1. Pre-service Education on FP and AYSRH
Session II, Topic 2 Progestin-only Contraceptive Pills (POPs)
PoPs, Session II Topic 2 Slide 1

2. POPs Are Safe for Nearly All Women
Almost all women can use POPs safely, including women who:
Are breastfeeding (can start immediately after birth)
Have or have not had children
Are not married
Are of any age
Have just had an abortion, miscarriage, or ectopic pregnancy
Smoke (no matter their age or the number of cigarettes)
Have anemia now or had it in the past
Have varicose veins
Have an STI or HIV/AIDS
Most health conditions do not affect safe and effective use of POPs
Explain: The key points to remember about POPs are that: one pill must be taken every day; effectiveness depends on the user; POPs are very safe and appropriate for women who are breastfeeding or cannot estrogen; some women have side effects at first (these are not harmful); and POPs don’t provide protection against STIs or HIV/AIDS.
Ask the students: What are some traits of progestin-only pills? <allow students to answer; click the mouse to reveal the following traits>
POPs only contain one hormone, progestin. They do not contain estrogen. Sometimes called the “mini-pill” because of this.
There are different types of POPs. There are no clinically significant differences in effectiveness, characteristics, eligibility criteria or safety between these.
POPs are packaged with either 28 or 35 pills per pack.
Both contain all active pills. Every pill contains the same amount of hormone.
There are no hormone free intervals or breaks between packs. A woman starts the next pack of pills the next day after she finishes the current pack.
Ask the students: Which brands of POPs are available in the country. Allow students to answer and add to the students’ responses as needed.
PoPs, Session II Topic 2 Slide 2

3. What Are POPs? Content and Types
Only one hormone, progestin. Do NOT contain estrogen. Sometimes called the “mini-pill”
Types
Common: norethistrone (norethindrone), levonorgestrel, desogestrel,
Less Common: etynodial diacetate, lynestrenol
Have similar effectiveness, safety, characteristics, and eligibility criteria
Pills per pack
28: all active pills 35: all active pills
(no break between packs)
PoPs, Session II Topic 2 Slide 3

4. Effectiveness of POPs
In this progression of effectiveness, where would you place combined oral contraceptives (POPs)?
Less effective
More effective
Implants
Male Sterilization
Female Sterilization
Intrauterine Devices
Progestin-Only Injectables
Combined Oral Contraceptives
Male Condoms
Standard Days Method
Female Condoms
Spermicides
Explain: The list on these slides lists contraceptive methods from most effective to least effective as commonly used. In this list, spermicides are the least effective method and the most effective methods are contraceptive implants, sterilization, and IUDs.
Ask students: Where would you place POPs on this list?
Click the mouse to show the answers. Not that effectiveness varies, depending on whether a woman is breastfeeding or not.
Point out that POPs are much less effective when women are not breastfeeding.
POPs (breastfeeding)
POPs (not breastfeeding)
PoPs, Session II Topic 2 Slide 4

5. POPs: Mechanism of Action
Suppresses
hormones
responsible for
ovulation (secondary)
Illustration credit: Salim Khalaf/FHI
Ask Students: How do you think POPs work to prevent pregnancy?
Explain that POPs work in two ways. They thicken the cervical mucus to block the sperm from meeting the egg and they disrupt the menstrual cycle, including preventing the release of eggs from the ovaries.
Ask the students to brainstorm ideas about how to explain how POPs work to prevent pregnancy, using simple language the client will understand. For example, “Your body stops producing eggs for as long as you take the pill so you cannot get pregnant.”
Thickens
cervical mucus to block sperm (primary)
POPs have no effect on an existing pregnancy.
PoPs, Session II Topic 2 Slide 5

6. POPs: Characteristics
Safe and more than 99% effective if used correctly
Can be stopped at any time
No delay in return to fertility
Are controlled by the woman
Do not interfere with sex
Very few health risks
Safe for breastfeeding
Less effective when not used correctly when breastfeeding (99%), especially if not breastfeeding (90-97%)
Require taking a pill every day at the same time
Do not provide protection from STIs/HIV
Have side effects
Ask students to brainstorm a list of the positive characteristics (advantages) of POPs and the characteristics of POPs that clients may perceive as negative (limitations)
Write their answers on the flipchart.
Show the slides 6, 7 and 8 and compare to the answers on the flipchart.
Source: Hatcher, 2011; WHO, 2010; CCP and WHO, 2011; Trussell , 2011.
PoPs, Session II Topic 2 Slide 6

