Technical Update on POPs

The pills are designed to be taken daily, with one pill to be taken every day at the same time without any break. All 28 pills in a packet are hormone tablets, either Levonorgestrel or Desogestrel. POPs are safe for breastfeeding women and can be started earlier than six weeks postpartum. In fact, they are more effective when used along with breastfeeding than when taken after breastfeeding stops. Bleeding changes are common but not harmful, and POPs decrease the risk of ectopic pregnancy. Women can take POPs at any time if it is reasonably certain that she is not pregnant, using a pregnancy checklist to confirm. The mechanism of action for POPs involves thickening cervical mucus, which blocks sperm from meeting an egg, and disrupting the menstrual cycle, including preventing the release of eggs from the ovaries (ovulation). This makes POPs an effective form of contraception. The timing of starting POPs varies depending on the individual's circumstances. For women with a menstrual cycle, POPs can be started within five days of menstrual bleeding without the need for a backup method. However, if started anytime after five days of menstrual bleeding, a backup method, such as a condom, should be used for the first two days. For breastfeeding women, POPs can be started at any time or immediately after childbirth, without the need for a backup method. In contrast, women not breastfeeding can start POPs at any time, but a backup method is required for the first two days if started more than four weeks after giving birth. After a miscarriage or abortion, POPs can be started within seven days without a backup method, but a backup method is required if started more than seven days after the event. To use POPs effectively, one pill should be taken every day at the same time until the packet is empty. Linking pill intake to a daily activity can help women remember to take the pill daily and reduce some side effects. When finishing one pack, the first pill from the next pack should be taken on the very next day at the same time. To increase compliance with POP use, healthcare providers can assure women that they can return to the health facility at any time if they experience problems. Women should also be encouraged to return to the health facility before the packet finishes and discuss ways to remember taking the pill every day. Additionally, women should be informed about potential side effects and how to make up for missed pills. POPs can cause irregular and heavy bleeding, but these side effects are not harmful and usually become less or stop after the initial months of use. Women experiencing irregular bleeding should make up for the missed pills, while those experiencing heavy bleeding can take Tranexamic acid (500 mg) three times daily to help alleviate symptoms. If heavy bleeding continues or starts after several months of normal or no monthly bleeding, further evaluation may be necessary. In the event of missed pills, women should take a pill as soon as possible and continue taking pills as usual. If monthly bleeding occurs, a backup method should be used for the next two days, and emergency contraception pills (ECPs) can be considered if sex occurred in the past 72 hours.