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FSRH Guideline (August 2022) Progestogen-only Pills

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1 Purpose and scope

This document updates previous Faculty of Sexual & Reproductive Healthcare (FSRH) guidance and aims to summarise the available evidence and expert opinion on progestogen-only pills (POPs). The guideline is intended for use by healthcare practitioners (HCPs) providing POPs.

2 Identification and assessment of the evidence

This guideline was developed in accordance with standard methodology for developing FSRH clinical guidelines. The recommendations made within this document are based on the best available evidence and the consensus opinion of experts and the guideline development group (GDG). The methodology used in developing this guideline and a list of GDG members and other contributors can be found in Appendix 1.

Appendix 1


The recommendations included should be used to guide clinical practice but are not intended to serve alone as a standard of medical care or to replace clinical judgement in the management of individual cases.

3 Introduction

This guideline will consider the progestogen-only contraceptive pills (POPs) available in the UK, namely desogestrel (DSG) 75 μg, drospirenone (DRSP) 4 mg (soon to be available in the UK) and the ‘traditional’ POPs levonorgestrel (LNG) 30 μg and norethisterone (NET) 350 μg.

HCPs should support individuals to make informed decisions about choosing and using POPs, ensuring that they are informed about contraceptive effectiveness, and how this compares to other contraceptive methods including long-acting reversible contraception (LARC) as well as potential risks and benefits.

4 Summary, including changes to existing guidance

In the UK there are soon to be four different POPs: desogestrel (DSG) 75 μg, drospirenone (DRSP) 4 mg (this is a new product not included in previous FSRH guidelines) and the ‘traditional’ POPs levonorgestrel (LNG) 30 μg and norethisterone (NET) 350 μg. (Section 5)

Contraceptive effectiveness

The contraceptive effect of DSG and DRSP POPs relies primarily on inhibition of ovulation. In contrast, LNG and NET POPs do not reliably suppress ovulation; their contraceptive effectiveness relies on their effect on cervical mucus, …

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  • Correction notice Since this set of guideline were published online the following changes have been made:

    July 2023Table 7 updated; Section 11.3 Risk of breast cancer updated to reflect newly published evidence