7. POPs: Advantages
All pills the same (no pill color changes or days without pill taking)
Slightly faster return to fertility
Okay for women who cannot use estrogen (such as a woman over 35 who smokes cigarettes
Less restrictive screening can increase distribution
Lower risk of complications such as stroke and blood clots
No impact on quality or quantity of milk for breastfeeding moms
One of the only methods that can be started right after delivery, even if a woman is breastfeeding
Source: Hatcher, 2011; WHO, 2010; CCP and WHO, 2011; Trussell , 2011.
PoPs, Session II Topic 2 Slide 7

8. POPs: Disadvantages
Need to be taken not only every day but every day at the same time
More menstrual changes, especially bleeding and spotting
Possibly more ovarian cysts
No reduction in risks of ovarian and endometrial cancer (but also no increase)
Source: Hatcher, 2011; WHO, 2010; CCP and WHO, 2011; Trussell , 2011.
PoPs, Session II Topic 2 Slide 8

9. Possible Side-Effects of POPs
If a woman chooses this method, she may have some side- effects. They are not usually signs of illness.
But many women do not have any side-effects.
Side-effects often go away after a few months and are not harmful.
Common (when not breastfeeding): irregular bleeding, spotting, no monthly bleeding
Adapted from WHO’s Decision-making tool for family planning clients and providers.
Remind students that as with all contraceptive methods, there are some side effects associated with POPs that are not harmful but may be unpleasant.
Women’s preferences for certain methods are often related to side effects. Ask the students: What side effects of POPs have you heard about?
As we have acknowledged, some women who take POPs experience certain side effects. These side effects may include nausea, dizziness, headaches, and breast tenderness. POPs may also cause bleeding changes.
Most women experience a reduction in the amount of menstrual bleeding. The majority of women have regular menstrual bleeding while taking POPs; however, some women may experience amenorrhea.
Breakthrough bleeding, or irregular bleeding between periods. This bleeding ranges from spotting to light bleeding episodes. This is less common in breastfeeding women.
Because some cultures or religions restrict sexual and religious activities during menstruation, breakthrough bleeding may interfere with a woman’s daily life. Breakthrough bleeding is generally not harmful to a woman’s health.
It is important to remember that many POP users do not experience any side effects. Those who do experience side effects may experience one or two of these side effects, but not all of them.
Typically, side effects diminish within a few months after a woman begins POP use.
Because these side effects may have an important impact on users’ experience with POPs, they should be addressed during counseling and follow-up visits.
Less common: nausea, headache, tender breasts, dizziness
PoPs, Session II Topic 2 Slide 9

10. Who Can and Cannot Use POPs
Most women can safely use POPs.
But usually cannot use POPs if:
Adapted from WHO’s Decision-making tool for family planning clients and providers.
Explain that most women can safely use the mini-pill. Use slides 10 and 11 to show who should not use POPs
May be pregnant
Some other serious health conditions
PoPs, Session II Topic 2 Slide 10

11. Who Should Not Use POPs Are pregnant
5/25/2012
Are
pregnant
Have rheumatic disease, such as lupus
Have or had breast cancer
Illustration credit: Ambrose Hoona-Kab.
Adapted from WHO’s Decision-making tool for family planning clients and providers.
Had blood clots in legs or lungs
My period is late…
Think they may be pregnant
Take pills for TB
or seizures
Have serious
liver disease
Source: WHO, 2015
PoPs, Session II Topic 2 Slide 11

12. Conditions (selected examples)
Category 1 and 2 Examples: Who Can Use POPs
WHO Category
Conditions (selected examples)
Category 1
menarche to >45 yrs; nulliparous; POPs can now be offered in the immediate postpartum period; postpartum non-breastfeeding <21 days; post-abortion (any trimester); smoking (any age or number of cigarettes; obesity; headaches including migraines; varicose veins; cervical cancer; endometriosis; hepatitis; thyroid disease; anemia; sickle cell disease; elevated BP
Category 2
past ectopic pregnancy; migraines with aura; history of DVT/PE; unexplained vaginal bleeding; gall bladder disease; diabetes; elevated BP systolic ≥ 160 or diastolic ≥ 100 mm Hg; some HIV meds
Remind students of the 4 types of medical eligibility criteria they have learned about is previous sessions.
Category 1: Use the method in any circumstances
Category 2: Generally use the method. The benefits of using generally outweigh the risks.
Category 3: Use of the method is generally not recommended unless other more appropriate methods are not available or acceptable
Category 4: Method not to be used
Use the slides to show the examples found in each category.
Explain that a new change to the Medical Eligibility Criteria allows women who have recently delivered to use POPs.
Source: WHO, 2016.
PoPs, Session II Topic 2 Slide 12

