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Backup methods

* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal.

Tell her that spermicides and withdrawal are the least effective contraceptive methods.

If possible, give her condoms.

 

Providing progestin-only pills


 When to start
Giving advice on side effects
Explaining how to use
Supporting the user
Making up missed pills
“Come back any time”: reasons to return 

When to start

Important: a woman can start using POPs any time she wants if it is reasonably certain she is not pregnant. To be reasonably certain she is not pregnant, use the Pregnancy Checklist (see p. 372). Also, a woman can be given POPs at any time and told when to start taking them. 

Woman’s situation When to start
Fully or nearly fully
breastfeeding
Less than 6 months
after giving birth
  • If she gave birth less than 6 weeks ago, give her
    POPs and tell her to start taking them 6 weeks
    after giving birth.
  • If her monthly bleeding has not returned, she can start POPs any time between 6 weeks and 6 months. No need for a backup method.
  • If her monthly bleeding has returned, she can start POPs as advised for women having
    menstrual cycles (see p. 33).
More than 6 months after giving birth
  • If her monthly bleeding has not returned, she can start POPs any time it is reasonably certain she is not pregnant. She will need a backup method for the first 2 days of taking pills. Backup methods include abstinence, male and female condoms, spermicides, and
    withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.(If you cannot be reasonably certain, give her POPs now and tell her to start taking them during her next monthly bleeding.)
  • If her monthly bleeding has returned, she can start POPs as advised for women having menstrual cycles (see p. 33).
More than 6 months after giving birth
  • If her monthly bleeding has not returned, she can start POPs any time it is reasonably certain she is not pregnant. She will need a backup method* for the first 2 days of taking pills. (If you cannot be reasonably certain, give her POPs now and tell her to start taking them during her next monthly bleeding.)
  • If her monthly bleeding has returned, she
    can start POPs as advised for women having menstrual cycles (see p. 33).
Partially breastfeeding
Less than 6 weeks
after giving birth
  • Give her POPs and tell her to start taking them 6 weeks after giving birth.
  • Also give her a backup method to use until 6 weeks since giving birth if her monthly bleeding
    returns before this time.
Woman’s situation When to start
Partially breastfeeding
(continued)
More than 6 weeks
after giving birth
  • If her monthly bleeding has not returned, she can start POPs any time it is reasonably
    certain she is not pregnant. Where a visit 6 weeks after childbirth is routinely recommended and other opportunities to
    obtain contraception limited, some providers and programs may allow a woman to start POPs at the 6-week visit, without further evidence that the woman is not pregnant, if her monthly bleeding has not yet returned. She will need a backup method for the first 2 days of taking
    pills. (If you cannot be reasonably certain, give her POPs now and tell her to start taking
    them during her next monthly bleeding.)
  • If her monthly bleeding has returned, she
    can start POPs as advised for women having menstrual cycles.
Not breastfeeding
Less than 4 weeks after giving birth		 She can start POPs at any time. No need for a
backup method.
More than 4 weeks after giving birth
  • If her monthly bleeding has not returned,
    she can start POPs any time it is reasonably
    certain she is not pregnant. Where a visit 6 weeks after childbirth is routinely recommended and other opportunities to
    obtain contraception limited, some providers and programs may allow a woman to start POPs at the 6-week visit, without further evidence that the woman is not pregnant, if her monthly bleeding has not yet returned. She will need a backup method for the first 2 days of taking
    pills. (If you cannot be reasonably certain, give her POPs now and tell her to start taking
    them during her next monthly bleeding.)
  • If her monthly bleeding has returned, she
    can start POPs as advised for women having menstrual cycles (see next page).
Switching from
a hormonal
method
  • Immediately, if she has been using the
    hormonal method consistently and correctly or if it is otherwise reasonably certain she is not pregnant. No need to wait for her next
    monthly bleeding. No need for a backup
    method.
  • If she is switching from injectables, she can begin taking POPs when the repeat injection
    would have been given. No need for a backup method.
Woman’s situation When to start
Having menstrual
cycles or
switching from
a nonhormonal
method

Any time of the month

  • If she is starting within 5 days after the start of her monthly bleeding, no need for a backup
    method.
  • If it is more than 5 days after the start of
    her monthly bleeding, she can start POPs
    any time it is reasonably certain she is not pregnant. She will need a backup method for
    the first 2 days of taking pills. (If you cannot be reasonably certain, give her POPs now and
    tell her to start taking them during her next
    monthly bleeding.)
  • If she is switching from an IUD, she can start POPs immediately (see Copper-Bearing IUD, Switching From an IUD to Another Method,
    p. 148).
No monthly
bleeding (not
related to childbirth
or breastfeeding)		 She can start POPs any time it is reasonably certain she is not pregnant. She will need a backup method for the first 2 days of taking
pills.
After miscarriage or abortion
  • Immediately. If she is starting within 7 days
    after first- or second-trimester miscarriage or abortion, no need for a backup method.
  • If it is more than 7 days after first- or secondtrimester
    miscarriage or abortion, she can
    start POPs any time it is reasonably certain she is not pregnant. She will need a backup
    method for the first 2 days of taking pills. (If you cannot be reasonably certain, give her POPs now and tell her to start taking them during her next monthly bleeding.)
After taking
emergency
contraceptive
pills (ECPs)		 She can start POPs the day after she finishes taking the ECPs. There is no need to wait for her next monthly bleeding to start her pills.
–A new POP user should begin a new pill pack.
–A continuing user who needed ECPs due to
pill-taking errors can continue where she left
off with her current pack.
– All women will need to use a backup method
for the first 2 days of taking pills.

