Birth Control

The Minipill (aka the progestin-only pill)

2 min read

What is it? How does it work?
The progestin-only pill, also known as the minipill, is a tiny pill that needs to be taken at the same time every day. Unlike combination pills, the minipill does not contain estrogen, and instead releases a small amount of progestin every day of the month. Progestin thickens the cervical mucus to prevent sperm from reaching an egg. The minipill may also suppress ovulation. In order to be effective, the minipill MUST be taken at the same time each day (within an hour). Unlike the combination pill, you take this every day and do not get a week without pills or placebo pills. You can learn more about combination pills here.

How effective is it?
The minipill is estimated to be 87% effective with typical use. With perfect use, the pill’s effectiveness shoots up to over 99% effective! “Perfect use” means taking the pill at the exact same time every single day.

What happens if you miss a pill?
Take the pill as soon as you remember and use a backup method of birth control if you have sex, such as a condom, for 48 hours. Remember - to be effective, the minipill must be taken at the same time each day.

Why might the doctor recommend the minipill over the combination pill?
You’re breast-feeding. The minipill is often recommended while breastfeeding because estrogen can interfere with milk production. Learn more about your birth control options after giving birth.

  • You have certain health problems. If you have a history of blood clots, or are at higher risk for them, the doctor might recommend the minipill.
  • You’re concerned about taking estrogen. Some people choose the minipill to avoid possible side effects of pills containing estrogen.
  • This is usually a recommended option for those who want an easily reversible form of birth control but cannot take estrogen.

It is important to know that the minipill is slightly less effective than other forms of birth control, especially if you miss or delay a dose. If you are unable to take combination pills, it might be helpful to consider other non-estrogen options like the IUD, implant, or injection that are more effective than the minipill for long-term birth control.

The minipill isn’t appropriate for everyone. Why might the doctor not recommend the minipill?
You have or have had breast cancer

  • You have liver disease
  • You have unexplained uterine bleeding
  • You’ll have trouble taking the pill at the same time every day due to a changing work schedule or other factors

What are the side effects?
Some people experience positive side effects, some experience negative side effects, and some do not have any side effects at all! Not everyone has the same experience with the pill. And to complicate things further—sometimes people experience different side effects with different types of pills. Below, we list the most commonly reported side effects. But remember, it is important to listen to how your own body feels on the pill!

The good:

  • Can help with cramping
  • Regulates menstrual cycles
  • Lighter periods
  • Offers protection against anemia
  • Helps control polycystic ovary syndrome and endometriosis

The not-so-good:

  • Spotting
  • Some people experience changes in mood while on the minipill
  • Headaches
  • Nausea
  • Breast tenderness
  • Bloating/Increased appetite

The totally random:

  • Some people experience weight gain or weight loss, but most experience no fluctuation in weight

Any long-term benefits?
+Reduces risk of endometrial cancer.

Any long-term risks?
Unclear. There may be a slightly increased risk of breast cancer or cervical cancer but the data is mixed.

What are some common myths about the pill? Is there any truth behind them?
MYTH: “The pill causes infertility.” The pill does not cause infertility. Many years of research demonstrate that most people return to fertility immediately after stopping the pill. Also, the data shows that people who took the pill get pregnant after stopping the pill just as quickly as those who did not use any form of hormonal birth control.

MYTH: “The pill causes abortions.” The pill does not cause abortions. Once an egg is fertilized and implanted in the uterus, the pill will not affect the pregnancy. Research has shown that taking the pill doesn’t harm a developing fetus.

MYTH: “The pill is not as effective when I’m taking antibiotics.” Commonly prescribed antibiotics have no effect on the pill. The only antibiotic that interferes with the pill is rifampin (Rifadin), a drug that treats tuberculosis. But your doctor will warn you about the reduced effectiveness before prescribing this medication.

Does it protect me against sexually transmitted infections?
It is important to remember that the pill does not protect against sexually transmitted infections (STIs), so a barrier method (external condom, internal condom, dental dam) should be used in addition to the pill.

What are common brands of the minipill?

  • Camila
  • Deblitane
  • Errin
  • Heather
  • Jencycla
  • Jolivette
  • Lyza
  • Nor-QD
  • Nora-Be
  • Norethindrone
  • Norlyda
  • Norlyroc
  • Ortho Micronor
  • Sharobel
  • Slynd

All brands of the minipill have the same active ingredient (norethindrone), and the same dosage (0.35 milligrams) per day. This means that they are medically equivalent. You can read more about the difference between brands and generics here.

Packs contain 28 active pills, and there are no placebo pills. If you start taking the minipill during the first 5 days of your period, you shouldn’t need any additional contraception. Otherwise, you should use another form of birth control, such as a condom, for at least two days.

Slynd: Unlike most POP pills, which need to be taken at the same time every day, the brand Slynd is still effective even if you are up to 24 hours late taking a pill. It’s still important to try to take your pill at the same time every day, but this added flexibility can be helpful. Each pack contains 24 active pills and 4 inactive pills. According to Sylnd, “You should not take Slynd® if you have kidney disease or kidney failure, reduced adrenal gland function (adrenal insufficiency), cervical cancer or any cancer that is sensitive to female hormones, liver disease, including liver tumors or unexplained vaginal bleeding.”

Does which brand I use matter?
While the active ingredients are the same among generics, the inactive ingredients can vary so if you have allergies or intolerances, it’s best to check the inactive ingredient list before trying a new generic. Different insurance companies may also cover different brands.

What are other estrogen-free birth control options besides the minipill?
Another option is the Depo-Provera shot. This is a shot that can be self-administered at home or at a clinic. Each shot lasts around 3 months. Click here for more detail. The implant and the IUD are also estrogen-free options. These are longer-term methods of contraception.

Looking for more personalized info? Message a doctor through Twentyeight to get medical advice based on your needs and lifestyle.

With the participation of
Dr. Alejandra Moscoso

Explore more topics.