13. Conditions (selected examples)
Category 3 Examples Who Should Generally Not Use POPs
WHO Category
Conditions (selected examples)
Category 3
Rheumatic Diseases:
Lupus with positive or unknown antiphospholipid antibodies
Vascular conditions:
Acute DVT/PE
Gastrointestinal conditions:
Severe cirrhosis
Liver tumors
Drug interactions:
Use of rifampicin or rifabutin, anticonvulsants
Source: WHO, 2015; White, 2012
PoPs, Session II Topic 2 Slide 13

14. Conditions (selected examples)
Category 4 Examples: Who Should Not Use POPs
WHO Category
Conditions (selected examples)
Category 4
Breast cancer: current or within 5 yrs
Source: WHO, 2015, White, 2012
PoPs, Session II Topic 2 Slide 14

15. POP Use by Women with HIV
WHO Eligibility Criteria
Condition
Category
HIV-infected 1
AIDS
ARV therapy with NRTIs
ARV therapy with NNRTIs and PIs including ritonavir
(as part of ARV regimen) 2
Women with HIV or AIDS can use without restrictions
Women on all ARVs can use POPs safely
Condom use should be encouraged in addition to POPs
Explain that women can safely use POPs even if they are infected with HIV, have AIDS, or are on antiretroviral (ARV) therapy. Women who are taking barbiturates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, rifampicin, or rifabutin can generally use the method, but a backup contraceptive method should also be used because these medications reduce the effectiveness of POPs.
Source: WHO, 2010
PoPs, Session II Topic 2 Slide 15

16. When to Start POPs (part 1)
Anytime you are reasonably certain the woman is not pregnant
Pregnancy can be ruled out if the woman meets one of the following criteria:
Started monthly bleeding within the past 7 days
Is breastfeeding fully, has no menses and baby is less than 6 months old
Has abstained from intercourse since last menses or delivery
Had a baby in the past 4 weeks
Had a miscarriage or an abortion in the past 7 days
Is using a reliable contraceptive method consistently and correctly
If none of the above apply, pregnancy can be ruled out by pregnancy test, pelvic exam, or waiting until next menses
Ask students the following question: If a woman is medically eligible and wants to use POPs, when can she start them? Students call out responses; accept responses from several students. Let us compare your responses with the information on the next several slides.
Use the slides to present the following:
A woman can start taking POPs anytime a provider is reasonably certain that she is not pregnant.
A provider can be reasonably certain that a woman is not pregnant if any of these situations apply:
Her monthly bleeding started within the past seven days.
The woman is fully breastfeeding, has no menses, and her baby is less than six months old.
She has abstained from intercourse since her last menses or since delivery.
She had a baby in the past four weeks.
She had a miscarriage or an abortion in the past seven days.
She has been using a reliable contraceptive method consistently and correctly.
If none of these situations apply, a provider can conduct a urine pregnancy test or a bimanual pelvic exam if appropriate to determine if the woman is pregnant.
If no other means to rule out pregnancy are available, a provider can ask a woman to come back at the time of her next menses and to use a backup contraceptive method in the meantime.
Providers may give a pack of POPs to the client with instructions to begin using them when her menses starts. This is known as advance provision.
Source: WHO, 2016
PoPs, Session II Topic 2 Slide 16

17. When to Start POPs (part 2)
If starting during the first 5 days of the menstrual cycle, no backup method needed
After day 5 of her cycle, rule out pregnancy and use backup method for the next 2 days
Postpartum
Breastfeeding or not breastfeeding: May start immediately after giving birth
Source: WHO, 2016
PoPs, Session II Topic 2 Slide 17

18. When to Start POPs (part 3)
After miscarriage or abortion
If within 7 days after miscarriage or abortion, no backup method needed
If more than 7 days after, rule out pregnancy, use backup method for 2 days
Switching from hormonal method
May start immediately, no backup method needed (with injectables, initiate within reinjection window)
Switching from nonhormonal method
If starting within 5 days of start of menstrual cycle, no backup method needed
If starting after day 5 of cycle, use backup method for 2 days
After using emergency contraceptive pills
Initiate next day, use backup method for 2 days
Source: WHO, 2016
PoPs, Session II Topic 2 Slide 18

