Progestogen-only pill (POP)
ATC code: G03AC09 (Desogestrel)
Desogestrel 75 µg daily suppresses ovulation in 97% of women (unlike older POPs, which work mainly via cervical mucus). Metabolized to active etonogestrel. Safe missed-dose window is 12 hours – wider than norethisterone mini-pills (3 hours). Suitable when estrogen is contraindicated.
First line
Regular contraception in women with estrogen contraindications (smoking after 35, migraine with aura, thrombophilia, prior VTE, breastfeeding). Per SEGO 2023 and FSRH 2017, the preferred mini-pill. Pearl Index 0.4 perfect-use, 9 typical-use. Taken continuously (no breaks or placebo) at the same time with a 12-hour missed-dose window.
First line
Contraception during breastfeeding. MEC 2015 and SEGO 2023 – category 1 from day 1 postpartum (fully compatible). Does not reduce milk supply, unlike COCs. Etonogestrel (active metabolite) transfers to milk in small amounts, RID about 0.2%, no adverse infant effects. First-choice contraceptive for breastfeeding women.
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Discontinue if pregnant. Accidental use in early pregnancy is not linked to birth defects.
WHO MEC 2015 category 1 from day 1 postpartum. Does not reduce milk supply. Etonogestrel RID about 0.2%, Hale L1. First-choice contraceptive for breastfeeding women.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Desogestrel is evaluated for the following indications with varying evidence strength: Contraception (evidence tier A), Contraception during breastfeeding (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Desogestrel (≥ 1 in 100): Irregular spotting in first 3 months, Amenorrhea (20-30%), Breast tenderness, Headache, Mood changes, Acne. See the Safety section for uncommon and serious reactions.
FDA category X. Discontinue if pregnant. Accidental use in early pregnancy is not linked to birth defects.
WHO MEC 2015 category 1 from day 1 postpartum. Does not reduce milk supply. Etonogestrel RID about 0.2%, Hale L1. First-choice contraceptive for breastfeeding women.
Desogestrel is contraindicated in: Hypersensitivity; Confirmed or suspected pregnancy; Active VTE; Severe liver disease; History of breast cancer. Full list in the Safety section.