Thinning the endometrium: Reducing implantation potential.

Comparison of various progesterone only contraception

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

Advantages of POCs

• Suitable in breastfeeding

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

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

Disadvantages of POCs

• 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.

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

• 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.

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Medically reviewed by

Dr Poonguzhali Liston

Researched by

Dr Poonguzhali Liston

Written by

Dr Poonguzhali Liston

References

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

2. 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