 

Giving Advice on Side Effects

Important: thorough counselling about bleeding changes and other side effects is an important part of providing the method. Counselling about bleeding changes may be the most important help a woman needs to keep using the method.

Describe the most common side effects

  • Breastfeeding women normally do not have monthly bleeding for several months after giving birth. POPs lengthen this period of time.
  • Women who are not breastfeeding may have frequent or irregular bleeding for the first several months, followed by regular bleeding or continued irregular bleeding.
  • Headaches, dizziness, breast tenderness, and possibly other side effects. 

Explain about these side effects

  • Side effects are not signs of illness.
  • Usually become less or stop within the first few months of using POPs. Bleeding changes, however, usually persist.
  • Common, but some women do not have them. 

Explain what to do in case of side effects

  • Keep taking POPs. Skipping pills risks pregnancy.
  • Try taking pills with food or at bedtime to help avoid nausea.
  • The client can come back for help if side effects bother her.

Explaining How to Use

1. Give pills
Give as many packs as possible—even as much as a year’s supply (11 or 13 packs). 

2. Explain pill pack

  • Show which kind of pack—28 pills or 35 pills.
  • Explain that all pills in POP packs are the same colour and all are active pills, containing a hormone that prevents pregnancy.
  • Show how to take the first pill from the pack and then how to follow the directions or arrows on the pack to take the rest of the pills.

3. Give key instruction

  • Take one pill each day— until the pack is empty.
  • Discuss cues for taking a pill every day. Linking pill-taking to a daily activity—such as cleaning her teeth—may help her remember.
  • Taking pills at the same time each day helps to remember them. 

4. Explain starting next pack

  • When she finishes one pack, she should take the first pill from the next pack on the very next day.
  • It is very important to start the next pack on time. Starting a pack late risks pregnancy.

5. Provide backup method and explain use
  • Sometimes she may need to use a backup method, such as when she misses pills.
  • Backup methods include abstinence, male or female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. Give her condoms, if possible.

6. Explain that effectiveness decreases when breastfeeding stops

  • Without the additional protection of breastfeeding itself, POPs are not as effective as most other hormonal methods.
  • When she stops breastfeeding, she can continue taking POPs if she is satisfied with the method, or she is welcome to come back for another method.

Supporting the user

Managing Missed Pills

It is easy to forget a pill or to be late in taking it. POP users should know what to do if they forgetto take pills.

If a woman is 3 or more hours late taking a pill or misses one completely, she should follow the instructions below.

For breastfeeding women, whether missing a pill places her at risk of pregnancy depends on whether or not her monthly bleeding has returned.

Making Up Missed Progestin-Only Pills

Key message

  • Take a missed pill as soon as possible.
  • Keep taking pills as usual, one each day. (She may take 2 pills at the same time or on the same day.)

    Do you have monthly bleeding regularly?

    • If yes, she also should use a backup method for the next 2 days.
    • Also, if she had sex in the past 5 days, can consider taking ECPs (see Emergency Contraceptive Pills, p. 45). 

    Severe vomiting or diarrhea

    • If she vomits within 2 hours after taking a pill, she should take another pill from her pack as soon as possible, and keep taking pills as usual.
    • If her vomiting or diarrhea continues, follow the instructions for making up missed pills above.

    “Come back any time”: reasons to return

    Assure every client that she is welcome to come back any time—for example, if she has problems, questions, or wants another method; she has a major change in health status; or she thinks she might be pregnant. Also if:

  • She has stopped breastfeeding and wants to switch to another method.

  • For a woman who has monthly bleeding: If she took a pill more than 3 hours late or missed one completely, and also had sex during this time, she may wish to consider ECPs (see Emergency Contraceptive Pills, p. 45).

    General health advice: anyone who suddenly feels that something is seriously wrong with her health should immediately seek medical care from a nurse or doctor. Her contraceptive method is most likely not the cause of the condition, but she should tell the nurse or doctor what method she is using.

    Planning the next visit

    Encourage her to come back for more pills before she uses up her supply of pills.

    1. Contacting women after the first 3 months of POP use is recommended.
    2. This offers an opportunity to answer any questions, help with any problems, and check on correct use. 

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