Executive summary (POP “exam-style” rules)
- Missed-pill window depends on product:
- Traditional POP (e.g., norethisterone): missed if >3 hours late.
- Desogestrel POP: missed if >12 hours late.
- Drospirenone POP: missed if >24 hours late (follow product/FSRH guidance).
- After a missed POP: take 1 pill ASAP, continue daily; use condoms for 48 hours (typical for many POP scenarios).
- Bleeding changes are common: irregular bleeding/spotting is expected; counsel early to prevent discontinuation.
- Key interaction: enzyme inducers reduce effectiveness → specialist advice/alternative method (often Cu-IUD).
Starting POP (quick-start friendly)
- Day 1 start: immediate cover.
- Day 2–5 start: usually immediate cover (method-dependent); if uncertain, advise condoms for 48 hours.
- After day 5: “quick start” if pregnancy reasonably excluded + condoms for 48 hours + pregnancy test in 3 weeks if any risk.
- Postpartum/breastfeeding: POP is generally compatible with breastfeeding; follow local maternity/sexual health guidance.
Missed POP (snippet format)
- Step 1: take a pill as soon as remembered (take only 1 even if multiple missed).
- Step 2: take the next pill at the usual time (two pills same day is fine).
- Step 3: use condoms for 48 hours after restarting correct use.
- Step 4: consider emergency contraception if there was unprotected sex during the missed-pill window and/or in the last 2 days (apply local/FSRH nuance; Cu-IUD is most effective EC).
Define “missed” correctly: traditional POP >3h late; desogestrel >12h late; drospirenone >24h late.
Bleeding counselling (retention saver)
Irregular bleeding is common and not dangerous. Reassure, check pregnancy if any risk, and consider a structured review (adherence, STI risk, cervical screening status, red flags). Most patterns settle within 3–6 months.
When to investigate abnormal bleeding (primary care “red flag” list)
- Pregnancy risk or symptoms (do a test).
- Pelvic pain, dyspareunia, abnormal discharge (STI/PID risk).
- Postcoital bleeding, persistent intermenstrual bleeding, or risk factors for endometrial pathology (age, obesity, PCOS, tamoxifen).
- New bleeding after a long stable pattern, especially age >40.
Frequently asked questions
Which POP is most practical for adherence?
Desogestrel POP has a 12-hour window (vs 3 hours for traditional POP), which often improves real-world adherence. Drospirenone POP has a longer window but follow product-specific guidance and local formulary.
Do antibiotics reduce POP effectiveness?
Most antibiotics do not. The major concern is enzyme-inducing drugs (and severe vomiting/diarrhoea). When in doubt, check BNF/SPC and consider Cu-IUD or specialist advice for prolonged enzyme induction.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.