19. How to Take POPs Take one pill each day, by mouth, at the same time.
The Mini-Pill
Take one pill each day, by mouth, at
the same time.
Most important instruction:
Give client her pill pack to hold and look at.
Discuss:
Easy to remember to take pills?
“What would help you to remember? What else do you do regularly every day?”
Easiest time to take the pills? At a meal? At bedtime?
Where to keep pills.
What to do if pill supply runs out.
Adapted from WHO’s Decision-making tool for family planning clients and providers.
Ask students the following question: If a woman is medically eligible and wants to use POPs, when can she start them? Students call out responses; accept responses from several students. Let us compare your responses with the information on the next several slides.
Use the slides to present the following:
A woman can start taking POPs anytime a provider is reasonably certain that she is not pregnant.
A provider can be reasonably certain that a woman is not pregnant if any of these situations apply:
Her monthly bleeding started within the past seven days.
The woman is fully breastfeeding, has no menses, and her baby is less than six months old.
She has abstained from intercourse since her last menses or since delivery.
She had a baby in the past four weeks.
She had a miscarriage or an abortion in the past seven days.
She has been using a reliable contraceptive method consistently and correctly.
If none of these situations apply, a provider can conduct a urine pregnancy test or a bimanual pelvic exam if appropriate to determine if the woman is pregnant.
If no other means to rule out pregnancy are available, a provider can ask a woman to come back at the time of her next menses and to use a backup contraceptive method in the meantime.
Providers may give a pack of POPs to the client with instructions to begin using them when her menses starts. This is known as advance provision.
PoPs, Session II Topic 2 Slide 19

20. How to Take POPs continued
The Mini-Pill
Caution the client: Waiting too long between packs greatly increases risk of pregnancy.
Take one pill each day at the same time
Once you have finished all the pills in the pack, start a new pack the following day
Late taking a pill?
— Take it as soon as you remember
— You may need to follow special instructions if more than 3 hours late
Adapted from WHO’s Decision-making tool for family planning clients and providers.
PoPs, Session II Topic 2 Slide 20

21. Missed Pills Instructions
The Mini-Pill
Source: WHO, 2016; CCP and WHO, 2011.
3 or more hours late taking a pill and are NOT breastfeeding or breastfeeding but menses has returned:
Take a missed pill as soon as possible.
Continue to take one pill every day.
Use a backup method for next 2 days.
If client has had sex in last 5 days, can consider ECP.
Adapted from WHO’s Decision-making tool for family planning clients and providers.
PoPs, Session II Topic 2 Slide 21

22. Missed Pills Instructions continued
The Mini-Pill
3 or more hours late taking a pill and are breastfeeding and menses has not returned:
Take a missed pill as soon as possible.
Continue to take one pill every day.
No extra protection necessary.
Adapted from WHO’s Decision-making tool for family planning clients and providers.
PoPs, Session II Topic 2 Slide 22

23. Anything else I can repeat or explain? Any other questions?
What to Remember
Take one pill at the same time each day
If you are late taking pills, you can get pregnant
Side-effects are common but rarely harmful. Come back if they bother you.
Come back for more pills before you run out or if you have problems.
See a nurse or doctor if:
A bright spot in your vision before bad headaches
May be pregnant, especially if pain or soreness in belly
Yellow skin or eyes
Unusually heavy or long bleeding
Adapted from WHO’s Decision-making tool for family planning clients and providers.
Ask the students:< If you had a client who wanted to start using POPs, what are some of the important things you need to tell her?>
Write their answers on the flipchart and compare their responses to the slide.
Anything else I can repeat or explain? Any other questions?
PoPs, Session II Topic 2 Slide 23

24. Follow-up for POPs No fixed schedule; return any time.
Resupply: Give more than 1 cycle of pills, if possible.
Assess for method satisfaction and any health problems or circumstances that may restrict POP use.
Manage and reassure about side effects.
Review correct pill taking and what to do when pills are missed.
If the woman has stopped breastfeeding, discuss switching to another method.
Use slides to present the following:
Key messages that clients remember.
Scheduled follow-up visits are not necessary for POP users, but clients should be advised to return to the clinic anytime they have questions or concerns.
Contact with the client within the first two to six months may improve continuation among women experiencing side effects, because this is when such problems are most likely to occur. A follow-up visit is also a good time to replenish a woman’s supply of pills and her backup method, if needed.
If supplies are available, the provider should give a woman as many packs as allowed by national policy and advise her to return for resupply before she runs out.
During follow-up visits, ask if the client is satisfied with the method and if she has noticed any health problems that developed since she began taking POPs.
Also ask whether the client’s reproductive goals have changed, as she may want to become pregnant or desire a long-acting or permanent method.
If the client reports or complains about side effects, assess her symptoms and, if appropriate, reassure her that the side effects are not harmful and discuss ways to manage them.
Also determine whether a client is taking pills correctly and reinforce instructions on what to do when she forgets to take one or more pills.
If the client has developed any conditions that are contraindications for continuing to use POPs, or if the client finds side effects unacceptable, the provider should help her choose another method.
If the woman has stopped breastfeeding, discuss with her that POP is slightly less effective in non-breastfeeding women and discuss switching methods.
PoPs, Session II Topic 2 Slide 24

