starting the progestogen only pill (POP) following the combined oral contraceptive pill (COC)

Last edited 03/2019 and last reviewed 03/2021

• changing from a combined oral contraceptive
  • start on the day following completion of the combined oral contraceptive course without a break (or in the case of ED tablets omitting the inactive ones)

• if starting the progestogen only pill after a combined oral contraceptive then the progestogen only pill should be commenced immediately after the last combined pill has been taken and not at the end of the 7 pill free days
  
  
  • if starting POP after combined hormonal contraceptive pill (CHC)
    
    

• Timing of initiation	Need for additional precautions after starting	Additional information
  Day 1-2 of HFI (hormone free interval)	No	Day 1 is the optimal time to switch
  Day 3-7 of HFI OR week 1 following HFI	Yes (48 hours). If UPSI has occurred after Day 3 of HFI advise continuing the CHC method for at least 7 days	If CHC cannot be continued, switch to POP immediately and consider the need for EC and PT
  Week 2-3 of CHC use	No, providing the method has been used consistently and correctly (i.e. at least 7 consecutive pills taken or 7 days of patch or ring use prior to switching)	There is evidence to suggest that taking hormonally active pills for 7 consecutive days prevents ovulation in the subsequent 7 days (2)

Reference:

• BNF 7.3.2.1
• FRSH (March 2015). Progestogen-only pills.
• FSRH (February 2019). Progestogen-only pills