Common side effects (more than 1 in 100)

• menstrual irregularities
• skin disorders
• breast tenderness
• nausea.

Less common side effects (less than 1 in 100)

• dizziness
• mood disturbance
• appetite disturbance
• changes in libido

Breast cancer

Breast cancer. Use of any progestogen-only method of contraception may be associated with a small increased risk of breast cancer similar to use of the combined pill.

Ectopic pregnancy (less than 1 in 100)

Up to 10% of pregnancies that occur in traditional POP users may be ectopic, so women should be informed to seek help if they have symptoms of possible ectopic pregnancy, e.g., lower abdominal pain, shoulder tip pain.

Advise women taking an enzyme inducer for more than 2 months to change to an alternative method. If short-term use (less than 2 months) is anticipated, the woman may continue POP use and take additional precautions e.g. condoms whilst taking, and for 28 days after discontinuing, the enzyme inducer. Alternatively, she could be prescribed a one-off dose of progestogen-only injection to cover the period of risk

History

Clinical history taking to allow an assessment of medical eligibility for POP - use the UK medical eligibility criteria. In this context the history should include relevant:

• social history
• medical history
• sexual history (to assess risk of STIs)
• family history
• drug history
• details of reproductive health
• details of previous contraceptive use.

Note: DRSP POP should not be used by individuals with

• severe renal insufficiency
• acute renal failure
• hyperkalaemia
• untreated hypoaldosteronism
• users of potassium sparing diuretics, aldosterone antagonists, potassium supplement

DRSP POP should be used with caution with mild/moderate renal impairment and treated hypoaldosteronism

Examination

No routine examinations required in asymptomatic patients.

Blood tests

Check U&E in people with risk factors for chronic renal disease if considering DRSP.