25. The Mini-Pill Return Visit
5/25/2012
The Mini-Pill Return Visit
How can I help you?
Are you happy using the mini-pill?
Want more supplies?
Any questions or problems?
Let’s check:
For any new health conditions
When do you take your pills?
What do you do if you forget a pill?
Need condoms too?
Ask students: What is the most important thing that you can do for women who experience side effects? Let us compare your responses with the slide. <click the mouse to reveal the answer>
Use slides to present the following:
Thorough counseling at the time POPs are provided often reduces the anxiety some women may feel when they experience side effects. If side effects do occur and are bothersome to the client, the first step of management is to address the client’s concerns through follow-up counseling.
If a client experiences ordinary headaches that are not migraines, tell the client that ordinary headaches do not indicate any dangerous conditions and usually diminish over time. She can use standard doses of painkillers such as aspirin, ibuprofen, paracetamol, or other pain relievers to relieve symptoms.
Although ordinary headaches are a common side effect of POP use, headaches that get worse or occur more often during POP use should be evaluated. While women who have migraine headaches with or without an aura can initiate POPs, a woman who develops migraine headaches with aura, or whose migraine headaches become worse while using POPs should stop using them. The provider should help her choose a method without hormones.
Taking pills on a full stomach or at bedtime may help prevent nausea and vomiting. If a woman experiences vomiting or diarrhea within two hours of taking POPs, she should take another pill from her pack as soon as possible and then continue taking pills as usual. If vomiting or diarrhea continues, she should continue daily POP use and start using a backup method, which she should continue using until two days after the vomiting and diarrhea have resolved.
For breast tenderness, recommend the client wear a supportive bra. She may also try pain relievers. If she is breastfeeding, she should also be evaluated for breastfeeding related issues such as engorged breasts, blocked ducts, and mastitis and treated appropriately according to national guidelines.
If side effects persist and are unacceptable to the client, you may recommend switching to a different pill formulation or to another contraceptive method.
PoPs, Session II Topic 2 Slide 25

26. Management of POP Side Effects
Counseling and reassurance are key.
Problem
Action/Management
Ordinary headaches
Reassure client: usually diminish over time; take painkillers
If side effects persist and are unacceptable to client:
if possible, switch mini-pill formulations or switch to another method.
Nausea and vomiting
Take pills with food or at bedtime
Breast
tenderness
Recommend supportive bra; suggest pain reliever; hot/cold compresses; if breastfeeding evaluate for engorgement, blocked ducts and treat
PoPs, Session II Topic 2 Slide 26

27. Management of POP Side Effects: Bleeding Changes
Problem
Action/Management
Irregular bleeding
Reassure client and that it is not harmful and often stops after first several months: reinforce correct pill taking and review missed pill instructions; ask about other drugs that may interact with POPs; administer short course of non-steroidal anti-inflammatory drugs
If side effects persist and are unacceptable to client: if possible, switch pill formulations or offer another method.
Amenorrhea
Reassure client: no medical treatment necessary.
If a client complains about irregular or breakthrough bleeding, the provider should first make sure the client is taking the pills correctly, without missing pills. The provider should also ask whether the client is taking any drugs that may interact with POPs, such as rifampicin or rifabutin, which make POPs less effective. Assure the woman that this bleeding does not mean that anything is wrong and usually diminishes with time. Suggest that she take pills at the same time each day—this may help to reduce irregular bleeding.
If the irregular bleeding is unacceptable to the client, consider giving her ibuprofen, up to 800 mg three times per day for five days, or an equivalent amount of another non-steroidal anti-inflammatory drug other than aspirin.
If the woman is experiencing unexplained, heavy, or prolonged vaginal bleeding that may suggest a serious medical condition not related to the method, she should be referred for evaluation as soon as possible.
Amenorrhea may simply be a sign that the pills are working effectively. Reassure the client that it does not indicate a health problem and no medical treatment is necessary. If the client develops amenorrhea while using pills incorrectly or after using POPs for only a short time, the provider should determine if the client is pregnant.
Sometimes side effects may diminish or disappear if the client switches to another formulation of POPs. A provider may prescribe a different pill brand if available.
If side effects persist and are unacceptable to the client, the provider should help her to choose another contraceptive method.
Source: CCP and WHO, 2011.
PoPs, Session II Topic 2 Slide 27

