Progesterone contraceptives
Progesterone-Only Pill (POP) (e.g., Desogestrel)
Absolute Contraindications
- Active breast cancer
- Severe liver disease
Main Side Effects
- Irregular or breakthrough bleeding
- Headache, nausea
- Breast tenderness
Main Interactions
- Enzyme inducers (e.g., rifampicin, carbamazepine) reduce efficacy
- Some antiretrovirals and anticonvulsants
Main Monitoring Requirements
- None routinely required
- Monitor for changes in bleeding patterns
Pregnancy & Breastfeeding
- Safe during breastfeeding; does not affect milk supply
- Avoid if pregnancy is confirmed
Progesterone Implant (e.g., Nexplanon)
Absolute Contraindications
- Active breast cancer
- Severe liver disease
Main Side Effects
- Irregular bleeding or amenorrhea
- Acne, weight changes
- Mood changes, headache
Main Interactions
- Enzyme inducers (e.g., rifampicin, carbamazepine) reduce efficacy
Main Monitoring Requirements
- Check implant placement and ensure proper insertion
- Assess bleeding patterns if problematic
Pregnancy & Breastfeeding
- Safe during breastfeeding
- Avoid if pregnancy is confirmed; remove implant if pregnancy occurs
Progesterone Injectable (e.g., Depo-Provera)
Absolute Contraindications
- Active breast cancer
- Severe liver disease
Main Side Effects
- Amenorrhea or irregular bleeding
- Weight gain
- Reduced bone mineral density with long-term use
- Delayed return to fertility after discontinuation
Main Interactions
- Nonsignificant
Main Monitoring Requirements
- Monitor for changes in menstrual patterns
- Consider bone health for long-term users
Pregnancy & Breastfeeding
- Safe during breastfeeding
- Avoid if pregnancy is confirmed
Progesterone Intrauterine Device (IUD) (e.g., Mirena)
Absolute Contraindications
- Active pelvic infection (e.g., PID)
- Known or suspected pregnancy
- Uterine abnormalities or fibroids that distort the cavity
Main Side Effects
- Irregular bleeding initially, followed by lighter or absent periods
- Pelvic discomfort during or after insertion
- Rare: Uterine perforation or expulsion
Main Interactions
- Nonsignificant
Main Monitoring Requirements
- Check placement (e.g., ultrasound or threads) after insertion
- Monitor for signs of infection or expulsion
Pregnancy & Breastfeeding
- Safe during breastfeeding
- Avoid if pregnancy is confirmed; if pregnancy occurs, device should be removed