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Key facts about Norgeston

• Norgeston has generally been replaced by the newer, simpler desogestrel POP.
• Norgeston can be up to 99% effective if taken correctly, meaning that fewer than 1 woman in 100 per year becomes pregnant whilst using the POP.
• 3 hour late-pill time window before contraceptive cover is lost.
• Some women, who can't take pills containing oestrogen, because of high blood pressure, migraine or other medical problems, may be able to take a POP such as Norgeston instead.
• Women over 35 who smoke can take POP including Norgeston.
• Vomiting and severe diarrhoea may prevent Norgeston from working.
• Norgeston does not protect against sexually transmitted diseases and women at risk of these should use condoms as well.
• Women sometimes get light irregular bleeding after starting Norgeston. This usually settles, often into a pattern of very infrequent or no bleeds.

How Norgeston stops pregnancy

Norgeston thickens the mucus at the neck of the womb (cervix), making it more difficult for sperm to pass through. There are also changes to the lining of the womb making it thinner and so less easy for a fertilised egg to be implanted. In around 60% of women, Norgeston also stops egg release from the ovaries (ovulation).

Obtaining Norgeston online

Dr Fox supplies 3-12 months of Norgeston, if you have already been using it for over a year.

There is a short online questionnaire to assess suitability and eligibility for POP.

Women ordering from Dr Fox are recommended to provide GP details and consent to a notification letter being sent to inform their GP.

Most contraception, including Norgeston, can be obtained free through the NHS from GPs and sexual health clinics. Under 16s can obtain contraception, without parents or guardians being informed, if the young person is assessed as competent, informed, and not vulnerable to exploitation or abuse.

Taking Norgeston POP

Take your tablet at the same time every day. Swallow the tablet whole, with water. Unlike a combined oral contraceptive pill, there is no 7 day pill-free break with POP. When one 35 day blister strip is finished, another is started straight away, with no break in between.

Starting Norgeston

Norgeston can be started on any day of the menstrual cycle, but if not started during the first five days after the period begins, additional contraception, usually condoms, will be needed for the first 48 hours. The rules are a little complicated and are regularly reviewed by the FSRH (Faculty of Sexual and Reproductive Health) so may differ from those in the patient information leaflet. See NHS contraception guide - progestogen-only pill for further details.

Missed pill rules for Norgeston

Because Norgeston does not reliably prevent ovulation, there are only 3 hours before the contraceptive effect drops after missing a tablet.

Forgotten pills:

• If you are less than 3 hours late:
  • Take the missed tablet as soon as you remember and take the next one at the usual time. It will still protect you from pregnancy.
• If you are more than 3 hours late:
  • You may not be completely protected against pregnancy.
  • Take a tablet as soon as you remember and take the next one at the usual time. This may mean taking two in one day. This is not harmful. (If you have forgotten more than one tablet you don't need to take the earlier missed ones). Continue to take your tablets as usual but you must also use an extra method, such as a condom, for the next 48 hours.
  • If you are more than 3 hours late taking your tablet and have had sex it is best to use emergency contraception - consult your pharmacist, GP, or sexual health clinic.
  • If you missed 1 or more tablets in the very first 2 days of taking your tablets and had unprotected intercourse in the week before missing the tablets, you may become pregnant. Speak to your GP or a sexual health clinic.

If you vomit or have severe diarrhoea:

• If you vomit, or have severe diarrhoea within 3-4 hours after taking your tablet, the active ingredient may not have been completely absorbed.
• Take another pill as soon as possible. If this pill is also vomited additional precautions (condoms) are needed until you have been taking Norgeston consistently for 48 hours.

Advance emergency contraception is available online from Dr Fox, but should not be ordered for immediate use as the postal service cannot be relied on to deliver in time.

Pharmacies, GP surgeries, GUM, and sexual health clinics can all provide rapid access to emergency contraception when it is needed.

NHS - Where can I get emergency contraception?

Suitability of Norgeston

There is a short online medical questionnaire to ensure treatment is suitable.

Dr Fox cannot supply Norgeston if any of the following apply:

• Allergy to levonorgestrel.
• Lactose or sucrose intolerance.
• History of breast, ovarian, or uterine (womb) cancer.
• Liver cancer or severe liver disease.
• Previous thrombosis (blood clot).
• Diabetes.
• Epilepsy.
• Tuberculosis.
• Unexplained vaginal bleeding.

Some women who cannot take combined contraceptive pills (combining oestrogen and progestogen) can take POP, including Norgeston. If in doubt, discuss with your GP or a specialist sexual health advisor.

Norgeston can usually be taken right up to the menopause or the age of 55 years.

Breastfeeding and pregnancy

Breastfeeding women can safely take Norgeston. However, women who are exclusively breastfeeding an infant under 6 months of age, and whose periods have not resumed, do not usually need to take contraception, as this lactational amenorrhoea (LAM) is over 98% effective at preventing pregnancy. If POPs are taken inadvertently during pregnancy, this will not usually adversely affect the pregnancy. A doctor or specialist sexual health advisor should be consulted.

Pros and cons

Pros

• Sex life can continue as normal, pills are taken daily and sex can be spontaneous.
• Can be taken whilst breastfeeding.
• Does not contain oestrogen, which some women cannot take.
• Can be taken by smokers over 35.
• Can reduce the occurrence and intensity of premenstrual syndrome and lighten periods.

Cons

• Must be taken regularly at the same time each day.
• No protection from sexually transmitted infections.
• Irregular bleeding pattern, initially.

Possible side effects

Vaginal bleeding may occur at irregular intervals while using Norgeston. This could be light spotting or heavier like a period. There may not be any bleeding at all but some bleeding is very common, especially in the first few months. The bleeding usually improves after taking Norgeston for 3 months and continues to improve the longer you take it. If bleeding is very heavy or prolonged you should consult your GP.

Most women can take Norgeston without significant side effects. Possible side effects include acne, breast tenderness, increased or decreased sex drive, headache and migraines, though migraines and mood changes often improve on POP. Whilst POPs reduce the total risk of pregnancy, around 1 in 10 pregnancies that do occur may be ectopic.

Alternatives to Norgeston

The modern alternative POP to Norgeston (levonorgestrel) is a desogestrel POP, which in most cases is the preferred POP, as it is believed to be the most effective POP contraceptive. Other alternatives include the COC or a Long-acting reversible contraception such as injections, implants, and intrauterine devices or systems.

Other medicines and Norgeston

Some medicines may stop Norgeston from working properly. These include medicines used for the treatment of:

• Epilepsy (e.g. primidone, phenytoin, carbamazepine, oxcarbazepine, felbamate, and phenobarbital).
• Tuberculosis (e.g. rifampicin).
• HIV infections (e.g. ritonavir), or other infectious diseases (e.g. griseofulvin).
• Stomach upset.
• Depressive moods (the herbal remedy St. John's Wort).

Please speak to your GP about contraception if you are on any of the above medications as Norgeston and other POPs may be unsuitable for you or you may need extra monitoring.

For a fuller list of side effects and details of interacting medicines see the patient information leaflets supplied with pills.

Risks

There is a small increased risk of ovarian cysts, but these are not usually dangerous and often disappear without treatment.

It is possible that there may be a small increased risk of breast cancer, but at present there is no research evidence of this and any risk would be expected to decrease with time after stopping Norgeston.

Further information

• NHS - Your contraception guide
• NIHR/UCL - Contraception Choices
• Frequently Asked Questions: Progestogen-only pill