28. Problems That May Require Stopping POPs or Switching to Another Method
Action
Unexplained vaginal bleeding
Refer or evaluate by history and pelvic exam
Diagnose and treat as appropriate
If an STI or PID is diagnosed, the client may continue using POPs during treatment
Migraines
If the client develops migraines without aura she can continue to use POPs if she wishes.
If she has migraine aura, stop POPs. Help the client choose a method without hormones.
Heart disease due to blocked or narrowed arteries or stroke
A woman who has these already can safely start POP.
If these conditions develop after she starts using POPs she should stop POPs and choose a method without hormones.
Refer for diagnosis and care
Use slides 28 and 29 to present the following:
There are some serious health conditions that may require a client to stop using POPs.
If a client experiences unexplained, heavy, or prolonged bleeding that is suggestive of a medical condition not related to the method, refer the client or evaluate by taking her medical history and doing a pelvic examination. Diagnose and treat as appropriate. The client can continue using POPs while her condition is being evaluated. If the bleeding is caused by an STI or PID, the client can continue using POPs during treatment.
Although women who have migraine headaches with or without aura can initiate POPs, a woman of any age who develops migraine headaches with aura, or whose migraine headaches become worse while using POPs should stop using them. The provider should help this client choose a method without hormones.
A woman who has heart disease due to blocked or narrowed arteries or stroke can safely start POPs. However, if these conditions develop after she starts using POPs, she should stop POPs and choose a method without hormones.
If a client is starting long-term treatment with anticonvulsants (include barbiturates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, and lamotrigine) or the antibiotics rifampicin and rifabutin, advise her to switch to another method, other than combined oral contraceptives, because these medications make POPs less effective. If their use is short term, she may consider using a backup method for the duration of treatment.
If a woman develops health conditions such as blood clots in the deep veins of the legs or lungs, heart disease due to blocked or narrowed arteries, severe liver disease, or breast cancer, tell the client to stop taking POPs.
Give the woman a backup method to use until her condition is evaluated.
Refer her for diagnosis and care if she is not already under care.
Finally, if you suspect a woman is pregnant, assess for pregnancy and tell her to stop using POPs if pregnancy is confirmed. Reassure her that there are no known risks to a fetus conceived while a woman is using POPs.
Source: CCP and WHO, 2011.
PoPs, Session II Topic 2 Slide 28

29. Problems That May Require Stopping POPs or Switching to Another Method
(continued)
Problem
Action
Starting treatment with anti- convulsants or rifampicin or rifabutin.
These drugs make POPs less effective
Advise the client to consider other contraceptive methods (long-term) or use a backup method (short-term).
Suspected blood clots in deep veins of legs or lungs, liver disease, or breast cancer
Tell the client to stop taking POPs
Give the client a backup method to use
Refer for diagnosis and care
Suspected pregnancy
Assess for pregnancy
If confirmed, tell the client to stop taking POPs
There are no known risks to a fetus conceived while a woman is taking POPs
Source: CCP; WHO, 2011; WHO 2015
PoPs, Session II Topic 2 Slide 29

30. POPs: Summary Safe for almost all women, including breastfeeding women
Effective if used consistently and correctly
Fertility returns without a delay
Screening and counseling are essential
Photo credits: © 1995 Lamia Jaroudi/CCP, Courtesy of Photoshare; © 2009 Nguyen Quoc Phong, Courtesy of Photoshare
Progestin-only pills have characteristics that make them a desirable family planning method for many women.
They are safe for almost all women, including breastfeeding women.
They are effective if used consistently and correctly.
Fertility returns without a delay after stopping pills.
Appropriate screening and counseling plays an important role in the provision of oral contraceptives. Providers can use a simple screening tool to determine medical eligibility. Counselors must ensure that clients are aware of potential side effects, understand how to take the pill, know what to do when pills are missed, and can identify situations that require the attention of a provider. Family planning programs that offer POPs benefit their clients by increasing their contraceptive options.
PoPs, Session II Topic 2 Slide 30